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Related Experiment Videos

Left ventricular volume reduction surgery for heart failure: a physiologic perspective.

J H Artrip1, M C Oz, D Burkhoff

  • 1Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.

The Journal of Thoracic and Cardiovascular Surgery
|October 3, 2001
PubMed
Summary

Ventricular volume reduction surgery outcomes depend on the type of tissue removed. Resecting dyskinetic scar tissue improves heart function, while removing contracting muscle impairs it.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Mechanics
  • Biomedical Engineering

Background:

  • Ventricular volume reduction surgery for idiopathic cardiomyopathy yields poor results.
  • Surgery after myocardial infarction shows better outcomes, but reasons are unclear.

Purpose of the Study:

  • To predict the hemodynamic effects of different ventricular volume reduction surgical approaches.
  • To elucidate the impact of resecting various myocardial tissue types on cardiac function.

Main Methods:

  • A composite left ventricular model was used to simulate volume reduction surgery.
  • Simulations involved resecting 20% of myocardium with properties of weak muscle, akinetic scar, or dyskinetic scar.
  • End-systolic and end-diastolic pressure-volume relationships were numerically determined.

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Main Results:

  • All volume reduction procedures reduced chamber size, shifting pressure-volume relationships leftward.
  • Resecting dyskinetic scar favorably impacted overall pump function.
  • Resecting contracting muscle negatively affected pump function, while akinetic scar had equivocal effects.

Conclusions:

  • The impact of ventricular volume reduction surgery on pumping characteristics is dictated by the specific material properties of the resected myocardial region.
  • Differential effects on end-systolic and end-diastolic properties determine surgical outcomes.