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Ann Thorac Surg 2007;84:1536-1537. doi:10.1016/j.athoracsur.2007.06.018
© 2007 The Society of Thoracic Surgeons
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Original Articles: Cardiovascular

Invited commentary

Amedeo Anselmi, MD

Department of Cardiac Surgery, Catholic University, Largo A. Gemelli 8, Rome, 00168 Italy

(Email: amedeo.anselmi{at}aliceposta.it).

As heart failure due to coronary artery disease achieves the features of a pandemic, surgeons are increasingly challenged to search for valuable treatment options. Our ignorance as to the mechanisms leading to infarct extension and to heart failure long after myocardial infarction, despite well-perfused myocardium, is underscored by the disappointing results of current nontransplant surgical strategies. Sakamoto and associates [1] provide insight into the pathophysiology of ventricular mechanics and remodeling after myocardial infarction, and they deserve our gratitude and appreciation.

In prior contributions this group showed that the perfused and hypo-contractile border zone myocardium is a separate pathophysiologic entity and a keystone in the evolution of late-onset heart failure. They concluded that in this evolution the interplay of geometric, mechanic, and tissue factors is much more complex than previously believed. The present article goes far beyond the findings previously achieved by this group. First it underscores the importance of an aggressive approach to revascularization as opposed to medical therapy in acute coronary syndromes.

Second, the diagnostic methods presented in this article are confirmed as powerful tools for evaluating left ventricular mechanics. The field of nontransplant surgical options for heart failure will be probably become the major area for applying these methods. Indeed, research in this exciting field has been severely limited by the unavailability of (1) adequate experimental models to test new surgical options, and (2) reliable quantitative tests to evaluate results. This timely article proposes a potential solution to both these problems. The animal model is reproducible and has been validated and continuously refined. More importantly, quantitative echocardiography is likely to become the ideal method of evaluation for surgery for heart failure during and after an operation. Thus, the methods of animal research and cardiac functional evaluation, which are described herein, should precede hazardous applications of new surgical techniques in a human population consisting of high-risk individuals. Painful experiences have occurred with innovative approaches for heart failure when these were directly applied to humans [2].

This study is not academic research with scarce clinical fallout, but it invites us to look forward to a major expanding area of investigation and therapeutics in our discipline and to seek evidence and processes for establishing new surgical treatments for heart failure.


   References
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 References
 

  1. Sakamoto H, Parish LM, Hamamoto H, et al. Effect of reperfusion on left ventricular regional remodeling strains after myocardial infarction Ann Thorac Surg 2007;84:1528-1537.[Abstract/Free Full Text]
  2. Moreira LF, Stolf N, de Lourdes Higuchi N, Bacal F, Bocchi EA, Oliveira SA. Current perspectives of partial left ventriculectomy in the treatment of dilated cardiomyopathy Eur J Cardiothorac Surg 2001;19:54-60.[Abstract/Free Full Text]

Related Article

Effect of Reperfusion on Left Ventricular Regional Remodeling Strains After Myocardial Infarction
Hiroaki Sakamoto, Landi M. Parish, Hirotsugu Hamamoto, Liam P. Ryan, Thomas J. Eperjesi, Theodore J. Plappert, Benjamin M. Jackson, Martin G. St John-Sutton, Joseph H. Gorman, III, and Robert C. Gorman
Ann. Thorac. Surg. 2007 84: 1528-1536. [Abstract] [Full Text] [PDF]




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