What is an endocardectomy?

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Last updated: March 25, 2026 • View editorial policy

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What is an Endocardectomy?

Endocardectomy is a surgical procedure involving the excision or removal of diseased endocardium (the inner lining of the heart chambers), typically performed to treat conditions such as endomyocardial fibrosis or to eliminate arrhythmogenic substrate in patients with ventricular tachycardia secondary to ischemic heart disease.

Primary Clinical Applications

Ventricular Tachycardia Treatment

  • Endocardectomy serves as a curative surgical technique for medically refractory ventricular tachycardia, particularly in patients with ischemic heart disease and left ventricular aneurysms 1, 2.
  • The procedure involves resection of 25-40% of the endocardial circumference in the area of arrhythmia origin, extending up to normal muscle tissue 2.
  • Intraoperative electrophysiologic mapping with radiofrequency ablation-induced markings guides precise identification of reentry zones for efficient endocardectomy during surgical ventricular restoration 1.
  • When performed as an integral part of surgical ventricular restoration, endocardectomy dramatically reduces postoperative ventricular tachycardia events (3% vs 38% in controls) 1.

Endomyocardial Fibrosis Management

  • Endocardectomy is the definitive surgical treatment for endomyocardial fibrosis, a progressive disease with poor prognosis when managed medically alone 3.
  • The procedure involves complete detachment and mobilization of affected valve leaflets (particularly the posterior mitral leaflet) with reconstruction using autologous pericardial patches when necessary 4.
  • Early surgical intervention is encouraged for all symptomatic patients with endomyocardial fibrosis given the inefficiency of medical treatment compared to good surgical outcomes 3.
  • The technique can be combined with valve repair procedures, achieving excellent results with minimal or no residual valvular insufficiency 4.

Technical Considerations

Surgical Approach

  • The procedure requires complete visualization and excision of fibrotic or diseased endocardium extending to healthy myocardial tissue 4, 3.
  • In cases of right ventricular endomyocardial fibrosis with severe restriction, endocardectomy may be combined with bidirectional cavopulmonary shunt to facilitate weaning from bypass 5.
  • Lifelong anticoagulation is mandatory following endocardectomy due to the pathophysiology of the underlying disease 3.

Outcomes

  • Operative mortality ranges from 5-13% depending on patient selection and disease severity 1.
  • The procedure demonstrates superior outcomes when performed early, with patients remaining free of sustained ventricular tachycardia for extended follow-up periods 2.
  • Hemodynamic parameters and ejection fractions improve postoperatively in survivors 2.

Important Caveats

  • Endocardectomy is distinct from standard aneurysmectomy or ventriculotomy—the arrhythmogenic substrate typically involves the border zone of aneurysms (often including the septum), which is not routinely resected during standard aneurysmectomy 2.
  • Preoperative electrophysiologic studies with programmed stimulation are essential to confirm reproducible tachycardia induction and guide surgical planning 2.
  • The procedure requires expertise in cardiac surgery and should be performed at centers with experience in complex ventricular reconstruction 1.

References

4
Research

Mitral valve repair in patients with endomyocardial fibrosis.

The Annals of thoracic surgery, 1992

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.