Invited commentary

Abstract

Surgical ventricular restoration (SVR) was introduced in the 1960s and has been part of the cardiac surgeon’s armamentarium ever since [1Cooley D.A. Henley W.S. Ahmad K.H. Chapman D.W. Ventricular aneurysm following myocardial infarction: results of surgical treatment.Ann Surg. 1959; 150: 595-612Crossref PubMed Scopus (48) Google Scholar, 2Houel J. Serradimigni A. Ruf G. Dor V. Malmejac C. Gosset C. Aneurysm of the left ventricle Resection under extracorporeal circulation.Mem Acad Chir. 1965; 91: 1021-1026PubMed Google Scholar]. Several reports have demonstrated the beneficial effects of this procedure on outcome and cardiac function, which have usually been attributed to restored ventricular geometry and normalized ventricular volume [3Di Donato M. Toso A. Maioli M. et al.Intermediate survival and predictors of death after surgical ventricular restoration.Semin Thorac Cardiovasc Surg. 2001; 13: 468-475PubMed Scopus (91) Google Scholar, 4Athanasuleas C.L. Stanley Jr, A.W.H. Buckberg G.D. et al.Surgical anterior ventricular endocardial restoration (SAVER) for dilated ischemic cardiomyopathy.Sem Thorac Cardiovasc Surg. 2001; 13: 448-458PubMed Scopus (60) Google Scholar]. However, a controversy remains about patient selection and indication for this operation [5Doenst T. Velazquez E.J. Beyersdorf F. et al.To STICH or not to STICH: We know the answer, but do we understand the question?.J Thorac Cardiovasc Surg. 2005; 129: 246-249Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 6Buckberg G.D. Questions and answers about the STICH trial: A different perspective.J Thorac Cardiovasc Surg. 2005; 130: 245-249Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. The issues previously mentioned are not the topic of the present work by Hsu and coworkers [7Hsu C.-P. Huang C.-Y. Wang J.-S. Chiang H.-I. Shih C.-C. Down-regulation of apoptosis after left ventricular aneurysm repair.Ann Thorac Surg. 2007; 84: 1279-1287Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Instead we find an excellent laboratory investigation on the effect of SVR after myocardial infarction on apoptosis of cardiomyocytes in surviving myocardium. To reiterate, the authors compared cardiac function, myocardial infarction size, and rate of apoptosis between animals with and without of left ventricular aneurysm repair in a rat infarction model. They found improved heart function, reduced rate of apoptosis, and a significant decrease in activated caspase-9 in animals with left ventricular aneurysm repair. The significance of apoptosis in various diseases of the heart has been widely investigated since the late 1980s [8James T.N. Normal and abnormal consequences of apoptosis in the human heart From postnatal morphogenesis to paroxysmal arrhythmias.Circulation. 1994; 90: 556-573Crossref PubMed Scopus (306) Google Scholar]. Remarkably this article by Hsu and colleagues [7Hsu C.-P. Huang C.-Y. Wang J.-S. Chiang H.-I. Shih C.-C. Down-regulation of apoptosis after left ventricular aneurysm repair.Ann Thorac Surg. 2007; 84: 1279-1287Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] is the first to show apoptosis reduction by SVR after myocardial infarction. Some questions remain open, such as why some important measurements of apoptosis, namely caspase-3 and Bax showed no difference between groups despite a significantly different rate of apoptosis. However further research into the possible benefits of SVR on the cellular level may help to elucidate these issues. Greater insight into the cellular effects of SVR may actually widen our perspective on it beyond the focus on ventricular geometry and mechanics. It will be interesting to see whether or not these basic scientific findings will have the potential to inspire the current clinical debate on SVR. Down-Regulation of Apoptosis After Left Ventricular Aneurysm RepairThe Annals of Thoracic SurgeryVol. 84Issue 4PreviewApoptosis is a common feature of the cardiomyopathic process contriuting to progressive decline in ventricular function after transmural myocardial infarction. We hypothesized that left ventricular aneurysm repair (LVAR) down-regulates apoptotic potential of cardiomyocytes in the surviving myocardium. Full-Text PDF