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Ann Thorac Surg 2002;73:1368-1370
© 2002 The Society of Thoracic Surgeons

Editorial

Ventricular remodeling surgery for heart failure: small animals and how to measure an improvement in ventricular function

John R. Teerlink, MDa, Mark B. Ratcliffe, MD*b

a Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine of the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
b Division of Cardiology, School of Medicine of the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA

* Address reprint requests to Dr Ratcliffe, VAMC Surgery 112D, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121 USA
e-mail: mark.ratcliffe@med.va.gov

Ventricular remodeling surgery in rodents

The quest for a simple direct surgical therapy for heart failure continues, driven by the geometrically increasing number of patients with heart failure. In fact, if one defines ventricular remodeling surgery (VRS) as operations that change either left ventricular (LV) size or shape then new shape change operations such as the Myocor Myosplint [1] now join aneurysm repair [2], RF infarct heating [3], and partial ventriculectomy [4]. The acute effects of VRS have been best studied in partial

ventriculectomy, in which wall stress is reduced but ventricular function is acutely depressed [5, 6]. Aneurysm repair may have a less pronounced reduction in LV function [7] and preliminary results suggest that the reduction in stress which occurs after LV shape change with the Myocor Myosplint may be accompanied by a slight improvement in LV function. However, we still do not understand the long term consequences of these operations.

The clinical effect of these operations is often masked by concomitant drugs and surgical procedures such as coronary bypass and mitral valve repair. This confusion in clinical results is compounded by the lack of a stable, easily-produced large animal model of dilated cardiomyopathy, the absence of randomized clinical trials and a failure to agree on what constitutes an improvement in ventricular function following ventricular remodeling surgery. We need to design operations with the best possible effect on LV function and then study the effect of long-term wall stress reduction that occurs in the face of negative and positive changes in LV function.

In this issue of The Annals of Thoracic Surgery, Kanashiro and colleagues [8] describe the acute mechanical effects of aneurysm plication in rats six weeks after anteroapical myocardial infarction (MI). Hearts from eleven rats with scar area greater than 40% were mounted on a Langendorff . . . [Full Text of this Article]






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