Surgery for Left Ventricular Aneurysm and Remodeling

Amelioration of left ventricular (LV) remodeling is an appealing target for medical and surgical therapies for heart failure. Remodeling is a complex process that leads to maladaptive ventricular dilation, hypertrophy, and altered ventricular wall stress and may occur after large myocardial infarction, chronic ischemia, or chronic valvular heart disease.

The most distinct sequela of remodeling is aneurysm formation at the site of infarction. Transmural infarcts result in full-thickness necrosis and scar formation, with subsequent thinning and infarct expansion secondary to mechanical stretch. Nontransmural infarcts alter regional compliance resulting in infarct area bulging and expansion. The net result is formation of a ventricular aneurysm and increased LV volume.

Consequently, surgical ventricular reconstruction (SVR) primarily involves aneurysmectomy and LV volume reduction. These operations are almost always done concomitantly with coronary artery bypass grafting or mitral valve surgery.