Patch size, shape and orientation affect geometrical outcomes of surgical anterior ventricular restoration.
OBJECTIVE
To verify whether the use of a small, oval-shaped patch limits the trend toward re-dilatation compared to endoventricular circular patch plasty and leads to different geometrical and functional results in surgical anterior restoration.


METHODS
Thirty-seven patients with ischemic cardiomyopathy after anterior myocardial infarction end-systolic volume index of > or =45 ml/m2, ejection fraction of < or =35%, and no combined mitral procedures, underwent surgical anterior ventricular restoration between January 2000 and April 2003: 18 patients (group 1) were operated on using the endoventricular circular patch plasty technique (mean patch area 9.6 cm2) and 19 patients (group 2) received a small, obliquely oriented, oval-shaped patch (mean patch area 6.2 cm2). Ten geometrical parameters were studied preoperatively and at least 6 and 12 months after surgery. Data were analyzed using repeated-measures ANOVA, chi2, paired and unpaired Student's t-test, and binary logistic regression.


RESULTS
Group 1 showed a worsening over time in systolic and diastolic longitudinal length, end-diastolic volume (P < 0.001), end-diastolic volume index (P = 0.006), end-systolic volume (P = 0.005), and end-systolic volume index (P = 0.03). Group 2 showed an improvement in percentage of akinesia and wall motion score index (P < 0.001) and a worsening only in end-systolic diameter (P = 0.03) and end-diastolic volume (P = 0.04). At 12-month follow-up, ANOVA revealed that the oval patch positively influenced end-diastolic volume (P = 0.03), end-systolic volume (P = 0.03), and end-systolic volume index (P = 0.05), and group 2 had a significantly higher number of patients with an end-systolic volume index of <45 ml/m2 (P = 0.01).


CONCLUSIONS
The use of a small, narrow, obliquely oriented, oval patch may help to prevent adverse ventricular remodeling over time.
Cirillo
Marco
M
Heart Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. cirillo-marco@poliambulanza.it
Amaducci
Andrea
A
Quaini
Eugenio
E
Villa
Emmanuel
E
Tomba
Margherita Dalla
MD
Mhagna
Zean
Z
Brunelli
Federico
F
Messina
Antonio
A
Troise
Giovanni
G
D000368:Aged; D000704:Analysis of Variance; D000818:Animals; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002417:Cattle; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D016896:Treatment Outcome; D020257:Ventricular Remodeling