Effect of ventricular size and patch stiffness in surgical anterior ventricular restoration: a finite element model study.
BACKGROUND
Surgical anterior ventricular restoration (SAVER) has been proposed for dilated ischemic cardiomyopathy with an akinetic distal anterior left ventricular wall. We tested the hypothesis that SAVER increases stroke volume, reduces mean myofiber stress and achieves optimal results without a patch.


METHODS
A finite element model of the left ventricle (LV) with an akinetic but contractile anteroapical LV wall segment was used. Separate versions of the model with normal and dilated LV sizes were developed and used to simulate the SAVER operation with and without a patch of varying stiffness from 10 to 100 kilopascals.


RESULTS
The SAVER operation reduced myofiber stress in the akinetic infarct and infarct borderzone, but caused a reduction in the Starling relationship. In all cases, stroke volume decreased while ejection fraction increased after SAVER. The SAVER operation was more beneficial in dilated ventricles, and the reduction in stroke volume after SAVER without patch was minimal. The effect of patch stiffness was mixed as stiffer material causes a greater reduction in stress yet has the greatest negative effect on stroke volume.


CONCLUSIONS
These simulations support the use of SAVER in dilated hearts without a patch.
Dang
Alan B C
AB
School of Medicine of the University of California, San Francisco, San Francisco, California, USA.
Guccione
Julius M
JM
Zhang
Peng
P
Wallace
Arthur W
AW
Gorman
Robert C
RC
Gorman
Joseph H
JH
Ratcliffe
Mark B
MB
D000818:Animals; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000601:surgery*; D003198:Computer Simulation; D003971:Diastole; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008955:Models, Cardiovascular; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging / Q000601:surgery*; D009210:Myofibrils / Q000502:physiology; D018583:Pliability; D011093:Polyethylene Terephthalates; D012756:Sheep; D013314:Stress, Mechanical; D013318:Stroke Volume; D013526:Surgical Mesh; D013599:Systole; D014463:Ultrasonography; D016277:Ventricular Function, Left
D011093:Polyethylene Terephthalates