title: Personalized surgical repair of left ventricular aneurysm with computer-assisted ventricular engineering.
abstract: OBJECTIVE
  Although circular ventricular resection techniques are the gold standard of left ventricular (LV) restoration, these techniques can lead to suboptimal results. Postoperative systolic resection can be inadequate, because it must be planned on a heart stopped in diastole. Low cardiac output due to insufficient LV volume results in a potentially unstable condition, and cannot be corrected. Our aim was to find a preoperative method to minimize risk and maximize outcome with ventricular restoration.
  
  
  METHODS
  We created a novel method combining surgery with gadolinium-enhanced magnetic resonance to construct a preoperative 3D systolic heart model. The model was utilized to determine resection points that could be intraoperatively used. According to our calculations with the predetermined resection line, the calculated percentage reduction in LV volume was above 30%, and LV volumes were predicted above normal values; thus, performing the operation using these resection points is likely to be safe and effective. We had a mixed, real-life patient group: mitral insufficiency or pulmonary hypertension were not exclusion criteria.
  
  
  RESULTS
  Forty-one procedures (12 concomitant mitral valve plasty) were done on consecutive patients in a single-centre experience. The incidence rate of major adverse clinical events was 32% postoperatively (n = 13). Control MRI showed a significant improvement in ejection fraction (18.3 ± 4.3 vs 31.3 ± 3.3; P = 0.04). All patients improved their New York Heart Association (NYHA) class postoperatively (40 patients NYHA III/IV versus 40 NYHA I/II). During long-term follow-up, 1 patient died due to end-stage heart failure.
  
  
  CONCLUSIONS
  Using this model, we were able to find the optimal resection line providing an excellent postoperative result, thus minimizing the risk of low cardiac output syndrome.
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary drharist@gmail.com.
authors.forename: István
authors.initials: I
authors.lastname: Hartyánszky
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Tóth
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Berta
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Miklós
authors.initials: M
authors.lastname: Pólos
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Veres
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabolcs
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Pepper
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003198:Computer Simulation; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000175:diagnosis / Q000601:surgery*; D006352:Heart Ventricles; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014584:User-Computer Interface
keywords: Ischaemic heart disease; Left ventricular geometry; Surgical restoration of left ventricle