Related Experiment Video
Updated: Jun 7, 2026
Implantation of hiPSC-derived Cardiac-muscle Patches after Myocardial Injury in a Guinea Pig Model
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
Insights
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.
Objective:
Surgical ventricular restoration has been the bailout therapy for end-stage heart failure due to ischemic cardiomyopathy in patients not suitable for cardiac transplantation. The recently concluded STICH trial has stated that surgical restoration of the left ventricle does not benefit this subgroup of patients clinically as compared with revascularization alone. The reasons for failure of this trial are multifactorial. The technique of surgical ventricular restoration employed in the STICH trial was circular endoventricular patch plasty. The various drawbacks related to this technique can be offset by a modification based on a mathematical hypothesis, which should result in a more physiological ventricular geometry, with consequent late reverse remodeling and improved left-ventricular performance.
Methods:
A total of 54 consecutive patients out of 102 patients with post-infarction left-ventricular aneurysms were studied before and 2 years after surgical ventricular restoration by linear endoventricular patch plasty using two-dimensional (2D) echocardiography and contrast ventriculography.
Results:
Linear endoventricular patch plasty resulted in a decrease in end-diastolic volume (EDV) of 40.2 ml (95% confidence interval (CI): 33.6, 46.7) and stroke volume (SV) of 10.0 ml (95% CI: 6.6, 13.5) and increase in ejection fraction (EF) of 6.7% (95% CI: 5.5, 7.9). There was a further 14% decrease in EDV and SV (30%) at 2 years with increase in EF (20%). There was a persistent significant improvement in sphericity index. The changes in EDV and SV were linearly related (r=0.72, p<0.001) and persisted at 2 years following surgery. The change in EDV was linearly related to the EF (r=0.35, p=0.02). The left-ventricular shape analysis showed improvements in the anterior and anterolateral segments (effect size=1.1, p<0.001) with nonsignificant changes in the inferior segments, conforming to an ellipsoid geometry.
Conclusions:
Linear endoventricular patch plasty restored a physiological elliptical ventricular geometry with persistent late reverse remodeling. The decreases in EDVs following surgery were significantly linearly proportional to the decreases in SVs at rest, which conforms to the normal left-ventricular geometry.
