Patch size, shape and orientation affect geometrical outcomes of surgical anterior ventricular restoration

Cirillo, Marco; Amaducci, Andrea; Quaini, Eugenio; Villa, Emmanuel; Tomba, Margherita Dalla; Mhagna, Zen; Brunelli, Federico; Messina, Antonio; Troise, Giovanni

doi:10.2459/jcm.0b013e3282eee951

Cited by 5 publications

(5 citation statements)

References 19 publications

(18 reference statements)

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“…Raman et al associated the use of a stiff and relatively big patch in EVR as cause for some adverse long-term outcomes [94]. Patch size, shape and orientation may prove to be important in preventing adverse ventricular remodeling over time, as Cirillo et al have shown in a small group with an EVR technique using a small, obliquely oriented and oval-shaped patch [93]. Third, insufficient residual remote myocardium to survive the procedure and to translate the surgically induced morphological changes to functional improvement leads to LV failure.…”

Section: Fatal-failure Modes Of Lvrmentioning

confidence: 96%

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Klein

Bax

Shaw³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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A systematic review of the literature was performed to determine early and late mortality associated with left ventricular (LV) reconstruction surgery and to assess the influence of different surgical techniques, concomitant surgical procedures, clinical and hemodynamic parameters on mortality. The MEDLINE database (January 1980-January 2005) was searched and from the pooled data, hospital mortality and survival were calculated. Summary estimates of relative risks (RR) were calculated for the techniques that were used and for concomitant coronary artery bypass grafting (CABG) and mitral valve surgery. The risk-adjusted relationships between mortality and clinical and hemodynamic parameters were assessed by meta-regression. A total of 62 studies (12,331 patients) were identified. Weighted average early mortality was 6.9%. Cumulative 1-year, 5-year and 10-year survival were 88.5%, 71.5% and 53.9%, respectively. Endoventricular reconstruction (EVR) showed a reduced risk for both early (RR=0.79, p<0.005) and late (RR=0.67, p<0.001) mortality compared to the linear repair (early: RR=1.38, p<0.001; late: RR=1.83, p<0.001). Early and late mortality were mainly cardiac in origin, with as predominant cause heart failure in respectively 49.7% and 34.5% of the cases. Ventricular arrhythmias caused 16.6% of early deaths and 17.2% of late deaths. Concomitant CABG significantly decreased late mortality (RR=0.28, p<0.001) without increasing early mortality (RR=1.018, p=0.858). Concomitant mitral valve surgery showed both an increased risk for early (RR=1.57, p=0.001) and late mortality (RR=4.28, p<0.001). No clinical or hemodynamic parameters were found to influence mortality. It is noteworthy that only one third of patients included in the current analysis were operated for heart failure (14 studies, 4135 patients). In this group we noted an early mortality of 11.0% with a late mortality (3-year) of 15.2%. This analysis of pooled literature data showed that LV reconstruction surgery is performed with acceptable mortality and EVR may be the preferred technique with a reduced risk for early and late mortality. Concomitant CABG improved outcome, whereas the need for mitral valve surgery appeared an index of gravity. No clinical or hemodynamic parameters were found to influence mortality; specifically LV ejection fraction and LV volumes both did not predict outcome.

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Section: Fatal-failure Modes Of Lvrmentioning

confidence: 96%

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Klein

Bax

Shaw³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…With use of an oval patch, EDV and ESV both improved significantly and had less re‐dilation at 6–12 months follow‐up 50 . It is hypothesized that these benefits may be due to the fact that an oval patch more accurately forms an ellipsoid shape when compared to the circular patch.…”

Section: Ventricular Function and Volumementioning

confidence: 99%

“…Even within one type of procedure, patch shape and size are also important considerations. In a study by Cirillo and colleagues, 50 the use of a circular patch improved end‐diastolic diameter (EDD), end‐systolic diameter (ESD), and EDV. However, at 1‐year follow‐up these measurements had returned to baseline.…”

Section: Ventricular Function and Volumementioning

confidence: 99%

“…With use of an oval patch, EDV and ESV both improved significantly and had less re-dilation at 6-12 months follow-up. 50 It is hypothesized that these benefits may be due to the fact that an oval patch more accurately forms an ellipsoid shape when compared to the circular patch. It can also be more effective to use a technique like the Dor procedure compared to linear closure for patients with larger anteroseptal or posterobasal aneurysms as the patch can help maintain shape in these severely damaged ventricles.…”

Section: Hemodynamics In Diastolementioning

confidence: 99%

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Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy

Hassanabad

Wiebe

Ali

2021

Journal of Cardiac Surgery

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Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever‐increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.

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“…10,11 However, late redilatation with mitral regurgitation has been reported. [12][13][14] Other methods such as the partial ventriculectomy of Batista et al, 15 the septal anterior ventricular exclusion 16 procedure, the apex restoring sutures of Buckberg et al, 17 and oval patch of Cirillo et al 12 Batista et al's 15 partial ventriculectomy, the septal anterior ventricular exclusion 16 procedure, Buckberg et al's 17 apex restoring sutures, and Cirillo et al's 12 oval patch and Keep flbers orientation with Strip patch reShaping (KISS) procedure 18 attempted to restore ventricular geometry. Although the amount of patients with true aneurysms is decreasing with modern reperfusion techniques, 19 information gathered on shape alteration might prove useful for patients with akinetic wall segments and diffuse dilatation.…”

mentioning

confidence: 99%

Resizable Ventricular Patch Plasty in the Porcine Left Ventricle a Pilot Study

Huijgen

Gründeman

Spoel

et al. 2010

Innovations�(Phila)

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Objective Endoventricular circular patch plasty is a method used to reconstruct the ventricular cavity in patients with (post) ischemic left ventricular aneurysm or global dilatation. However, late redilatation with mitral regurgitation has been reported, in which postoperative apex shape seems to play an important role. We studied the feasibility of ventricular volume downsizing with a variably shaped patch in porcine hearts. Methods In five in vitro and two acute animal experiments, a dyskinetic aneurysm was simulated with a pericardial insert. Reducing patch surface by changing patch shape diminished end-diastolic volume. In vitro, static end-diastolic volume was determined for each patch shape using volumetry and echocardiography. In the acute animal experiments, preliminary observations of patch behavior in live material were made, and pressure/time relationship, dPdTmax, was registered. Results In vitro, bringing the convex patch into a flat plane reduced LV volume from 66 ± 7 mL (aneurysm) to 49 ± 5 mL. Four of 5 patch shapes further reduced volume to a mean of 38 ± 7 mL (P = 0.03). The in vitro echocardiographic measurements correlated with volumetry findings (r = 0.81). In the acute animal experiments, dPdTmax varied with patch shape, independent of volume changes. Conclusions In this pilot study, in vitro shape configuration of the resizable ventricular patch resulted in a calibrated end-diastolic volume reduction. The data of the two in vivo pilot experiments clearly indicate that change in patch configuration in the situation of more or less unchanged end-diastolic volume had impact on cardiac performance. Future studies must substantiate the results of this observation.

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Patch size, shape and orientation affect geometrical outcomes of surgical anterior ventricular restoration

Abstract: The use of a small, narrow, obliquely oriented, oval patch may help to prevent adverse ventricular remodeling over time.

Cited by 5 publications

References 19 publications

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy

Resizable Ventricular Patch Plasty in the Porcine Left Ventricle a Pilot Study

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