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SVR Procedure Technique
Clinical Articles
Who Can Benefit from SVR?
Patient Selection Considerations
SVR System Reimbursement Reference

Case Study
Why Elliptical? Law of Laplace

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Surgical Ventricular Restoration: Reduce Risk, Standardize the Procedure and Create an Elliptical Ventricle ... Every Time.

The Surgical Ventricular Restoration (SVR) ® procedure is a comprehensive surgical technique utilizing the Mannequin device to treat patients suffering from ischemic heart failure. This comprehensive surgical procedure enables surgeons to create an elliptical ventricle, with repeatable and optimal outcomes every time. Patient after patient.

Chase Medical is passionate about Surgical Ventricular Restoration, because we have seen first-hand the benefits of SVR for heart failure patients around the globe. Chase Medical works closely with distinguished physicians such as: Lorenzo Menicanti, M.D., John Conte, M.D., Marisa Di Donato, M.D. and others who continue to advance the surgical technique for SVR. Chase Medical sponsors educational programs in the U.S. and in Europe to promote SVR surgical best practices.

Our goal is to encourage the use of a standardized procedure for surgical consistency while reducing risk and variability.

The ideal procedure for any surgeon is one that is time-tested, repeatable and generates optimal outcomes for their patients. The proper surgical technique using the Mannequin creates an elliptical ventricle every time – patient after patient.

The SVR procedure is being performed around the world.

Geographical map of SVR procedures performed globally

 

   
  SVR Procedure Technique
 
  View Illustrated Technique Overview
 
   
  Clinical Articles
 
 
The Dor Procedure: What has changed after fifteen years of clinical practice
Lorenzo Menicanti and Marisa Di Donato. The Dor Procedure: What has changed after fifteen years of clinical practice. The Journal of Thoracic and Cardiovascular Surgery. 2002;124(5): 886–890.
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Ventricular restoration aids ischemic cardiomyopathy
Robert Finn. Ventricular restoration aids ischemic cardiomyopathy. Thoracic Surgery News.  2008;4(2): 10.
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Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration
Lorenzo Menicanti, Serenella Castelvecchio, Marco Ranucci, et al. Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration. The Journal of Thoracic and Cardiovascular Surgery. 2007;134(2): 433-441.
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Impact of surgical ventricular restoration on diastolic function: Implications of shape and residual ventricular size
Serenella Castelvecchio, Lorenzo Menicanti, Marco Ranucci, Marisa Di Donato. Impact of surgical ventricular restoration on diastolic function: Implications of shape and residual ventricular size. The Annals of Thoracic Surgery. 2008;86: 1849-1855.
   
  Who can Benefit from SVR?
 
 
  • Patients with a previous myocardial infarction (MI)
  • Patients with increased end-diastolic volumes
  • Patients with a decreased ejection fraction and a dilated left ventricle
  • Patients who are experiencing heart failure symptoms, even with medical therapy
  • Patients who were previously revascularized and are now experiencing heart failure symptoms
  • Patients on the heart transplant list
  • Patients undergoing resynchronization therapy
  • Patients referred for CABG with a dilated left ventricle
  Patient Selection Considerations
 
 

Crucial to SVR outcomes is correct patient selection. Cardiac MRI is the recommended diagnostic method for determining patient selection.

  Indications:
 
  • Previous MI in antero septal portion of the ventricle – this is usually from a previous MI in a branch of the Left
    Anterior Descending (LAD) artery
  • End-diastolic volume (EDVI) >100 ml/m2
  • Asynergy of >35% - the area of akinetic/dyskinetic tissue versus viable tissue
  • Good lateral wall motion
  • Good basal contraction
  • Good right ventricle
  Contraindications:
 
  • A severe right ventricular dysfunction as assessed by TAPSE (tricuspid annulus plane
    systolic excursion) less than 10 mm
  • Infarcts in two or more distinct areas of the ventricle
  • Systolic pulmonary pressure >60mmHg (when not associated with severe mitral regurgitation)
  • Asynergy of >60% - more than 60% of the tissue is akinetic/dyskinetic
  SVR System Reimbursement Reference
 
  Medicare assigned a code specifically for the Surgical Ventricular Restoration (SVR) procedure. CPT Code 33548 describes
the SVR procedure utilizing a patch and a shaping device, such as the Mannequin.
 
  More Medicare CPT Coding Information.
 
   
 

 
SVR Case Study

48 year old previously stented patient, requiring no further revascularization,
benefits from Surgical Ventricular Restoration.
Click here to view SVR Case Study.

Why Elliptical? Law of Laplace

A critical outcome of any procedure to treat heart failure must be to
reduce ventricular wall stress, stop the disease progression, and restore
contractile function to the heart. The Law of Laplace is a generally held law of
physics that clearly describes the factors that determine wall stress increases
or decreases in a vessel (the ventricle):


 

In the HF patient, all of the variables (pressure, ventricle radius and wall thickness) conspire to increase wall stress. The left
ventricular pressure rises as more volume enters the ventricle. The radius increases as the ventricle dilates into a sphere to
accommodate the increasing volume. The wall thins as the ventricle dilates.

Restoring the size of the ventricle to near its “normal” size (reducing its volume) is one factor in reducing the wall stress.
More importantly, restoring the ventricle to an elliptical chamber is a critical factor to reduce wall stress by decreasing the
radius of the dilated ventricle.

Correctly orienting all of the constituent components of the ventricle, i.e. aortic valve, mitral valve apparatus and papillary
muscles, helps ensure optimal performance.

 

 

 

Chase Medical     885 East Collins Boulevard, Suite 110, Richardson, Texas 75081 USA     972-783-7005     800-787-0378    cust_svc@chasemedical.com

 
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