Form versus disease: optimizing geometry during ventricular restoration.
OBJECTIVE
Dilated cardiomyopathy from many causes results in a change in ventricular geometry, whereby the elliptical chamber becomes more spherical. This may be the unifying geometric concept of heart failure, with similar alteration of spatial configuration in non-ischemic diffuse myocyte disease, ischemic cardiomyopathy with and without scar, and in valvular heart disease.


METHODS
This change in architecture alters fiber direction and diminishes function, and has been related to alteration of the apical loop of the helical ventricular myocardial band model of cardiac shape. The underlying concept of rebuilding the ventricle by ventricular restoration is suggested to be reconstruction of form, rather than focusing on only the underlying disease.


RESULTS
Examples are shown where the Surgical Anterior Ventricular Exclusion (SAVE) or Pacopexy procedure has been successfully applied to each of the above-mentioned diseases, and is suggested for dilated valvular cardiomyopathy. The interaction between rebuilding form and how this procedure restores more normal fiber orientation is discussed, and the possibility of a macroscopic/microscopic marriage between surgically altering the cardiac scaffold by restoration (macro) and cell biology to improve function in a new helical shape is suggested.


CONCLUSIONS
The implication of these observations is that the surgical objective should become rebuilding ventricular form, rather than restricting restoration procedures to only addressing the disease.
Option on Bioengineering, California Institute of Technology, 1200 E. California Blvd, Pasadena, CA 91125, USA. gbuckberg@mednet.ucla.edu
Gerald D
GD
Buckberg
D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D018485:Muscle Fibers, Skeletal / Q000473:pathology; D017202:Myocardial Ischemia / Q000150:complications