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Time series analysis of physiologic left ventricular reconstruction in ischemic cardiomyopathy.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2016 Aug; Vol. 152 (2), pp. 382-91. Date of Electronic Publication: 2016 Apr 14. - Publication Year :
- 2016
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Anterior Wall Myocardial Infarction diagnostic imaging
Anterior Wall Myocardial Infarction physiopathology
Biomechanical Phenomena
Cardiomyopathies diagnostic imaging
Cardiomyopathies etiology
Cardiomyopathies physiopathology
Echocardiography
Female
Heart Failure diagnostic imaging
Heart Failure etiology
Heart Failure physiopathology
Heart Ventricles diagnostic imaging
Heart Ventricles physiopathology
Humans
Linear Models
Male
Middle Aged
Recovery of Function
Stroke Volume
Time Factors
Torsion, Mechanical
Treatment Outcome
Anterior Wall Myocardial Infarction complications
Cardiac Surgical Procedures adverse effects
Cardiomyopathies surgery
Heart Failure surgery
Heart Ventricles surgery
Plastic Surgery Procedures adverse effects
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 152
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27167021
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2016.03.087