A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

BACKGROUND Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible. METHODS This study involved 12 consecutive patients with previous anterior myocardial infarction, dilated cardiomyopathy and no mitral procedures, who underwent left ventricular reconstruction and coronary revascularization between May 2002 and May 2003 using a small, narrow, oval patch aiming at a volume <or= 45 mL/m2 with elliptical shape. Eleven geometric parameters were examined preoperatively and at least 3, 12 and 24 months after the operation by serial echocardiographic studies and evaluated by paired t test taking the time of surgery as a starting point for remodeling. RESULTS All patients were in NYHA class 1 at follow-up. Patch geometry obtained a conical shape of the ventricle with new apex, physiologic rearrangement of functioning myocardial wall and small residual akinesia. Ventricular changes at the four time-points showed that all parameters improved significantly compared to preoperative values (end-diastolic volume = 184.2 +/- 23.9 vs 139.9 +/- 22.0, p = 0.001; vs 151.0 +/- 33.8, p = 0.06; vs 144.9 +/- 34.0, p = 0.38; end-systolic volume = 125.7 +/- 20.6 vs 75.2 +/- 14.1, p = 0.001; vs 82.1 +/- 23.9, p = 0,18; vs 77.1 +/- 19.4, p = 0.41) without further changes during follow-up except for wall motion score index (2.0 +/- 0.2 to 1.7 +/- 0.2, to 1.4 +/- 0.2, to 1.3 +/- 0.2) and percentage of akinesia (30.4 +/- 7.5 to 29.3 +/- 4.2, to 19.8 +/- 11.6, to 14.5 +/- 7.2) which slowly and significantly improved suggesting a positive post-surgery remodeling. CONCLUSION Ventricular reconstruction caring of physiological shape, volume, revascularization and residual akinesia obtained a steady geometry. Positive remodeling and equalization of geometrical outcome may persistently prevent long-term redilation.