Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation

Athanasuleas, Constantine L.; Buckberg, Gerald D.; Stanley, Alfred W.H.; Siler, William; Dor, Vincent; Donato, Marisa Di; Menicanti, Lorenzo; Oliveira, Sérgio Almeida de; Beyersdorf, Friedhelm; Krön, Irving L.; Suma, Hisayoshi; Kouchoukos, Nicholas T.; Moore, Wistar; McCarthy, Patrick M.; Öz, Mehmet C.; Fontán, F; Scott, Meredith L.; Accola, Kevin A.

doi:10.1016/j.jacc.2004.07.017

Cited by 395 publications

(221 citation statements)

References 34 publications

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“…The prerequisite for effective SVR seems to be an end-systolic volume C60 ml/ m2 BSA with viable remote myocardium. The clinical outcomes were improved functional class and long term survival [50,51]. Tulner et al [52] studied the LV function immediately following endoventricular circular patch plasty by pressure-volume loops.…”

Section: Surgical Ventricular Restorationmentioning

confidence: 99%

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

Adhyapak

Parachuri

2009

Heart Fail Rev

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The normal left ventricular shape has been defined as prolate ellipsoid. This shape is an adaptation to evolution. A knowledge of its unique macro and micro architecture forms the cornerstone in the understanding of its complex function. The left ventricle has a unique architecture with three different myofiber orientations, the longitudinal, circumferential and oblique fibers. The oblique orientation of fibers is essential for effective clockwise and anticlockwise torsional movements during systole and diastole, for optimal ventricular ejection and filling. The orientation and fiber angle decide the shape of the ventricle. An ellipsoid shape is vital for optimal function. Pathological disease states such as ischemic heart disease, valvular heart disease and cardiomyopathies cause a loss of obliquity of the myofibers. The myofibers become more horizontal resulting in ventricular dilatation and increased sphericity. The change from ellipsoid to globular shape with disease heralds the onset of left ventricular dysfunction and initiates the cascade of heart failure. Several strategies have been successful in reverting ventricular dilatation and sphericity to a more ellipsoid geometry. Pharmacological therapies like beta blockade and angiotensin converting enzyme inhibition have proven beneficial in early stages of heart failure with pathological remodeling. However, these agents in isolation are limited in reversing pathological remodeling in advanced heart failure. In some cases of advanced heart failure due to postinfarction left ventricular aneurysms, ventricular volume reduction with restoration surgeries have a role in restoring ventricular geometry with beneficial clinical outcomes. Surgical ventricular restoration has progressively evolved from the 1950s. Initially, aneurysmal resection and linear repair was done. This was gradually replaced by endoventricular patch plasty, which had better results. The resulting left ventricle was smaller in size but still continued to have a spherical configuration. Exclusion of the infarct area with a smaller longitudinal patch results in realignment of the non-diseased ventricular fibers with a resulting ellipsoid shape. This ellipsoid shape ensures clinical benefits. The geometry of the endoventricular patch thus holds the key to optimal ventricular shape in these patients. The technique to optimally restore a diseased ventricle to normal continues to evolve. This requires insights into the normal architecture and function, and the pathophysiologic effects of disease.

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Section: Surgical Ventricular Restorationmentioning

confidence: 99%

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

Adhyapak

Parachuri

2009

Heart Fail Rev

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“…The impact of surgical ventricular restoration on LV function has been studied in several large registries [8,19,20]. The EVCPP significantly reduced LV volumes and improved EF.…”

Section: Discussionmentioning

confidence: 99%

“…Linear plication failed to exclude the infracted septum, did not improve systolic and diastolic functions, and demonstrated ventricular re-dilatation [6]. The EVCPP performed with concomitant coronary bypass and mitral valve repair resulted in better ventricular geometry and systolic function [8,9]. There was a compromise on the diastolic function, which was partially corrected with an intracavitary measuring device [8,10].…”

Section: Introductionmentioning

confidence: 99%

“…The EVCPP performed with concomitant coronary bypass and mitral valve repair resulted in better ventricular geometry and systolic function [8,9]. There was a compromise on the diastolic function, which was partially corrected with an intracavitary measuring device [8,10]. The shape changes following EVCPP document changes confined to the inferior wall [11].…”

Section: Introductionmentioning

confidence: 99%

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

Adhyapak

Parachuri

2011

European Journal of Cardio-Thoracic Surgery

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“…Definitive care usually requires whole heart transplantation, but the insufficiency of donor organs necessitates another approach. One alternative is a surgical technique, the Dor procedure, in which infarcted myocardium is replaced with an inert patch [2]. Typically, the patch is composed of biologically inert woven polyethylene terephthalate fibers (Dacron) [3].…”

Section: Introductionmentioning

confidence: 99%

Microtopographical effects of natural scaffolding on cardiomyocyte function and arrhythmogenesis

2010

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A natural myocardial patch for heart regeneration derived from porcine urinary bladder matrix (UBM) was previously reported to outperform synthetic materials (Dacron and expanded polytetrafluoroethylene (ePTFE)) used in current surgical treatments. UBM, an extracellular matrix prepared from urinary bladder, has intricate three-dimensional architecture with two distinct sides: the luminal side with a smoother surface relief; and the abluminal side with a fine mesh of nano- and microfibers. This study tested the ability of this natural scaffold to support functional cardiomyocyte networks, and probed how the local microtopography and composition of the two sides affects cell function. Cardiomyocytes isolated from neonatal rats were seeded in vitro to form cardiac tissue onto luminal (L) or abluminal (Ab) UBM. Immunocytochemistry of contractile cardiac proteins demonstrated growth of cardiomyocyte networks with mature morphology on either side of UBM, but greater cell compactness was seen in L. Fluorescence-based imaging techniques were used to measure dynamic changes in intracellular calcium concentration upon electrical stimulation of L and Ab-grown cells. Functional differences in cardiac tissue grown on the two sides manifested themselves in faster calcium recovery (p < 0.04) and greater hysteresis (difference in response to increasing and decreasing pacing rates) for L vs Ab side (p < 0.03). These results suggest that surface differences may be leveraged to engineer the desired cardiomyocyte responses and highlight the potential of natural scaffolds for fostering heart repair.

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Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation

Abstract: Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.

Cited by 395 publications

References 34 publications

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

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

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

Microtopographical effects of natural scaffolding on cardiomyocyte function and arrhythmogenesis

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