Off-pump epicardial ventricular reconstruction restores left ventricular twist and reverses remodeling in an ovine anteroapical aneurysm model

Objective The loss of normal apical rotation is associated with left ventricular (LV) remodeling and systolic dysfunction in patients with congestive heart failure after myocardial infarction. The objective of the present study was to evaluate the effect of epicardial ventricular reconstruction, an...

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Published in:The Journal of thoracic and cardiovascular surgery 2014-07, Vol.148 (1), p.225-231
Main Authors: Cheng, Yanping, MD, Aboodi, Michael S., BS, Annest, Lon S., MD, Wechsler, Andrew S., MD, Kaluza, Greg L., MD, PhD, FACC, Granada, Juan F., MD, FACC, Yi, Geng-Hua, MD
Format: Article
Language:English
Subjects:
Animals
Biomechanical Phenomena
Cardiac Surgical Procedures
Cardiothoracic Surgery
Disease Models, Animal
Heart Aneurysm - diagnosis
Heart Aneurysm - physiopathology
Heart Aneurysm - surgery
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Heart Ventricles - surgery
Pericardium - diagnostic imaging
Pericardium - physiopathology
Pericardium - surgery
Reconstructive Surgical Procedures
Recovery of Function
Sheep
Stroke Volume
Systole
Time Factors
Torsion, Mechanical
Ultrasonography
Ventricular Function, Left
Ventricular Remodeling
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Summary:Objective The loss of normal apical rotation is associated with left ventricular (LV) remodeling and systolic dysfunction in patients with congestive heart failure after myocardial infarction. The objective of the present study was to evaluate the effect of epicardial ventricular reconstruction, an off-pump, less-invasive surgical reshaping technique, on myocardial strain, LV twist, and the potential alteration of myocardial fiber orientation in an ovine model of LV anteroapical aneurysm. Methods LV anteroapical myocardial infarction was induced by coil embolization of the left anterior descending artery. Eight weeks after occlusion, epicardial ventricular reconstruction was performed using left thoracotomy under fluoroscopic guidance in 8 sheep to completely exclude the scar. The peak systolic longitudinal/circumferential strains and LV twist were evaluated using speckle tracking echocardiography before (baseline), after device implantation, and at 6 weeks of follow-up. Results Epicardial ventricular reconstruction was completed in all sheep without any complications. Immediately after device implantation, LV twist significantly increased (4.18 ± 1.40 vs baseline 1.97 ± 1.92; P  = .02). The ejection fraction had increased 17% and LV end-systolic volume had decreased 40%. The global longitudinal strain increased from −5.3% to −9.1% ( P  
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2013.08.030