Surgical Ventricular Restoration (SVR)

Surgical Ventricular Restoration

Reduce Risk, Standardize the Procedure and Create an Elliptical Ventricle … Every Time.

“A ventricle sizing device is one of the most important parts of the operation to ensure a properly sized and shaped ventricle.”

Conte J. Surgical Ventricular Restoration: Techniques and Outcomes. Congestive Heart Failure. 2004 Jan-Feb; 10(1):43-53.

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., 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.

SVR Procedure Technique

SVR
Surgical Ventricular Restoration
Surgical Technique

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 Case Study

48 year old previously stented patient, requiring no further revascularization, benefits from Surgical Ventricular Restoration.

Clinical Studies

Longitudinal profile of NT-proBNP levels in ischemic heart failure patients undergoing surgical ventricular reconstruction: The Biomarker Plus study

Serial profiles (either in increasing or in decreasing) at different time points are associated with a modulation of the risk of adverse events and, therefore, are important indicators for monitoring the evolution of the disease, even after cardiac surgery.

Myocardial reconstruction in ischaemic cardiomyopathy

An increase in left ventricular volume after a myocardial infarction is a key component of the adverse remodelling process leading to chamber dysfunction, heart failure and an unfavourable outcome.

Restrictive filling pattern in ischemic cardiomyopathy: Insights after surgical ventricular restoration

RFP was reversed after SVR in 22 of our 43 patients with ICM with a response that remained stable over time, associated with improved New York Heart Association class.

Surgical Ventricular Restoration for Ischemic Heart Failure: A Glance at a Real-World Population

Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes.

Comparable outcomes between genders in patients undergoing surgical ventricular reconstruction for ischaemic heart failure

In this study, long‐term outcomes for women and men with ischaemic HF undergoing complex cardiac surgery were equivalent. Albeit older and more symptomatic, women should not be denied this type of cardiac surgery.

Elucidating the mechanisms underlying left ventricular function recovery in patients with ischemic heart failure undergoing surgical remodeling: A 3-dimensional ultrasound analysis

Surgical LV reconstruction improves endocardial strains mostly in the basal region, suggesting the major role of the remote myocardium in enhancing LV functional recovery.

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):

The Law of Laplace
Wall Stress = (Pressure in Ventricle) x (Ventricle Radius)
2 (Wall Thickness)

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.

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.

CPT Code
CPT 33548	Restore/remodel, ventricle
MS-DRG Codes (formerly DRG 108)
MS DRG Code 228	Other cardiothoracic prodecures with MCC (major complications or co-morbidities)
MS DRG Code 229	Other cardiothoracic prodecures with CC (complications or co-morbidities)
MS DRG Code 230	Other cardiothoracic prodecures (without CC/MCC)