LV-LV
LV-LV scar exclusion can be applied when there is LV scar limited to the antero-lateral and apical walls, without septal involvement. Consequently, the reconstruction doesn’t include the septum in the exclusion. As such, the procedure is carried out in a purely surgical fashion.
Case planning follows the same principles of multimodality imaging. Anchor deployment and orientation can be tailored to the scar location and full scar exclusion should be feasible in most patients (Figure 6B ). The patients treated with this therapy have suffered from a LAD MI and the consequent scar tissue is located in anterior, antero-septal, antero-lateral and apical segments. However, different scar locations can be addressed with this technique as it is essentially based on plicating scarred segments, using the same surgical approach. In fact, manipulation of the heart from an apical skin incision by the liberal use of “myocardial leashes” - temporary “U” stitches in the scarred myocardium, snugged and fixed with a hemostatic clamp, enabling direct manipulation of the heart without hemodynamic disturbance - allows the surgeon to expose the lateral and inferior walls as well. Figure 6C shows an example of a post-operative left ventriculography of patient with an extensive lateral scar due to a previous left circumflex myocardial infarction.