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The Impact of Surgical Technique on Cardiac Hemodynamics Following Surgical Ventricular Restoration

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Ventricular Geometry in Post-Myocardial Infarction Aneurysms

Abstract

The improvements in cardiac anatomy in terms of decreased volumes with resulting clinical improvements following surgical ventricular restoration have been well documented. Improvements in ventricular function were assessed by the left ventricular ejection fraction which showed significant improvements. As detailed in the previous chapter, the technique of surgical ventricular restoration profoundly impacts the effective restoration of a near normal ventricular anatomy and function. The evolution in the surgical techniques has resulted in an evolutionary progress toward near normal ventricular restoration. The hemodynamics in the failing ventricle was discussed in Chap. 5. In this chapter, the hemodynamics following the various surgical techniques has been discussed. These hemodynamic studies are warranted in the surgically restored ventricle to assess its impact on ventricular function, which directly impacts morbidity and mortality.

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References

  1. Shapira OM, Davidoff R, Hilkert RJ, Aldea GS, Fitzgerald CA, Shemin RA. Repair of left ventricular aneurysm: long term results of linear repair versus endoaneurysmorraphy. Ann Thorac Surg. 1997;63:701–5.

    Article  PubMed  CAS  Google Scholar 

  2. Pocar M, Di Mauro A, Massolunghe D, Monneta A, Megali A, Alsheirei TA, Bregasi A, Matteoli R, Donatelli F. Predictors of adverse events after surgical ventricular restoration for advanced ischemic car­diomyopathy. Eur J Cardiothorac Surg. 2010;37:1093–100.

    Article  PubMed  Google Scholar 

  3. Tiscler MD, Niggel J, Borowski DT, Le Winter MM. Relation between left ventricular shape and exercise capacity in patients with left ventricular dysfunction. J Am Coll Cardiol. 1993;22:751–7.

    Article  Google Scholar 

  4. Sabbah HN, Konno T, Stein PD, Mancini GB, Goldstein S. Left ventricular shape changes during the course of evolving heart failure. Am J Physiol. 1992;263(1):H266–70.

    PubMed  CAS  Google Scholar 

  5. Tulner SAF, Steendjik P, Klautz RJM, Bax JJ, Shalij MJ, Wall EVD. SVR in patients with ischemic dilated cardiomyopathy: evaluation of systolic and diastolic ventricular function, wall stress, dyssynchrony and mechanical efficiency by pressure–volume loops. J Thorac Cardiovasc Surg. 2006;132:610–20.

    Article  PubMed  Google Scholar 

  6. Kawachi K, Kitamura S, Kawata T, Morita R, Nishii T, Seki T, Taniguchi S, Inoue K. Hemodynamic assessment during exercise after left ventricular aneurysmectomy. J Thorac Cardiovasc Surg. 1994;107:178–83.

    PubMed  CAS  Google Scholar 

  7. Tanoue Y, Ando H, Fukumura F, Umesue M, Uchida T, Taniguchi K, Tanaka J. Ventricular energetics in endoventricular circular patch plasty for dyskinetic anterior left ventricular aneurysm. Ann Thorac Surg. 2003;75:1205–8.

    Article  PubMed  Google Scholar 

  8. Stephens JD, Dymond DS, Stone DL, Rees GM, Spurrell RAJ. Left ventricular aneurysm and congestive heart failure: value of exercise stress and isosorbide dinitrate in predicting hemodynamic results of aneurysmectomy. Am J Cardiol. 1980;45:932–9.

    Article  PubMed  CAS  Google Scholar 

  9. Artrip JH, Oz MC, Burkhoff D. Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J Thorac Cardiovasc Surg. 2001;122:775–82.

    Article  PubMed  CAS  Google Scholar 

  10. Suga H, Sagawa K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res. 1974;35:117–26.

    Article  PubMed  CAS  Google Scholar 

  11. Burkhoff D, et al. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J Thorac Cardiovasc Surg. 2006;132:459–63.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Menicanti L, Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J Thorac Cardiovasc Surg. 2002;124:886.

    Article  PubMed  Google Scholar 

  14. Di Donato M, Sabatier M, Dor V, Gensini GF, Toso A, Maioli M, Stanley AWH, Athanasuleas C, Buckberg G. Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery. J Thorac Cardiovasc Surg. 2001;121:91–6.

    Article  PubMed  CAS  Google Scholar 

  15. Castelvecchio S, Menicanti L, Ranucci M, Di Donato M. Impact of surgical ventricular restoration on diastolic function: implications of shape and residual ventricular size. Ann Thorac Surg. 2008;86:1849–54.

    Article  PubMed  Google Scholar 

  16. Fantini F, Barletta G, Toso A, Baroni M, Di Donato M, Sabatier M, Dor V. Effects of reconstructive surgery for left ventricular anterior aneurysm on ventriculoarterial coupling. Heart. 1999;81:171–6.

    PubMed  CAS  Google Scholar 

  17. Di Donato MM, Toso A, Dor V, Sabatier M, Barletta G, Menicanti L, Fantini F, and the RESTORE group. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004;109:2536–43.

    Article  PubMed  Google Scholar 

  18. Biederman RWW, Doyle M. The contribution of CMR to patients undergoing the surgical ventricular restoration (SVR) procedure; one center’s experience over five years. Open Magn Reson. 2009;2:33–45.

    Article  Google Scholar 

  19. Biederman R, Doyle M, Young A. Global and regional mechanics together with reverse remodeling after LV reconstruction surgery: a one year 3-D MRI analysis. J Cardiovasc Magn Reson. 2002;4:142–3.

    Google Scholar 

  20. Adhyapak SM, Parachuri VR. Lessons from a mathematical hypothesis – modification of the endoventricular circular patch plasty. Eur J Cardiothorac Surg. 2011;39:945–51.

    Article  PubMed  Google Scholar 

  21. Jacob R, Dierberger B, Gulch RW, Kissling G. Geometric and muscle physiologic factors of the Frank–Starling mechanism. Basic Res Cardiol. 1993;88:86–91.

    PubMed  CAS  Google Scholar 

  22. Jacob R, Gulch RW. The functional significance of ventricular geometry for the transition from hypertrophy to cardiac failure. Does a critical degree of structural dilatation exist? Basic Res Cardiol. 1998;93:423–9.

    Article  PubMed  CAS  Google Scholar 

  23. Holubarsch C, Ruf T, Goldstein DJ, Ashton RC, Nickl W, Pieske B, Pioch K, Ludemann J, Weissner S, Hasenfuss G, Poseval H, Just H, Burkhoff D. Existence of the Frank–Starling mechanism in the failing human heart. Circulation. 1996;94:683–9.

    Article  PubMed  CAS  Google Scholar 

  24. Mangano DT, Van Dyke DC, Ellis RJ. The effect of increasing pre load on ventricular output and ejection in man. Limitations of the Frank–Starling mechanism. Circulation. 1980;62:535–41.

    Article  PubMed  CAS  Google Scholar 

  25. Adhyapak SM, Parachuri VR. Impact of surgical ventricular restoration on stroke volume: surgical fine tuning the relationship between end diastolic volume and stroke volume. J Thorac Cardiovasc Surg. 2011;141(6):1552–3.

    Article  PubMed  Google Scholar 

  26. Renlund DG, Gerstenblith G, Fleg JL, Becker LC, Lakatta EG. Interaction between end diastolic and end systolic volumes in normal humans. Am J Physiol Heart Circ Physiol. 1990;258:H473–81.

    CAS  Google Scholar 

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Parachuri, V.R., Adhyapak, S.M. (2012). The Impact of Surgical Technique on Cardiac Hemodynamics Following Surgical Ventricular Restoration. In: Ventricular Geometry in Post-Myocardial Infarction Aneurysms. Springer, London. https://doi.org/10.1007/978-1-4471-2861-8_9

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  • DOI: https://doi.org/10.1007/978-1-4471-2861-8_9

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