1. LEFT VENTRICULOPLASTY FOR ENDSTAGE CARDIOMYOPATHY HISAYOSHI SUMA THE CARDIOVASCULAR INSTITUTE TOKYO THE CARDIOVASCULAR INSTITUTE TOKYO

2. LEFT VENTRICULOPLASTY lSCHEMIC CARDIOMYOPATHY -EVCPP(Dor), SAVE(Suma) NON ISCHEMIC CARDIOMYOPATHY -PLV(Batista), SAVE(Suma)

3. ISCHEMIC CARDIOMYOPATHY Definition: Non-aneurysmal diffuse akinetic left ventricle with chronic heart failure following myocardial infarction Diastole Systole (EF 6%)

4. ISCHEMIC CARDIOMYOPATHY Trias of “ Bad ” ventricle Dilated LV Intractable heart failure No angina pectoris

5. 0 2 4 68 10 12 1.0 0.8 0.6 0.2 0.0 Years since operation n = 57 EF < 35% CABG FOR ISCHEMIC CARDIOMYOPATHY Shah et.al. JTCVS 2OO3; 126:1320 - 7 0.4 Estimate of Survival 50% 20%

8. SAVE operation

10. Septal Anterior Ventricular Exclusion

14. SAVE FOR DCM Preop. Postop. EF (%) EDVI (ml /m 2 ) ESVI (ml /m 2 ) BNP (pg/ml) 27 233 171 714 EF (%) EDVI (ml /m 2 ) ESVI (ml /m 2 ) BNP (pg/ml) 27 233 171 714 39 133 81 267

15. SAVE FOR DCM Preop. Postop. LVEDP(mmHg) PAP (mmHg) 11 28/17 18 38/15

16. LEFT VENTRICULOPLASTY FOR ISCHEMIC CARDIOMYOPATHY 100 (%) 50 12 3 45 Survival Rate Postoperative years 91 82 67 75 64 No MR (n=68) MR > 2 + (n=56) = - HAYAMA HEART CENTER -

18. VENTRICULOPLASTY FOR IDIOPATHIC DCM - Actuarial Survival Curve - 100 90 80 70 60 50 40 10 0 30 20 1 2 3456 7 Survival Rate (%) Postoperative Years 66.4 53.5 44.7 41.3 n = 96

19. VENTRICULOPASTY FOR DCM 0 12345 100 (%) Survival Rate Postoperative Years 50 LVP No inotropes LVP Preop. inotropes LVAS REMATCH Medical Treatment 55 60 78 20 10 43 74 34 59

20. LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (%) 40 30 20 10 0 Preop. Preop. 1 mo.1 yr2 yrs3 yrs n 80 74 28 20 9 19.8 30.1 31.8 30.2 28.3 (mmHg) 30 20 10 0 Preop. Preop. 1 mo.1 yr2 yrs3 yrs n 37 31 19 6 26 22 18 EF LVEDP

21. LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (l/min/m 2 ) (pg/ml) 1000 500 0 Preop. Preop. 1 mo.1 yr2 yrs3 yrs 898 629 413 229 4 3 2 1 0 Preop. Preop. 1 mo.1 yr2 yrs3 yrs n 35 33 23 18 6 2.3 3.3 2.8 2.7 362 CI BNP n 41 33 23 15 7

22. LVAD LV Plasty HTX Ongoing shock Valve Repair Small LV RV CM