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J Thorac Cardiovasc Surg. 2016 Aug;152(2):382-91. doi: 10.1016/j.jtcvs.2016.03.087. Epub 2016 Apr 14.

Time series analysis of physiologic left ventricular reconstruction in ischemic cardiomyopathy.

Author information

1
Heart Failure Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. Electronic address: marco.cirillo@poliambulanza.it.
2
Echocardiography Laboratory, Cardiology Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy.
3
Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy.
4
Intensive Care Unit, Emergency Department, Poliambulanza Foundation Hospital, Brescia, Italy.

Abstract

OBJECTIVE:

The history of left ventricular reconstruction has demonstrated that the full spectrum of recoverable physiologic parameters is essential for a good functional result. We report the long-term outcome of a new surgical technique that arranges myocardial fibers in a near-normal disposition, also recovering left ventricular twisting.

METHODS:

Between May 2006 and October 2013, 29 consecutive patients with previous anterior myocardial infarction and heart failure symptoms underwent physiologic left ventricular reconstruction surgery and coronary revascularization. Patients were examined by means of standard echocardiography and 2-dimensional speckle tracking at 8 time steps until 7 years after surgery. Ten geometric and functional parameters were evaluated at each step and analyzed by the linear mixed model test.

RESULTS:

Hospital mortality was 0%. The mean percentage of indexed end-diastolic and end-systolic volume reduction was 45.7% and 50.9%, respectively. Ejection fraction and all of the volumes were significantly different in the postoperative period with a steady correction during time. Diastolic parameters were not worsened by surgical reconstruction. Ejection fraction and deceleration time showed a significant improvement during time. Left ventricular torsion increased immediately after the surgical correction from 2.8 ± 4.4 degrees to 8.7 ± 3.9 degrees (P = .02) and was still present 4 years after surgery.

CONCLUSIONS:

Surgical conduction of ventricular reconstruction should be standardized to achieve the full spectrum of recoverable physiologic parameters. The renewal of ventricular torsion should be pursued as an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical level in the Frank-Starling relationship and pressure-volume loop.

KEYWORDS:

ischemic cardiomyopathy; left ventricular torsion; surgical ventricular reconstruction

PMID:
27167021
DOI:
10.1016/j.jtcvs.2016.03.087
[Indexed for MEDLINE]
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