Document Detail

Lessons from a mathematical hypothesis - modification of the endoventricular circular patch plasty.
MedLine Citation:
PMID:  20971019     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Surgical ventricular restoration has been the bailout therapy for end-stage heart failure due to ischemic cardiomyopathy in patients not suitable for cardiac transplantation. The recently concluded STICH trial has stated that surgical restoration of the left ventricle does not benefit this subgroup of patients clinically as compared with revascularization alone. The reasons for failure of this trial are multifactorial. The technique of surgical ventricular restoration employed in the STICH trial was circular endoventricular patch plasty. The various drawbacks related to this technique can be offset by a modification based on a mathematical hypothesis, which should result in a more physiological ventricular geometry, with consequent late reverse remodeling and improved left-ventricular performance.
METHODS: A total of 54 consecutive patients out of 102 patients with post-infarction left-ventricular aneurysms were studied before and 2 years after surgical ventricular restoration by linear endoventricular patch plasty using two-dimensional (2D) echocardiography and contrast ventriculography.
RESULTS: Linear endoventricular patch plasty resulted in a decrease in end-diastolic volume (EDV) of 40.2 ml (95% confidence interval (CI): 33.6, 46.7) and stroke volume (SV) of 10.0 ml (95% CI: 6.6, 13.5) and increase in ejection fraction (EF) of 6.7% (95% CI: 5.5, 7.9). There was a further 14% decrease in EDV and SV (30%) at 2 years with increase in EF (20%). There was a persistent significant improvement in sphericity index. The changes in EDV and SV were linearly related (r=0.72, p<0.001) and persisted at 2 years following surgery. The change in EDV was linearly related to the EF (r=0.35, p=0.02). The left-ventricular shape analysis showed improvements in the anterior and anterolateral segments (effect size=1.1, p<0.001) with nonsignificant changes in the inferior segments, conforming to an ellipsoid geometry.
CONCLUSIONS: Linear endoventricular patch plasty restored a physiological elliptical ventricular geometry with persistent late reverse remodeling. The decreases in EDVs following surgery were significantly linearly proportional to the decreases in SVs at rest, which conforms to the normal left-ventricular geometry.
Srilakshmi M Adhyapak; Venkateswara Rao Parachuri
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Publication Detail:
Type:  Journal Article     Date:  2010-10-22
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  39     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-09     Completed Date:  2012-02-06     Revised Date:  2012-03-06    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  945-51     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Department of Cardiology, St. John's Medical College Hospital, Bangalore, India.
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MeSH Terms
Follow-Up Studies
Heart Aneurysm / etiology,  pathology,  physiopathology,  surgery*
Heart Ventricles / surgery*
Middle Aged
Models, Cardiovascular
Myocardial Infarction / complications
Prostheses and Implants
Prosthesis Implantation / methods*
Stroke Volume / physiology
Treatment Outcome
Ventricular Remodeling / physiology
Comment In:
Eur J Cardiothorac Surg. 2012 Feb;41(2):459-60; author reply 460-1   [PMID:  21820907 ]

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