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Surgical Ventricular Restoration
Welcome to the Johns Hopkins Surgical Ventricular Restoration (SVR) Web site. We would like to thank you for taking the time to learn more about this important surgical procedure that can benefit many patients with heart failure. When you are finished with this Web site you will know the following:
- What is Surgical Ventricular Restoration (SVR)?
- Who may benefit from this surgical procedure?
- What tests are needed to determine if I am a candidate?
- What are the names of similar procedures?
- How is the procedure performed?
- What are the results of SVR?
- What is the difference between SVR and other procedures?
- What are other options for my heart failure?
- If I receive this procedure will my medical care change, and who will care for me after the procedure?
- How to contact the Johns Hopkins Cardiac Surgery team to learn more about the procedure, and set up an appointment to be evaluated.
- Patient testimonial
Surgical Ventricular Restoration (SVR):
SVR is a surgical procedure to treat congestive heart failure caused by myocardial infarction (heart attack). Following a heart attack, scar or an aneurysm may develop resulting in an enlarged rounded heart. This may lead to congestive heart failure (CHF). The goal of the SVR is to restore the heart to a more normal size and shape, therefore improving function. The SVR procedure is usually performed in conjunction with coronary artery bypass grafting (CABG) to ensure optimal blood supply to the heart. Some patients will also have valve repair.
The patients who will benefit the most from SVR have certain traits:
- They have had a heart attack which resulted in the formation of an aneurysm or scar in the left ventricle, and now have enlarged hearts; AND
- They have systolic heart failure (the type of heart failure that causes poor heart pumping); AND
- Have Symptoms: Shortness of breath, fatigue, swelling, unusual weight gain, that are not relieved with medications and lifestyle changes; OR
- Angina (chest pain) that is not able to be controlled with medications; OR
- Ventricular tachycardia (an electrical rhythm in the left bottom of the heart that makes the heart beat too quickly causing you to pass out, feel lightheaded or feel rapid pounding); OR
- You may have severe coronary artery disease (blockages of the arteries of your heart), or valve disease that requires surgery.
- Some patients who have been told that they need a heart transplant may benefit from an SVR procedure as an alternative to transplantation. We will evaluate your needs and work with your cardiologist to determine if this may be a good alternative to transplantation.
We will require the following tests. If tests have been performed recently, than they will not need to be repeated.
- Echocardiogram (ECHO): A test which uses sound waves to create a picture of your heart and help us determine how well your heart functions as a pump.
- Cardiac Catheterization (Cath): A catheter placed in your groin allows pictures to be taken using X-rays and dye. These pictures help your team determine the function of your heart, along with the condition of the coronary vessels of your heart, to determine if bypass grafting is needed.
- Magnetic Resonance Image (MRI): A test which uses magnetic imaging to create a picture of your heart and its structures, and helps guide surgical decision making. This is often a preferred way to determine if you are a candidate for SVR. If you have an AICD or pacemaker a special cardiac CT may be obtained.
These tests will be looked at by our team to determine if you are a candidate. The ECHO and or MRI will also be repeated 3 months and one year after your SVR to help your doctor track the success of your procedure and keep your medical care at its best.
You may also hear of similar procedures named: Dor procedure, LV reconstruction, and TR3SVR. This is not the Batista procedure.
During the SVR procedure the patient is placed on a heart lung machine. The surgeon will make a small incision into the left bottom part of your heart, through scarred tissue. The heart is opened, and a plastic model of a specific size is used to reshape the heart.
At Johns Hopkins the SVR procedure is performed on the poorly functioning ventricle, which is remodeled to a calculated size based on each person's body surface area. To achieve a more normal shape, a plastic model is used to create a more elliptical shape. Many other procedures performed do not use such calculations.
Initial SVR results from a multi-center study (the Restore Group) were published in the April 2001 issue of the Journal of the American College of Cardiology. These results were also presented at the American Association of Thoracic Surgeons Meeting, May 7, 2001 in San Diego, CA. The data represents the results of SVR performed on 439 patients at 11 medical centers and may be summarized as follows:
- The data confirms the feasibility and safety of SVR
- 91% of patients achieved functional improvement
- 85% had not been readmitted to the hospital for CHF at 18 months
- A rehospitalization rate of only 8.8%
Conclusion: SVR is a safe and effective operation in the treatment of congestive heart failure.
Other published results regarding ventricular shaping may be referenced:
Dor V, Kreitmann P, Jourdan J, et al. Interest of physiological closure (circumferential plasty on contractile areas) of left ventricle after resection and endocardectomy for aneurysm of akinetic zone: comparison with classical technique about a series of 209 left ventricular resections (abstract). J Cardiovascular Surg. 1985;26:73
Dor V, Saab M, Coste P, et al. Left Ventricular aneurysm: new surgical approach. Thorac Cardiovasc Surg. 1989;27:11-9
Di Donato M, Toso A, Maioli, et al. Intermediate survival and predictors of death after surgical ventricular restoration. Thorac Cardiovasc Surg. 2001;13:468-75
Athanasuleas C, Stanley A, Dor V, et al. Surgical anterior ventricular restoration (SAVER) in dilated remodeled ventricle after anterior myocardial infarction. J Am Coll Cardiol. 2001;37:1999-209
Heart Transplant: An option when nothing else is appropriate
- Limited donors
- Waiting list may be long (years)
- Complex dosing regimens, difficult to follow
- Treats the symptoms not the shape of your heart
- 5- year survival rate only 55-60%
- Only for patients with specific electrical disturbances
- The devices are costly
- Does not alter or restore the size or shape of the ventricle
- May enhance SVR, in some patients
Left Ventricular Assist Device:
- Used for end-stage patients
- Usually as a bridge to transplant, but may be used as an alternative for some patients
Coronary Artery Bypass Grafting:
- Done to improve blood supply and may improve function
- Does nothing to address the changes caused by the heart attack
- SVR is usually done in conjunction with CABG
- Reduces/eliminates amount of leakage
- May improve function
- May improve shape/size over time
- Reduces the size of the ventricle (bottom part of your heart)
- Restores the elliptical shape of your heart
- Significantly improves the pumping action of your heart
- Usually done with CABG
- Often done with valve repair
- Improves clinical status (your symptoms may improve)
If I receive this procedure will my medical care change, and who will care for me after the procedure?
It is very important to continue good heart-healthy lifestyle practices. This may include
- Follow a 2000mg sodium diet
- Restrict your fluids to 8 cups or less per day
- Stay active and exercise
- Weigh yourself at the same time every day, and report sudden weight gain of more than 2 pounds in a day or 5 pounds in a week.
- Take all your medications as prescribed
Most patients feel that their quality of life improves after SVR. This improvement will make it even easier to follow a heart healthy lifestyle.
Will I need lifelong follow-up?
After discharge you will be seen in the CHF clinic for medication adjustment. You will then see the surgeon within 6 weeks to ensure you are healing properly. Between discharge and when you see the surgeon, you will be given information and be supported by the Hopkins cardiac surgery team. No question is ever too small, and no concern is ever unimportant. You have entrusted us with your care and are now part of our cardiac surgery family for life. The Johns Hopkins Cardiac Surgery team thanks you for your trust.
Even after the care of the surgical team, your cardiologists and nurse practitioners will continue to monitor and ensure your care. During these regular visits, your medications may be altered to keep your quality of life as high as possible.
Even if you are not having symptoms after surgery you will still need to see your doctor regularly. These visits will be based on your individual health, and generally occur at least 2 times per year.
We encourage you to use the Heart Failure Cardiologists at The Johns Hopkins Hospital. We are also happy to arrange and communicate with and to all cardiologists who have referred patients to The Johns Hopkins Hospital for SVR.
The surgeon and his team will work closely with your physicians no matter where you call home. We respect your need to return to as normal a life as possible, and will go the distance to maintain and achieve that normalcy.
How do I contact The Johns Hopkins Cardiac surgery team to learn more about the procedure, and set up an appointment to be evaluated?
SVR is part of your open heart experience. The cardiac surgery team at Johns Hopkins will guide you and your family though the entire experience with honesty and care. For physician to physician referral please call The Division of Cardiac Surgery at 410-955-1753, or you may e-mail your questions to the Hopkins team at hopkinsSVR@csurg.jhmi.jhu.edu