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Li RK. Commentary: Toward the creation of a functional cardiac patch for repair and regeneration. J Thorac Cardiovasc Surg 2023; 165:e141-e142. [PMID: 35115141 DOI: 10.1016/j.jtcvs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Ren-Ke Li
- Toronto General Hospital Research Institute, and Division of Cardiovascular Surgery, University Health Network, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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2
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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3
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Fatehi Hassanabad A, Wiebe K, Ali IS. Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy. J Card Surg 2021; 36:4345-4366. [PMID: 34494297 DOI: 10.1111/jocs.15968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kiana Wiebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Surgical Treatment of Ischemic Dilative Cardiomyopathy by Ventricular Restoration. Surg Technol Int 2021. [PMID: 33970474 DOI: 10.52198/21.sti.38.cv1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with symptomatic post-ischemic dilative myocardiopathy of the left ventricle require, in selected cases, an operation to reshape and reduce the volume of the left ventricular chamber, in addition to surgical myocardial revascularization and mitral valve repair, with the aim of prolonging survival, improving the quality of life and minimizing the need for re-hospitalizations related to recurrent heart failure. This procedure is called surgical ventricular restoration (SVR), and is a useful tool for the treatment of heart failure patients as an alternative to heart transplant. This article provides an overview of surgical ventricular restoration for the treatment of dilative ischemic myocardiopathy. It illustrates several surgical options, describes the operative details, and discusses the correct indications for the procedure. Finally, an interesting protocol for one-step cell therapy during SVR is proposed, as an innovative treatment for heart failure patients.
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5
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Giao DM, Wang Y, Rojas R, Takaba K, Badathala A, Spaulding KA, Soon G, Zhang Y, Wang VY, Haraldsson H, Liu J, Saloner D, Guccione JM, Ge L, Wallace AW, Ratcliffe MB. Left ventricular geometry during unloading and the end-systolic pressure volume relationship: Measurement with a modified real-time MRI-based method in normal sheep. PLoS One 2020; 15:e0234896. [PMID: 32569290 PMCID: PMC7307770 DOI: 10.1371/journal.pone.0234896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
The left ventricular (LV) end-systolic (ES) pressure volume relationship (ESPVR) is the cornerstone of systolic LV function analysis. We describe a 2D real-time (RT) MRI-based method (RTPVR) with separate software tools for 1) semi-automatic level set-based shape prior method (LSSPM) of the LV, 2) generation of synchronized pressure area loops and 3) calculation of the ESPVR. We used the RTPVR method to measure ventricular geometry, ES pressure area relationship (ESPAR) and ESPVR during vena cava occlusion (VCO) in normal sheep. 14 adult sheep were anesthetized and underwent measurement of LV systolic function. Ten of the 14 sheep underwent RTMRI and eight of the 14 underwent measurement with conductance catheter; 4 had both RTMRI and conductance measurements. 2D cross sectional RTMRI were performed at apex, mid-ventricle and base levels during separate VCOs. The Dice similarity coefficient was used to compare LSSPM and manual image segmentation and thus determine LSSPM accuracy. LV cross-sectional area, major and minor axis length, axis ratio, major axis orientation angle and ESPAR were measured at each LV level. ESPVR was calculated with a trapezoidal rule. The Dice similarity coefficient between LSSPM and manual segmentation by two readers was 87.31±2.51% and 88.13±3.43%. All cross sections became more elliptical during VCO. The major axis orientation shifted during VCO but remained in the septo-lateral direction. LV chamber obliteration at the apical level occurred during VCO in 7 of 10 sheep that underwent RTMRI. ESPAR was non-linear at all levels. Finally, ESPVR was non-linear because of apical collapse. ESPVR measured by conductance catheter (EES,Index = 2.23±0.66 mmHg/ml/m2) and RT (EES,Index = 2.31±0.31 mmHg/ml/m2) was not significantly different. LSSPM segmentation of 2D RT MRI images is accurate and allows calculation of LV geometry, ESPAR and ESPVR during VCO. In the future, RTPVR will facilitate determination of regional systolic material parameters underlying ESPVR.
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Affiliation(s)
- Duc M. Giao
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yan Wang
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Renan Rojas
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Anusha Badathala
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kimberly A. Spaulding
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Gilbert Soon
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Vicky Y. Wang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Henrik Haraldsson
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Jing Liu
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - David Saloner
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Julius M. Guccione
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Liang Ge
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Arthur W. Wallace
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Anesthesia, University of California, San Francisco, CA, United States of America
| | - Mark B. Ratcliffe
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
- * E-mail:
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6
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Klein P, Anker SD, Wechsler A, Kelle S. Left ventricular volume reduction and reshape - 'Re-STICHING' the field. Reply. Eur J Heart Fail 2020; 22:1053-1054. [PMID: 32463544 DOI: 10.1002/ejhf.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Stefan D Anker
- BIH Center for Regenerative Therapies (BCRT), Charité, Universitätsmedizin Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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7
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Stefanelli G, Bellisario A, Meli M, Chiurlia E, Barbieri A, Weltert L. Outcomes after surgical ventricular restoration for ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2020; 163:1058-1067. [PMID: 32653287 DOI: 10.1016/j.jtcvs.2020.04.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study objective was to evaluate the short- and long-term outcomes of patients with ischemic cardiomyopathy after surgical ventricular restoration and to identify risk factors related to poor results. METHODS Between August 2002 and April 2016, 62 patients affected by ischemic cardiomyopathy underwent surgical left ventricular restoration at our unit. Patients' mean age at operation was 63 years (39-79 years). Mean ejection fraction was 29.6%. The Surgical Treatment for Ischemic Heart Failure trial criteria have been used as indications for surgery. Fifty-seven patients (91%) received surgical myocardial revascularization. Mitral valve repair was performed in 39 patients (63%). The surgical technique consisted of the classic Dor operation or a different approach reducing the equatorial diameter of the left ventricle and avoiding the use of a patch. The data were analyzed retrospectively for perioperative results and short- and long-term clinical outcomes. RESULTS One patient died of noncardiac causes within 30 days (1.6%). All-cause death occurred in 36 patients (58%) during follow-up (0.6-14.7 years; median follow-up time, 7.02 years), of whom 15 died of cardiac causes. Age, need for preoperative intra-aortic balloon pump, reduction less than 35% of postoperative left ventricular end-diastolic and end-systolic volumes, type of surgical technique, and ejection fraction less than 25% were identified as risk factors for late cardiac mortality. Perioperative levosimendan administration and presence of preoperative moderate to severe mitral regurgitation influenced early and intermediate-term outcomes, but no statistical relevance on long-term results was demonstrated. CONCLUSIONS Patients with ischemic dilative cardiomyopathy have favorable short- and long-term outcomes after ventricular restoration. Age, preoperative ejection fraction less than 25%, inadequate left ventricular surgical reverse remodeling, and type of surgical technique negatively affect long-term survival.
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Affiliation(s)
| | - Alessandro Bellisario
- Department of Cardiac Surgery, European Hospital, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Marco Meli
- Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Emilio Chiurlia
- Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Andrea Barbieri
- Department of Cardiology, University Hospitals, Modena, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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8
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Wakasa S, Matsui Y, Kobayashi J, Cho Y, Yaku H, Matsumiya G, Isomura T, Takanashi S, Usui A, Sakata R, Komiya T, Sawa Y, Saiki Y, Shimizu H, Yamaguchi A, Hamano K, Arai H. Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction. J Thorac Cardiovasc Surg 2018; 156:2088-2096.e3. [DOI: 10.1016/j.jtcvs.2018.06.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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9
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Yamazaki S, Numata S, Inoue T, Itatani K, Morimoto K, Ohira S, Manabe K, Yokota I, Yaku H. Impact of right ventricular volume and function evaluated using cardiovascular magnetic resonance imaging on outcomes after surgical ventricular reconstruction†. Eur J Cardiothorac Surg 2018; 54:867-874. [DOI: 10.1093/ejcts/ezy189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 04/06/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoya Inoue
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suguru Ohira
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaichiro Manabe
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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10
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Couperus LE, Delgado V, van Vessem ME, Tops LF, Palmen M, Braun J, Verwey HF, Klautz RJM, Schalij MJ, Beeres SLMA. Right ventricular dysfunction after surgical left ventricular restoration: prevalence, risk factors and clinical implications. Eur J Cardiothorac Surg 2017; 52:1161-1167. [DOI: 10.1093/ejcts/ezx201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/21/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lotte E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke E van Vessem
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Harriëtte F Verwey
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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11
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Haberbosch W. Folgen der STICH-Studie für den klinischen Alltag. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Bonnet B, Jourdan F, du Cailar G, Fesler P. Noninvasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension. Am J Physiol Heart Circ Physiol 2017; 313:H237-H243. [PMID: 28476921 DOI: 10.1152/ajpheart.00086.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
End-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection ("ejection P-V curve" method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.NEW & NOTEWORTHY The use of real-time three-dimensional echocardiography-derived left ventricular volumes in conjunction with carotid tonometry was found to be reproducible and sensitive enough to detect expected differences in left ventricular elastance in arterial hypertension. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.
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Affiliation(s)
- Benjamin Bonnet
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Franck Jourdan
- Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Guilhem du Cailar
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France;
| | - Pierre Fesler
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, Institut National de la Santé et de la Recherche Médicale U1046, Centre National de la Recherche Scientifique, UMR 9214, Montpellier, France
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Asai H, Shingu Y, Yamakawa T, Niwano H, Wakasa S, Ooka T, Kato H, Tachibana T, Matsui Y. Left-Ventricular Plication Reduces Wall Stress and Cardiomyocyte Hypertrophy in a Rat Model of Ischemic Cardiomyopathy. Eur Surg Res 2016; 58:69-80. [PMID: 27884008 DOI: 10.1159/000452682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The indications of left-ventricular plication (LVP) are controversial, although several studies have reported favorable outcomes in heart failure patients. The aim of this study was to assess left-ventricular (LV) wall stress and myocardial remodeling after LVP in a rat model of myocardial infarction (MI). METHODS Sixteen rats underwent LVP by excluding the LV anterior wall scar 4 weeks after ligation of the left anterior descending artery. After 4 weeks, LV wall stress was assessed using transthoracic echocardiography and an LV catheter. Gene expression of the wall stress markers, atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP), were evaluated via reverse transcription polymerase chain reaction. Cardiomyocyte area and myocardial fibrosis were also examined through histological examinations. These parameters were compared to those in 16 rats that underwent coronary artery ligation but not LVP. RESULTS We noted that the LV end-diastolic dimension was smaller (9.9 ± 0.3 vs. 11.2 ± 0.2 mm, p < 0.05) and fractional shortening was greater (25 ± 2 vs. 15 ± 1%, p < 0.05) in LVP rats than in sham rats. Moreover, systolic wall stress was lower in LVP rats (71 ± 7 vs. 111 ± 9 × 103 dyn/cm2, p < 0.05). Myocardial ANF and BNP expression levels were lower in LVP rats (2.6 ± 0.3 vs. 4.4 ± 0.5 and 1.0 ± 0.1 vs. 1.5 ± 0.2 arbitrary units, respectively; p < 0.05). Cardiomyocyte area was significantly decreased in LVP rats (556 ± 15 vs. 670 ± 28 μm2, p = 0.003) and was correlated with LV wall stress (r = 0.669, p = 0.002). The reduction in myocardial fibrosis after LVP was not significant. CONCLUSION LVP reduced LV wall stress and cardiomyocyte hypertrophy in a rat model of MI.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Calafiore AM, Iaco' AL, Kheirallah H, Sheikh AA, Al Sayed H, El Rasheed M, Allam A, Awadi MO, Alfonso JJ, Osman AA, Di Mauro M. Outcome of left ventricular surgical remodelling after the STICH trial. Eur J Cardiothorac Surg 2016; 50:693-701. [PMID: 27072008 DOI: 10.1093/ejcts/ezw103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES After the publication of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial, surgical indications to left ventricular surgical remodelling (LVSR) have become more restrictive. The experience we report reflects the changes in the real world after the publication of STICH trial. METHODS From May 2009 to July 2014, 113 patients underwent LVSR, targeted mainly to the left anterior descending territory (89.4%). Of these, 18 patients (15.9%) were operated on an emergency basis. Early and mid-term outcomes were assessed to identify clinical and echocardiographic risk factors. RESULTS Most patients (90.3%) had chronic ischaemic mitral regurgitation (CIMR) and were in New York Heart Association (NYHA) class III/IV (77.9%). The median ejection fraction (EF) was 26% [95% confidence interval (CI): 26, 28] and scarred areas were akinetic (86.7%) in most cases. Severe left ventricular diastolic dysfunction (LVDD) was found in 33.6% of patients. Mitral valve surgery was performed in 84.1% of patients. Five patients (4.4%) died while in hospital, all from cardiac causes. Risk factors were abnormal bilirubin and emergency status. After a median follow-up of 12 (95% CI: 6, 18) months, 22 patients died, 17 from cardiac causes. Five-year freedom from death any from cause was 73 ± 5%, emergency status and MR Grade 4 being the only risk factors. Five-year freedom from death from any cause and NYHA class III/IV was 61 ± 6%. Severe LVDD and emergency status were risk factors, along with high bilirubin and diabetes mellitus on insulin. Five-year freedom from death from any cause and non-fatal cardiovascular events (rehospitalization, reoperation and stroke) was 55 ± 6%. LVDD and atrial fibrillation were found to be risk factors. After a median follow-up of 31 (95% CI: 19, 38) months, 91 patients underwent postoperative echocardiography. EF increased by 20%, but stroke volume remained unchanged. Postoperatively, patients with severe LVDD had lower EF and higher end-systolic volumes than patients without LVDD. CONCLUSIONS Our findings show that patients, who are candidates for LVSR, have mostly akinetic areas and CIMR requiring surgical correction and are severely symptomatic. Severe LVDD is common and, along with emergency status, is the most important risk factor for early and late outcome.
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Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Angela L Iaco'
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hatim Kheirallah
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Azmat A Sheikh
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hussain Al Sayed
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammed El Rasheed
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Allam
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Ain Shams University, Ain Shams, Egypt
| | - Mohammed O Awadi
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Benha University, Benha, Egypt
| | - Juan J Alfonso
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed A Osman
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Critical Care, Cairo University, Cairo, Egypt
| | - Michele Di Mauro
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiology, L'Aquila University, L'Aquila, Italy
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Domingues JS, Vale MDP, Barbosa MP. Partial Left Ventriculectomy: Have Well-Succeeded Cases and Innovations in the Procedure Been Observed in the Last 12 Years? Braz J Cardiovasc Surg 2016; 30:579-85. [PMID: 26735606 PMCID: PMC4690664 DOI: 10.5935/1678-9741.20150061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/16/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In 1996, the Brazilian cardiovascular surgeon, Dr. Randas Batista, introduced a
surgical technique called partial left ventriculectomy, where he admitted the
possibility of reducing the diameter of the left ventricle through the sectioning
of one section of its wall. After the publication of this study, thousands of case
reports and procedure analysis have been published, and due to several
disappointing results, many doctors and institutions failed to execute it. As the
main objective of this study, stands out the search for success cases of
ventriculectomy in the last 12 years and if during this period it was achieved
some significant development in this procedure that allows obtaining lower
mortality rate postoperatively. METHODS Systematic review of indexed scientific literature over the past 12 years and the
term "Partial Left Ventriculectomy". RESULTS There has been a considerable number of reported successful cases and highly
significant findings in regard to determining the most suitable region for the
section, proper selection of the patients indicated to the procedure, including
the influence of the coronary artery anatomy in the nomination procedure and the
need for preservation of ventricular geometry to ensure better quality of
ventricular contractions after the sectioning. CONCLUSION This surgical procedure has been successfully performed, mainly in Japan,
improvements in its efficiency were found and the need for a mathematical modeling
of the slice to be severed is a prominent factor in many studies.
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Affiliation(s)
- José Sérgio Domingues
- Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Marcos Pinotti Barbosa
- Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Pantoja JL, Zhang Z, Tartibi M, Sun K, Macmillan W, Guccione JM, Ge L, Ratcliffe MB. Residual Stress Impairs Pump Function After Surgical Ventricular Remodeling: A Finite Element Analysis. Ann Thorac Surg 2015; 100:2198-205. [PMID: 26341601 DOI: 10.1016/j.athoracsur.2015.05.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical ventricular restoration (Dor procedure) is generally thought to reduce left ventricular (LV) myofiber stress (FS) but to adversely affect pump function. However, the underlying mechanism is unclear. The goal of this study was to determine the effect of residual stress (RS) on LV FS and pump function after the Dor procedure. METHODS Previously described finite element models of the LV based on magnetic resonance imaging data obtained in 5 sheep 16 weeks after anteroapical myocardial infarction were used. Simulated polyethylene terephthalate fiber (Dacron) patches that were elliptical and 25% of the infarct opening area were implanted using a virtual suture technique (VIRTUAL-DOR). In each case, diastole and systole were simulated, and RS, FS, LV volumes, systolic and diastolic function, and pump (Starling) function were calculated. RESULTS VIRTUAL-DOR was associated with significant RS that was tensile (2.89 ± 1.31 kPa) in the remote myocardium and compressive (234.15 ± 65.53 kPa) in the border zone. VIRTUAL-DOR+RS (compared with VIRTUAL-DOR-NO-RS) was associated with further reduction in regional diastolic and systolic FS, with the greatest change in the border zone (43.5-fold and 7.1-fold, respectively; p < 0.0001). VIRTUAL-DOR+RS was also associated with further reduction in systolic and diastolic volumes (7.9%; p = 0.0606, and 10.6%; p = 0.0630, respectively). The resultant effect was a further reduction in pump function after VIRTUAL-DOR+RS. CONCLUSIONS Residual stress that occurs after the Dor procedure is positive (tensile) in the remote myocardium and negative (compressive) in the border zone and associated with reductions in FS and LV volumes. The resultant effect is a further reduction in LV pump (Starling) function.
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Affiliation(s)
| | - Zhihong Zhang
- Veterans Affairs Medical Center, San Francisco, California
| | | | - Kay Sun
- Veterans Affairs Medical Center, San Francisco, California
| | | | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Liang Ge
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Mark B Ratcliffe
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
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17
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Warriner DR, Brown AG, Varma S, Sheridan PJ, Lawford P, Hose DR, Al-Mohammad A, Shi Y. Closing the loop: modelling of heart failure progression from health to end-stage using a meta-analysis of left ventricular pressure-volume loops. PLoS One 2014; 9:e114153. [PMID: 25479594 PMCID: PMC4257583 DOI: 10.1371/journal.pone.0114153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction The American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for the classification of heart failure (HF) are descriptive but lack precise and objective measures which would assist in categorising such patients. Our aim was two fold, firstly to demonstrate quantitatively the progression of HF through each stage using a meta-analysis of existing left ventricular (LV) pressure-volume (PV) loop data and secondly use the LV PV loop data to create stage specific HF models. Methods and Results A literature search yielded 31 papers with PV data, representing over 200 patients in different stages of HF. The raw pressure and volume data were extracted from the papers using a digitising software package and the means were calculated. The data demonstrated that, as HF progressed, stroke volume (SV), ejection fraction (EF%) decreased while LV volumes increased. A 2-element lumped parameter model was employed to model the mean loops and the error was calculated between the loops, demonstrating close fit between the loops. The only parameter that was consistently and statistically different across all the stages was the elastance (Emax). Conclusions For the first time, the authors have created a visual and quantitative representation of the AHA/ACC stages of LVSD-HF, from normal to end-stage. The study demonstrates that robust, load-independent and reproducible parameters, such as elastance, can be used to categorise and model HF, complementing the existing classification. The modelled PV loops establish previously unknown physiological parameters for each AHA/ACC stage of LVSD-HF, such as LV elastance and highlight that it this parameter alone, in lumped parameter models, that determines the severity of HF. Such information will enable cardiovascular modellers with an interest in HF, to create more accurate models of the heart as it fails.
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Affiliation(s)
- David R. Warriner
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
- * E-mail:
| | - Alistair G. Brown
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Susheel Varma
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Paul J. Sheridan
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - David R. Hose
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Abdallah Al-Mohammad
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
| | - Yubing Shi
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
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Hartyánszky I, Tóth A, Berta B, Pólos M, Veres G, Merkely B, Szabolcs Z, Pepper J. Personalized surgical repair of left ventricular aneurysm with computer-assisted ventricular engineering. Interact Cardiovasc Thorac Surg 2014; 19:801-6; discussion 806. [PMID: 25146325 DOI: 10.1093/icvts/ivu219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although circular ventricular resection techniques are the gold standard of left ventricular (LV) restoration, these techniques can lead to suboptimal results. Postoperative systolic resection can be inadequate, because it must be planned on a heart stopped in diastole. Low cardiac output due to insufficient LV volume results in a potentially unstable condition, and cannot be corrected. Our aim was to find a preoperative method to minimize risk and maximize outcome with ventricular restoration. METHODS We created a novel method combining surgery with gadolinium-enhanced magnetic resonance to construct a preoperative 3D systolic heart model. The model was utilized to determine resection points that could be intraoperatively used. According to our calculations with the predetermined resection line, the calculated percentage reduction in LV volume was above 30%, and LV volumes were predicted above normal values; thus, performing the operation using these resection points is likely to be safe and effective. We had a mixed, real-life patient group: mitral insufficiency or pulmonary hypertension were not exclusion criteria. RESULTS Forty-one procedures (12 concomitant mitral valve plasty) were done on consecutive patients in a single-centre experience. The incidence rate of major adverse clinical events was 32% postoperatively (n = 13). Control MRI showed a significant improvement in ejection fraction (18.3 ± 4.3 vs 31.3 ± 3.3; P = 0.04). All patients improved their New York Heart Association (NYHA) class postoperatively (40 patients NYHA III/IV versus 40 NYHA I/II). During long-term follow-up, 1 patient died due to end-stage heart failure. CONCLUSIONS Using this model, we were able to find the optimal resection line providing an excellent postoperative result, thus minimizing the risk of low cardiac output syndrome.
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Affiliation(s)
| | - Attila Tóth
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Balázs Berta
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Miklós Pólos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Gábor Veres
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Zoltán Szabolcs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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19
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Shimamoto T, Sakaguchi G, Komiya T. Clinical impact of diastolic function after surgical ventricular restoration. Asian Cardiovasc Thorac Ann 2014; 22:558-65. [PMID: 24867030 DOI: 10.1177/0218492313501165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The impact of diastolic function on the clinical outcome of surgical ventricular restoration remains controversial. METHODS 71 patients undergoing surgical ventricular restoration between 1999 and 2012 were investigated. Perioperative echocardiographic parameters were compared, risk factors for deaths and cardiac events were analyzed, and actuarial freedom from death and cardiac events was computed. RESULTS Preoperatively, the left ventricular end-systolic volume index was 77 ± 40 mL·m(-2) and left ventricular ejection fraction was 33% ± 11%. Postoperatively, left ventricular systolic function was significantly improved (end-systolic volume index 49 ± 31 mL·m(-2), ejection fraction 42.1% ± 11.7%) with a 33.8% ± 21.9% reduction in left ventricular end-systolic volume index. The transmitral filling deceleration time decreased from 198 ± 54 to 150 ± 46 ms, and the ratio of early peak filling velocities increased significantly postoperatively (from 16 ± 10 to 21 ± 17). Freedom from death and cardiac events at 5 years was 78% ± 5% and 64% ± 6%, respectively. Multivariate analyses revealed that age was a significant risk factor for all-cause death, postoperative transmitral inflow pattern for cardiac death, and preoperative mitral regurgitation and postoperative transmitral inflow pattern for cardiac events. CONCLUSION Despite its positive impact on systolic function, surgical ventricular restoration negatively affects postoperative diastolic function. Postoperative severe diastolic dysfunction may correlate with late mortality and cardiac events.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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20
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Di Mauro M, Iaco AL, Bencivenga S, Clemente D, Marcon S, Asif M, Di Saverio MC, Romano S, Gallina S, Penco M, Calafiore AM. Left ventricular surgical remodelling: is it a matter of shape or volume? Eur J Cardiothorac Surg 2014; 47:473-9; discussion 479. [DOI: 10.1093/ejcts/ezu186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Garatti A, Castelvecchio S, Di Mauro M, Bandera F, Guazzi M, Menicanti L. Impact of right ventricular dysfunction on the outcome of heart failure patients undergoing surgical ventricular reconstruction. Eur J Cardiothorac Surg 2014; 47:333-40; discussion 340. [DOI: 10.1093/ejcts/ezu152] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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ten Brinke EA, Witkowski TG, Delgado V, Klein P, Klok M, Marsan NA, Klautz RJ, van der Wall EE, Bax JJ, van der Laarse A, Steendijk P. Myocardial collagen turnover after surgical ventricular restoration in heart failure patients. Eur J Heart Fail 2014; 13:1202-10. [DOI: 10.1093/eurjhf/hfr097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ellen A. ten Brinke
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Tomasz G. Witkowski
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Victoria Delgado
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Patrick Klein
- Departments of Cardiothoracic Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Margreet Klok
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Nina A. Marsan
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Robert J. Klautz
- Departments of Cardiothoracic Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Ernst E. van der Wall
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Arnoud van der Laarse
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
| | - Paul Steendijk
- Department of Cardiology; Leiden University Medical Center; PO Box 9600, 2300RC Leiden The Netherlands
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Mann DL, Bogaev R, Buckberg GD. Cardiac remodelling and myocardial recovery: lost in translation? Eur J Heart Fail 2014; 12:789-96. [DOI: 10.1093/eurjhf/hfq113] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Douglas L. Mann
- Division of Cardiology, Department of Medicine; Washington University; St Louis MO 63110 USA
| | - Roberta Bogaev
- Section of Cardiology, Department of Medicine; Baylor College of Medicine, St. Luke's Episcopal Hospital, Texas Heart Institute; Houston TX 77030 USA
| | - Gerald D. Buckberg
- Department of Cardiothoracic Surgery; David Geffen School of Medicine at UCLA; 10833 Le Conte Avenue, 62-258 CHS Los Angeles CA 90095 USA
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Buckberg GD, Athanasuleas CL, Wechsler AS, Beyersdorf F, Conte JV, Strobeck JE. The STICH trial unravelled. Eur J Heart Fail 2014; 12:1024-7. [PMID: 20861131 DOI: 10.1093/eurjhf/hfq147] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gerald D. Buckberg
- Division of Cardiothoracic Surgery; David Geffen School of Medicine at UCLA; 62-258 CHS, 10833 Le Conte Avenue Los Angeles CA 90095 USA
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Velagaleti RS, Gona P, Pencina MJ, Aragam J, Wang TJ, Levy D, D'Agostino RB, Lee DS, Kannel WB, Benjamin EJ, Vasan RS. Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction. Am J Cardiol 2014; 113:117-22. [PMID: 24210333 DOI: 10.1016/j.amjcard.2013.09.028] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 12/11/2022]
Abstract
Higher left ventricular (LV) mass, wall thickness, and internal dimension are associated with increased heart failure (HF) risk. Whether different LV hypertrophy patterns vary with respect to rates and types of HF incidence is unclear. In this study, 4,768 Framingham Heart Study participants (mean age 50 years, 56% women) were classified into 4 mutually exclusive LV hypertrophy pattern groups (normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy) using American Society of Echocardiography-recommended thresholds of echocardiographic LV mass indexed to body surface area and relative wall thickness, and these groups were related to HF incidence. Whether risk for HF types (HF with reduced ejection fraction [<45%] vs preserved ejection fraction [≥45%]) varied by hypertrophy pattern was then evaluated. On follow-up (mean 21 years), 458 participants (9.6%, 250 women) developed new-onset HF. The age- and gender-adjusted 20-year HF incidence increased from 6.96% in the normal left ventricle group to 8.67%, 13.38%, and 15.27% in the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups, respectively. After adjustment for co-morbidities and incident myocardial infarction, LV hypertrophy patterns were associated with higher HF incidence relative to the normal left ventricle group (p = 0.0002); eccentric hypertrophy carried the greatest risk (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.41 to 2.54), followed by concentric hypertrophy (HR 1.40, 95% CI 1.04 to 1.87). Participants with eccentric hypertrophy had a higher propensity for HF with reduced ejection fraction (HR 2.23, 95% CI 1.48 to 3.37), whereas those with concentric hypertrophy were more prone to HF with preserved ejection fraction (HR 1.66, 95% CI 1.09 to 2.51). In conclusion, in this large community-based sample, HF risk varied by LV hypertrophy pattern, with eccentric and concentric hypertrophy predisposing to HF with reduced and preserved ejection fraction, respectively.
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Chan BT, Abu Osman NA, Lim E, Chee KH, Abdul Aziz YF, Abed AA, Lovell NH, Dokos S. Sensitivity analysis of left ventricle with dilated cardiomyopathy in fluid structure simulation. PLoS One 2013; 8:e67097. [PMID: 23825628 PMCID: PMC3692440 DOI: 10.1371/journal.pone.0067097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is the most common myocardial disease. It not only leads to systolic dysfunction but also diastolic deficiency. We sought to investigate the effect of idiopathic and ischemic DCM on the intraventricular fluid dynamics and myocardial wall mechanics using a 2D axisymmetrical fluid structure interaction model. In addition, we also studied the individual effect of parameters related to DCM, i.e. peak E-wave velocity, end systolic volume, wall compliance and sphericity index on several important fluid dynamics and myocardial wall mechanics variables during ventricular filling. Intraventricular fluid dynamics and myocardial wall deformation are significantly impaired under DCM conditions, being demonstrated by low vortex intensity, low flow propagation velocity, low intraventricular pressure difference (IVPD) and strain rates, and high-end diastolic pressure and wall stress. Our sensitivity analysis results showed that flow propagation velocity substantially decreases with an increase in wall stiffness, and is relatively independent of preload at low-peak E-wave velocity. Early IVPD is mainly affected by the rate of change of the early filling velocity and end systolic volume which changes the ventriculo:annular ratio. Regional strain rate, on the other hand, is significantly correlated with regional stiffness, and therefore forms a useful indicator for myocardial regional ischemia. The sensitivity analysis results enhance our understanding of the mechanisms leading to clinically observable changes in patients with DCM.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
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Lee LC, Wenk JF, Zhong L, Klepach D, Zhang Z, Ge L, Ratcliffe MB, Zohdi TI, Hsu E, Navia JL, Kassab GS, Guccione JM. Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function. J Appl Physiol (1985) 2013; 115:136-44. [PMID: 23640586 DOI: 10.1152/japplphysiol.00662.2012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial (20) for the neutral outcome, that "the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility."
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Affiliation(s)
- Lik Chuan Lee
- Department of Surgery, University of California, San Francisco, California, USA
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Suma H, Anyanwu AC. Current Status of Surgical Ventricular Restoration for Ischemic Cardiomyopathy. Semin Thorac Cardiovasc Surg 2012; 24:294-301. [DOI: 10.1053/j.semtcvs.2013.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
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Chiba S, Naya M, Iwano H, Yoshinaga K, Katoh C, Manabe O, Yamada S, Wakasa S, Kubota S, Matsui Y, Tamaki N, Tsutsui H. Interrelation between myocardial oxidative metabolism and diastolic function in patients undergoing surgical ventricular reconstruction. Eur J Nucl Med Mol Imaging 2012. [PMID: 23184309 DOI: 10.1007/s00259-012-2297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Diastolic function is impaired in patients with end-stage heart failure. Favorable structural changes by surgical ventricular reconstruction (SVR) are thought to improve diastolic function, however, previous studies reported the contradictory results. We hypothesized that cardiac oxidative metabolism and diastolic dysfunction might improve in parallel to the reduction of left ventricular chamber size after SVR. METHODS We studied 11 patients underwent SVR associated with mitral valve repair for end-stage heart failure due to dilated cardiomyopathy. Diastolic function was assessed by echocardiography and myocardial oxidative metabolism was measured by the monoexponential clearance (k-mono) of (11)C-acetate positron emission tomography at baseline and 1 month after SVR. RESULTS All patients had preoperative severe diastolic dysfunction [E/A 4.11 ± 1.18, deceleration time (DT) 134 ± 26 ms]. The study patients were divided into 2 groups according to the changes in diastolic function after SVR; unchanged or worsened diastolic function in 6 patients (55 %, Non-responder) and improved diastolic function in 5 (45 %, Responder). K-mono and wall stress decreased only in responder. The changes in k-mono before and after SVR correlated with those in deceleration time (r = -0.63; p < 0.05) and wall stress (r = 0.75; p < 0.01). CONCLUSIONS Improvement of diastolic dysfunction in patients with end-stage heart failure by SVR was in parallel to that in oxidative metabolism. It suggests that SVR reduced excessive metabolism during the diastolic phase, in part, via the improvement in diastolic function and the reduction in LV wall stress.
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Affiliation(s)
- Satoru Chiba
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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Oh JK, Velazquez EJ, Menicanti L, Pohost GM, Bonow RO, Lin G, Hellkamp AS, Ferrazzi P, Wos S, Rao V, Berman D, Bochenek A, Cherniavsky A, Rogowski J, Rouleau JL, Lee KL. Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. Eur Heart J 2012; 34:39-47. [PMID: 22584648 DOI: 10.1093/eurheartj/ehs021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS The Surgical Treatment for Ischemic Heart Failure (STICH) trial demonstrated no overall benefit when surgical ventricular reconstruction (SVR) was added to coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. The present analysis was to determine whether, based on baseline left ventricular (LV) function parameters, any subgroups could be identified that benefited from SVR. METHODS AND RESULTS Among the 1000 patients enrolled, Core Lab measures of baseline LV function with adequate quality were obtained in 710 patients using echocardiography, in 352 using cardiovascular magnetic resonance, and in 344 using radionuclide imaging. The relationship between LV end-systolic volume index (ESVI), end-diastolic volume index, ejection fraction (EF), regional wall motion abnormalities, and outcome were first assessed only by echocardiographic measures, and then by 13 algorithms using a different hierarchy of imaging modalities and their quality. The median ESVI and EF were 78.0 (range: 22.8-283.8) mL/m2 and 28.0%, respectively. Hazard ratios comparing the randomized arms by subgroups of LVESVI and LVEF measured by echocardiography found that patients with smaller ventricles (LVESVI <60 mL/m2) and better LVEF (≥33%) may have benefitted by SVR, while those with larger ventricles (LVESVI >90 mL/m(2)) and lower LVEF (≤25%) did worse with SVR. Algorithms using all three imaging modalities found a weaker relationship between LV global function and the effects of SVR. The extent of regional wall motion abnormality did not influence the effects of SVR. CONCLUSIONS Subgroup analyses of the STICH trial suggest that patients with less dilated LV and better LVEF may benefit from SVR, while those with larger LV and poorer LVEF may do worse. Clinical Trial Registration #: NCT00023595.
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Affiliation(s)
- Jae K Oh
- Mayo Clinic, Gonda 6 South, 200 1st Street, SW, Rochester, MN, USA.
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Gründeman PF, van der Spoel TIG, Steendijk P, van Slochteren F, Cramer MJM, Doevendans PA, Pasterkamp G. Surgical left ventricular radius enlargement by patch insertion on the beating heart: a new experimental aneurysm model. Interact Cardiovasc Thorac Surg 2012; 15:10-3. [PMID: 22523129 DOI: 10.1093/icvts/ivr148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We presented a novel experimental aneurysm model for studies in left ventricular (LV) reconstruction techniques and assessed LV function. In eight pigs, the LV radius and geometry were enlarged surgically on the beating heart by inserting an aortic allograft construct. Haemodynamics and LV dimensions were assessed by echocardiography at baseline and under dobutamine stress. Surgery was successfully performed without lethal blood loss or arrhythmias. LV end-diastolic and end-systolic short-axis areas increased from 13.0 ± 1.7 to 17.0 ± 4.3 cm(2) (P = 0.001) and from 4.0 ± 0.9 to 13.0 ± 2.6 cm(2) (P = 0.001), respectively. Stroke volume decreased from 56 ± 11 to 33 ± 16 ml (P = 0.001). Incremental dobutamine infusion concurred with a biphasic response on fractional area shortening. Mitral valve insufficiency ranging from grades 2 to 4 was observed. In the pig, a novel, reproducible aneurysm model for acute cardiac dysfunction was created on the beating heart. Innovative (surgical) strategies for (staged) reconfiguration of the ventricle, e.g. adjustable Dor procedures and stepwise volume restraining cardiac support devices, can be tested for efficacy using this acute model.
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Affiliation(s)
- Paul F Gründeman
- Experimental Cardiology Laboratory, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
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Non-transplant surgical management of end-stage heart failure. FORMOSAN JOURNAL OF SURGERY 2012. [DOI: 10.1016/j.fjs.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zhong L, Ghista D, Tan RS. Improved aorto-ventricular matching in ischemic dilated cardiomyopathy patients after surgical ventricular restoration. Med Eng Phys 2011; 33:1120-6. [DOI: 10.1016/j.medengphy.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 04/30/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
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Castelvecchio S, Menicanti L, Donato MD. Surgical ventricular restoration to reverse left ventricular remodeling. Curr Cardiol Rev 2011; 6:15-23. [PMID: 21286274 PMCID: PMC2845790 DOI: 10.2174/157340310790231626] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 03/06/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022] Open
Abstract
Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.
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Castelvecchio S, Menicanti L, Donato MD. Cirugía de restauración ventricular para revertir el remodelado del ventrículo izquierdo. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Buckberg GD. Methods, outcomes, and relationships. J Thorac Cardiovasc Surg 2011; 142:236; author reply 236-8. [PMID: 21683842 DOI: 10.1016/j.jtcvs.2011.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 01/19/2011] [Accepted: 02/09/2011] [Indexed: 11/17/2022]
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Lessons from a mathematical hypothesis — modification of the endoventricular circular patch plasty. Eur J Cardiothorac Surg 2011; 39:945-51. [DOI: 10.1016/j.ejcts.2010.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 09/15/2010] [Indexed: 11/19/2022] Open
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Zhong L, Su Y, Gobeawan L, Sola S, Tan RS, Navia JL, Ghista DN, Chua T, Guccione J, Kassab GS. Impact of surgical ventricular restoration on ventricular shape, wall stress, and function in heart failure patients. Am J Physiol Heart Circ Physiol 2011; 300:H1653-60. [PMID: 21357513 DOI: 10.1152/ajpheart.00021.2011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Surgical ventricular restoration (SVR) was designed to treat patients with aneurysms or large akinetic walls and dilated ventricles. Yet, crucial aspects essential to the efficacy of this procedure like optimal shape and size of the left ventricle (LV) are still debatable. The objective of this study is to quantify the efficacy of SVR based on LV regional shape in terms of curvedness, wall stress, and ventricular systolic function. A total of 40 patients underwent magnetic resonance imaging (MRI) before and after SVR. Both short-axis and long-axis MRI were used to reconstruct end-diastolic and end-systolic three-dimensional LV geometry. The regional shape in terms of surface curvedness, wall thickness, and wall stress indexes were determined for the entire LV. The infarct, border, and remote zones were defined in terms of end-diastolic wall thickness. The LV global systolic function in terms of global ejection fraction, the ratio between stroke work (SW) and end-diastolic volume (SW/EDV), the maximal rate of change of pressure-normalized stress (dσ*/dt(max)), and the regional function in terms of surface area change were examined. The LV end-diastolic and end-systolic volumes were significantly reduced, and global systolic function was improved in ejection fraction, SW/EDV, and dσ*/dt(max). In addition, the end-diastolic and end-systolic stresses in all zones were reduced. Although there was a slight increase in regional curvedness and surface area change in each zone, the change was not significant. Also, while SVR reduced LV wall stress with increased global LV systolic function, regional LV shape and function did not significantly improve.
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Affiliation(s)
- L Zhong
- Department of Cardiology, National Heart Centre, Singapore.
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Witkowski TG, ten Brinke EA, Delgado V, Ng AC, Bertini M, Marsan NA, Ewe SH, Auger D, Yiu KH, Braun J, Klein P, Steendijk P, Versteegh MI, Klautz RJ, Bax JJ. Surgical Ventricular Restoration for Patients With Ischemic Heart Failure: Determinants of Two-Year Survival. Ann Thorac Surg 2011; 91:491-8. [DOI: 10.1016/j.athoracsur.2010.09.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
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ten Brinke EA, Klautz RJ, Tulner SA, Verwey HF, Bax JJ, Delgado V, Holman ER, Schalij MJ, van der Wall EE, Braun J, Versteegh MI, Dion RA, Steendijk P. Clinical and Functional Effects of Restrictive Mitral Annuloplasty at Midterm Follow-Up in Heart Failure Patients. Ann Thorac Surg 2010; 90:1913-20. [DOI: 10.1016/j.athoracsur.2010.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 10/18/2022]
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ten Brinke EA, Klautz RJ, Tulner SA, Verwey HF, Bax JJ, Schalij MJ, van der Wall EE, Versteegh MI, Dion RA, Steendijk P. Long-term effects of surgical ventricular restoration with additional restrictive mitral annuloplasty and/or coronary artery bypass grafting on left ventricular function: Six-month follow-up by pressure–volume loops. J Thorac Cardiovasc Surg 2010; 140:1338-44. [PMID: 20381088 DOI: 10.1016/j.jtcvs.2010.01.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 01/04/2010] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
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Shanmugam G, Ali IS. Surgical Ventricular Restoration: An Operation to Reverse Remodeling - Clinical Application (Part II). Curr Cardiol Rev 2010; 5:350-9. [PMID: 21037852 PMCID: PMC2842967 DOI: 10.2174/157340309789317913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 12/04/2022] Open
Abstract
The first part of the article dealt with the basic science behind the evolution of ventricular restoration procedures and the rationale for the use of novel surgical techniques. The second part describes the preoperative workup of patients in advanced heart failure, the core information required to determine the surgical approach and the essential principles and techniques of ventricular restoration. It then examines the effects of ventricular restorative procedures on pump function and clinical outcomes, the results of the worldwide experience with ventricular restoration and concludes with more recent advances in this field.
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Affiliation(s)
- Ganesh Shanmugam
- Department of Surgery, Division of Cardiac Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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Shudo Y, Matsumiya G, Sakaguchi T, Miyagawa S, Yamauchi T, Takeda K, Saito S, Taniguchi K, Sawa Y. Impact of surgical ventricular reconstruction for ischemic dilated cardiomyopathy on restrictive filling pattern. Gen Thorac Cardiovasc Surg 2010; 58:399-404. [DOI: 10.1007/s11748-010-0597-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Effects of surgical ventricular reconstruction on diastolic function at midterm follow-up. J Thorac Cardiovasc Surg 2010; 140:285-291.e1. [DOI: 10.1016/j.jtcvs.2009.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 09/15/2009] [Accepted: 10/22/2009] [Indexed: 11/18/2022]
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An indictment of the STICH trial: "True, true, and unrelated". J Heart Lung Transplant 2010; 29:491-6. [PMID: 20382350 DOI: 10.1016/j.healun.2009.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 12/16/2009] [Accepted: 12/16/2009] [Indexed: 11/20/2022] Open
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Marui A, Nishina T, Saji Y, Yamazaki K, Shimamoto T, Ikeda T, Sakata R. Significance of Left Ventricular Diastolic Function on Outcomes After Surgical Ventricular Restoration. Ann Thorac Surg 2010; 89:1524-31. [DOI: 10.1016/j.athoracsur.2010.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 01/25/2010] [Accepted: 01/28/2010] [Indexed: 11/29/2022]
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ten Brinke EA, Bertini M, Klautz RJ, Antoni ML, Holman ER, van de Veire NR, Bax JJ, Steendijk P. Noninvasive estimation of left ventricular filling pressures in patients with heart failure after surgical ventricular restoration and restrictive mitral annuloplasty. J Thorac Cardiovasc Surg 2010; 140:807-15. [PMID: 20117802 DOI: 10.1016/j.jtcvs.2009.11.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 07/14/2009] [Accepted: 11/17/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Doppler echocardiography, including tissue Doppler imaging, is widely applied to assess diastolic left ventricular function using early transmitral flow velocity combined with mitral annular velocity as a noninvasive estimate of left ventricular filling pressures. However, the accuracy of early transmitral flow velocity/mitral annular velocity in patients with heart failure, particularly after extensive cardiac surgery, is debated. Global diastolic strain rate during isovolumic relaxation obtained with 2-dimensional speckle-tracking analysis was recently proposed as an alternative approach to estimate left ventricular filling pressures. METHODS We analyzed diastolic function in patients with heart failure after surgical ventricular restoration and/or restrictive mitral annuloplasty. Echocardiography, including tissue Doppler imaging and speckle-tracking analysis, was performed to determine early transmitral flow velocity/atrial transmitral flow velocity, isovolumetric relaxation time, deceleration time, early transmitral flow velocity/mean mitral annular velocity, strain rate during isovolumic relaxation, and early transmitral flow velocity/strain rate during isovolumic relaxation. These noninvasive indices were correlated with relaxation time constant Tau, peak rate of pressure decline, and left ventricular end-diastolic pressure obtained in the catheterization room using high-fidelity pressure catheters. RESULTS Twenty-three patients were analyzed 6 months after restrictive mitral annuloplasty (n = 8), surgical ventricular restoration (n = 4), or a combined procedure (n = 11). The strongest correlation with invasive indices, in particular left ventricular end-diastolic pressure, was found for strain rate during isovolumic relaxation (r = -0.76, P < .001). Early transmitral flow velocity/mean mitral annular velocity did not correlate significantly with any of the invasive indices. Strain rate during isovolumic relaxation (cutoff value < 0.38 s(-1)) accurately predicted left ventricular end-diastolic pressure of 16 mm Hg or more with 100% sensitivity and 93% specificity. CONCLUSIONS In a group of patients with heart failure who were investigated 6 months after cardiac surgery, early transmitral flow velocity/mean mitral annular velocity correlated poorly with invasively obtained diastolic indexes. Global strain rate during isovolumic relaxation, however, correlated well with left ventricular end-diastolic pressure and peak rate of pressure decline. Our data suggest that global strain rate during isovolumic relaxation is a promising noninvasive index to assess left ventricular filling pressures in patients with heart failure after extensive cardiac surgery, including restrictive mitral annuloplasty and surgical ventricular restoration.
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Affiliation(s)
- Ellen A ten Brinke
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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ten Brinke EA, Klautz RJ, Verwey HF, van der Wall EE, Dion RA, Steendijk P. Single-beat estimation of the left ventricular end-systolic pressure-volume relationship in patients with heart failure. Acta Physiol (Oxf) 2010; 198:37-46. [PMID: 19735484 DOI: 10.1111/j.1748-1716.2009.02040.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The end-systolic pressure-volume relationship (ESPVR) constructed from multiple pressure-volume (PV) loops acquired during load intervention is an established method to asses left ventricular (LV) contractility. We tested the accuracy of simplified single-beat (SB) ESPVR estimation in patients with severe heart failure. METHODS Nineteen heart failure patients (NYHA III-IV) scheduled for surgical ventricular restoration and/or restrictive mitral annuloplasty and 12 patients with normal LV function scheduled for coronary artery bypass grafting were included. PV signals were obtained before and after cardiac surgery by pressure-conductance catheters and gradual pre-load reductions by vena cava occlusion (VCO). The SB method was applied to the first beat of the VCO run. Accuracy was quantified by the root-mean-square-error (RMSE) between ESPVR(SB) and gold-standard ESPVR(VCO). In addition, we compared slopes (E(ES)) and intercepts (end-systolic volume at multiple pressure levels (70-100 mmHg: ESV(70)-ESV(100)) of ESPVR(SB) vs. ESPVR(VCO) by Bland-Altman analyses. RESULTS RMSE was 1.7 + or - 1.0 mmHg and was not significantly different between groups and not dependent on end-diastolic volume, indicating equal, high accuracy over a wide volume range. SB-predicted E(ES) had a bias of -0.39 mmHg mL(-1) and limits of agreement (LoA) -2.0 to +1.2 mmHg mL(-1). SB-predicted ESVs at each pressure level showed small bias (range: -10.8 to +9.4 mL) and narrow LoA. Two-way anova indicated that differences between groups were not dependent on the method. CONCLUSION Our findings, obtained in hearts spanning a wide range of sizes and conditions, support the use of the SB method. This method ultimately facilitates less invasive ESPVR estimation, particularly when coupled with emerging noninvasive techniques to measure LV pressures and volumes.
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Affiliation(s)
- E A ten Brinke
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Herreros J, Trainini JC, Menicanti L, Stolf N, Cabo J, Buffolo E. Cirugía de restauración ventricular después del estudio STICH. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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