and has performed five since then.
"There's no question that this is a new surgical treatment for people with heart failure," says Dr. Robert James Cusimano, a cardiovascular surgeon at The Toronto Hospital and Assistant Professor, Department of Surgery at the University of Toronto. "Until now, the only option for these patients has been heart transplantation when all other medical interventions failed. But many patients die while waiting for a donor organ, or are not suitable for transplantation because of other medical conditions."
During the procedure, a portion of the heart muscle from the left ventricle is removed to make the heart smaller. As a result, the heart is able to pump blood more easily, and a person's heart failure may improve. Heart failure is a progressive deterioration of the heart muscle and occurs frequently following major cardiac injury such as a heart attack. It is the fastest growing cardiovascular disease due to better treatment of heart attacks and an aging population. Heart failure affects five per cent of Canadians and 50 per cent of these die within two to four years of diagnosis.
Ventricular Volume Reduction surgery was first pioneered by Brazilian surgeon, Randas Batista, who trained in Toronto during the 1970s. Dr. Batista has performed more than 600 of these procedures. His survival rate at one year is 65 per cent. Dr. Cusimano visited Dr. Batista while he was in Buffalo last summer and observed the procedure first hand.
"Technically, this is not a difficult operation. In fact, it's very similar to a ventricular aneurysm resection where we remove a diseased portion of the heart that has ballooned out," Dr. Cusimano says. "What is amazing about the Ventricular Volume Reduction surgery is that this concept works: patients can have a part of their normal heart muscle removed and survive the operation."
Dr. Cusimano explains that there is a natural ratio between the radius of the heart and the heart muscle mass. However, patients with enlarged hearts have a radius/mass ratio that has been distorted by heart failure, rendering the heart ineffective in its pumping. The aim of the Ventricular Volume Reduction is to surgically reduce the size of the heart as close to its natural radius/mass ratio as possible.
"By reducing the radius of the curvature we are able to reduce the amount of energy required to pump blood through the heart," Dr. Cusimano says. "Although the operation does not make the heart any stronger, it may allow blood to be pumped more efficiently. This will hopefully reduce the deterioration of heart function, allowing patients to improve."
Following the two-hour procedure, patients remain in hospital approximately 10 days.
Patients will also have their heart rhythms monitored regularly and will be prescribed anti-arrhythmia medication.
The patients who undergo this procedure will be followed closely. The goal for surgeons and researchers like Dr. Cusimano is to determine which patients would make the best candidates for this procedure. "The operation is not for any heart failure patient," Dr. Cusimano explains. "Our goal is to determine who is best suited for this procedure and what the lasting effects and durability of the operation are."
Video Segmentof Procedure
Video downloads:
MPEG format (2m30s, 7 Mb)
AVI format (2m30s, 10 fps, 240x160, 7 Mb)
AVI format (2m30s, 5 fps, 160x120, 2 Mb)
QT format (2m30s, 10 fps, 240x160, 7 Mb)
QT format (2m30s, 5 fps, 160x120, 2 Mb)
For more information, contact Josey Panetta, Senior Media Relations Officer, The Toronto Hospital, (416) 340-3303
Back
to The Toronto Hospital Home Page