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Published on: March 18, 2019
Resizable ventricular patch plasty in the porcine left ventricle: a pilot study
Willemijn H F Huijgen1, Paul F Gründeman, Tycho van der Spoel
1From the *University of Leiden, Leiden, The Netherlands; †Experimental and Clinical Cardiothoracic Surgery, University Hospital Utrecht, Utrecht, The Netherlands; ‡Department of Cardiology, University Hospital Utrecht, Utrecht, The Netherlands; and §Department of Cardio-Thoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
This study explored using a variably shaped patch to reduce left ventricular (LV) volume in simulated aneurysms. Changing patch shape effectively reduced end-diastolic volume in vitro and impacted cardiac performance in animal models.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Cardiac Mechanics
Background:
- Endoventricular circular patch plasty reconstructs the left ventricle (LV) for aneurysm or dilatation.
- Late redilatation and mitral regurgitation are concerns, potentially linked to postoperative apex shape.
- Ventricular volume reduction is a target for improving outcomes in these patients.
Purpose of the Study:
- To investigate the feasibility of ventricular volume downsizing using a variably shaped patch.
- To assess the impact of patch shape on end-diastolic volume and cardiac performance.
- To evaluate a novel approach for left ventricular reconstruction.
Main Methods:
- Simulated dyskinetic aneurysms using pericardial inserts in porcine hearts (in vitro and acute animal experiments).
- Varied patch shapes to alter surface area and reduce end-diastolic volume.
- Measured end-diastolic volume via volumetry and echocardiography (in vitro); assessed pressure/time relationship (dPdTmax) in acute animal models.
Main Results:
- In vitro, reducing patch convexity significantly decreased LV volume (66 ± 7 mL to 49 ± 5 mL).
- Four of five patch shapes further reduced volume to a mean of 38 ± 7 mL (P = 0.03).
- In vivo, patch shape changes affected cardiac performance (dPdTmax) independently of volume changes.
Conclusions:
- Configurable ventricular patch shapes can achieve calibrated end-diastolic volume reduction in vitro.
- Patch configuration influences cardiac performance in vivo, even with minimal volume changes.
- This pilot study suggests shape optimization is crucial for ventricular reconstruction and warrants further investigation.
