BlueCross BlueShield of Tennessee Medical Policy Manual

Surgical Ventricular Restoration

DESCRIPTION

Surgical ventricular restoration (SVR) is a procedure designed to restore or remodel the left ventricle to its normal, spherical shape and size in individuals with akinetic segments of the heart, secondary to either dilated cardiomyopathy or postinfarction left ventricular aneurysm. The SVR procedure is usually performed after coronary artery bypass grafting (CABG) and may proceed or be followed by mitral valve repair or replacement and other procedures such as endocardiectomy and cryoablation for treatment of ventricular tachycardia.  SVR is performed using circular “purse string” suturing around the border of the aneurysmal scar tissue.  Tightening of this suture is believed to isolate the akinetic or dyskinetic scar, bring the healthy portion of the ventricular walls together and restore a more normal ventricular contour.  If the defect is large (i.e., an opening larger than 3 cm), the ventricle may also be reconstructed using patches of autologous or artificial material to maintain the desired ventricular volume and contour during closure of the ventriculotomy. 

The SVR procedure is also referred to as ventricular remodeling, ventricular reduction surgery, surgical anterior ventricular endocardial restoration (SAVER), endoventricular circular patch or the Dor procedure.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

To date, studies addressing SVR have failed to demonstrate a positive impact on net health outcomes. The 2012 STICH trial, a pivotal randomized clinical trial, did not find any improvements in clinical outcomes or quality-of-life measures for individuals undergoing SVR in addition to standard CABG surgery.

SOURCES 

American Heart Association. (2013). ACCF/AHA Practice Guideline: 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Retrieved August 27, 2014 from http://circ.ahajournals.org. (385 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Surgical ventricular restoration (7.01.103). Retrieved September 27, 2017 from BlueWeb. (19 articles and/or guidelines reviewed)

Center for Medicare & Medicaid Services (1997, April). National Coverage Determination (NCD) for Partial Ventriculectomy (20.26). Retrieved September 27, 2017 from https://www.cms.gov.

Holly, T., Bonow, R., Arnold, M., Oh, J., Varadarajan, P., Pohost, G., et al. (2014). Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: results of the surgical treatment for ischemic heart failure (STICH) trial. Journal of Thoracic Cardiovascular Surgery, 148 (6), 2677-2684. (Level 2 evidence)

Kukulski, T., She, L., Racine, N., Gradinac, S., Panza, J., Velaquez, E., et al. (2015). Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Journal of Thoracic Cardiovascular Surgery, 149 (5), 1312-1321. (Level 2 evidence)

Oh, J., Velazquez, E., Menicanti, L., Pohost, G., Bonow, R., Lin, G., et al. (2012, May) Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. European Heart Journal, (34), 39-47. (Level 3 evidence)

U. S. Food and Drug Administration. (2001, November). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K011487 (CorRestore™ Patch). Retrieved February 28, 2013 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2008, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K082139 (PeriPatch™ Sheet). Retrieved July 21, 2011 from http://www.accessdata.fda.gov.

Zhaohua, Y., Wei, F., Fei, X., Jiqiang, Z., Junzhe, D., and Yangwu, S. (2016, December) Concomitant CABG, left ventricular restoration and mitral valve repair for ischemic heart disease. Heart Surgery Forum, 19 (6), 272-275. Abstract retrieved September 27, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  8/12/2006

MOST RECENT REVIEW DATE:  11/9/2017

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