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Published on: March 18, 2019
Lessons from a mathematical hypothesis - modification of the endoventricular circular patch plasty
Srilakshmi M Adhyapak1, Venkateswara Rao Parachuri
1Department of Cardiology, St. John's Medical College Hospital, Bangalore, India. srili2881967@yahoo.com
Summary
Linear endoventricular patch plasty improved heart function in patients with ischemic cardiomyopathy by restoring physiological left-ventricular geometry. This surgical ventricular restoration technique showed persistent benefits, including reduced volumes and improved ejection fraction, two years post-operation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- Surgical ventricular restoration (SVR) is a bailout therapy for end-stage heart failure due to ischemic cardiomyopathy.
- The STICH trial indicated SVR with circular endoventricular patch plasty offers no clinical benefit over revascularization alone.
- Limitations of previous SVR techniques necessitate modifications for improved patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a modified linear endoventricular patch plasty technique for SVR.
- To assess the impact of this technique on left-ventricular geometry and performance.
- To determine long-term reverse remodeling and functional improvements after SVR.
Main Methods:
- Studied 54 patients with post-infarction left-ventricular aneurysms undergoing linear endoventricular patch plasty.
- Utilized two-dimensional echocardiography and contrast ventriculography for pre-operative and 2-year post-operative assessments.
- Analyzed changes in end-diastolic volume (EDV), stroke volume (SV), ejection fraction (EF), and ventricular sphericity.
Main Results:
- Linear endoventricular patch plasty significantly decreased EDV and SV, while increasing EF.
- SVR resulted in a persistent improvement in left-ventricular sphericity towards an ellipsoid geometry.
- Long-term follow-up showed further reductions in EDV and SV, with sustained improvements in EF.
Conclusions:
- Linear endoventricular patch plasty effectively restores physiological elliptical left-ventricular geometry.
- The procedure promotes persistent late reverse remodeling and improved left-ventricular performance.
- Observed decreases in EDV and SV correlate with normal left-ventricular geometry, indicating successful restoration.
