Ventricular Restoration by Linear Endoventricular Patchplasty and Linear Repair

Abstract

Surgical ventricular restoration improves cardiac function in patients with large left ventricular aneurysms. Aneurysm repair techniques have evolved to geometric repair by exclusion of the aneurysmal area with a circular patch. But even circular endoventricular patchplasty may result in a less elliptical ventricle. We modified the techniques of both linear and geometric repair. The early and intermediate outcomes in 102 patients with post-infarction left ventricular aneurysm, treated between 2001 and 2004, were analyzed. Concomitant procedures included coronary artery bypass grafting in 73 patients, mitral valve repair in 29, cryoablation in 3, and post-infarction ventricular septal rupture repair in 3. Overall mortality was 12.7%. Left ventricular ejection fraction increased significantly postoperatively, from 31.5% +/- 6.5% to 34.2% +/- 5.9%. There were significant decreases in end-diastolic volumes from 140.3 +/- 38.3 to 100.8 +/- 33.5 mL, and end-systolic volumes from 95.1 +/- 26.1 to 66.0 +/- 21.7 mL. These benefits continued at the 12- to 52-month follow-up. Our modified technique restores a near physiological left ventricular geometry and has a favorable clinical outcome.

Architecture of the left ventricle: insights for optimal surgical ventricular restoration

“…We modified the technique of endoventricular patch plasty advocated by Cooley [60], by making the patch linear to address the dyskinetic/akinetic area, and adding a Teflon buttressed linear repair to the ventriculotomy site [62]. The LV cavity was opened by a linear incision parallel to the LAD.…”

“…Several authors [62,67] have shown better results in terms of ventricular geometry and clinical outcome with narrow endoventricular patches as compared to circular endoventricular patches. The near normal geometry of the left ventricle can be achieved with rectangular endoventricular patch plasty as evidenced by our results.…”

Lessons from a mathematical hypothesis — modification of the endoventricular circular patch plasty

“…Following surgery, there were significant improvements in the inferior segment curvatures with no change in the anterior and anterolateral curvatures. We used a rectangular linear patch < 25% of the ventricular surface area to exclude the akinetic/dyskinetic segments [14,15]. By our LV shape analysis, the realignment of the anterior and anterolateral segments toward the linear endoventricular patch has documented an ellipsoid geometry (Fig.…”

“…By applying a mathematical hypothesis, we modified the surgical technique of ventricular restoration by excluding the aneurysmal area with a linear endoventricular patch [14][15][16]. We applied a mathematical hypothesis to modify the technique of SVR and assessed left-ventricular geometry, remodeling, and function following the modified linear endoventricular patch plasty (EVLPP).…”

Results of the Modified Left Ventricle Reconstruction With Evaluation of Geometric Parameters in Postinfarction Aneurysm of the Heart

“…После трансмурального инфаркта миокарда в 10-35% случаев формируется постинфарктная анев-ризма левого желудочка (ЛЖ), в 80-90% -передне-перегородочно-верхушечной локализации [1][2][3][4][5][6][7][8].…”