Abstract 3255: Left ventricular stroke volume reduction after Surgical Ventricular Restoration: a diastolic dysfunction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marisa Di Donato ◽  
Fabio Fantini ◽  
Serenella Castelvecchio ◽  
Claudio Bussadori ◽  
Francesca Giacomazzi ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Diastolic Dysfunction ◽  
Nyha Class ◽  
Experimental Studies ◽  
Left Ventricular ◽  
Volume Reduction ◽  
Diastolic Filling ◽  
Surgical Ventricular Restoration ◽  
Post Surgery ◽  
Ventricular Restoration

Background. Experimental studies and theoretical considerations suggest that reduction of left ventricle (LV) stroke volume (SV) following Surgical Ventricular Restoration (SVR) is a consequence of diastolic dysfunction. Aim. To analyze changes in SV following SVR and assess if SV reduction is related to diastolic dysfunction. Patients. 134 consecutive patients submitted to SVR for symptoms of HF and/or angina. Patients with mitral regurgitation were excluded. Results. SV improved in 43 patients (54 ± 13 to 60 ± 15 ml; p 0.0001)-G1- and decreased in 91 patients (69 ± 19 to 48 ± 13 ml, p 0.0001)-G2-. The greater EDV reduction, the greater SV reduction (r = 0.609) and the greater EF improvement (r = 0.402)(Graph). Preoperatively, EF and SV were lower in G1 (31 ± 8 vs 35 ± 8%, p 0.002 and 54 ± 13 vs 69 ± 19 ml, respectively); no differences in LV volumes and Diastolic Filling Pattern (DP). Post surgery G2 shows smaller EDV and ESV and lower SV. DP significantly increased in G1 (from 1.42 ± 0.8 to 1.7 ± 0.7, p 0.01) and was higher than in G2, after surgery (p 0.008). NYHA class at FUP improved (2.4 ± 0.6 to 1.6 ± 0.6 in G1 and 2.4 ± 0.7 to 1.7 ± 0.6 in G2, p 0.001) Post-operative data Conclusions. Post-SVR stroke volume reduction is not related to diastolic dysfunction; paradoxically, diastolic function is more impaired in patients with SV improvement and larger residual volumes.

Abstract 4310: Chronic Effects of Surgical Ventricular Restoration on Left Ventricular Function: 6 Months Follow-Up by Pressure-Volume Loops

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ellen A ten Brinke ◽  
Robert J Klautz ◽  
Sven A Tulner ◽  
Frank H Engbers ◽  
Hariette F Verwey ◽  
...  
Keyword(s):  
Systolic Function ◽  
Nyha Class ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Lv Function ◽  
Stroke Work ◽  
Surgical Ventricular Restoration ◽  
Chronic Effects ◽  
Ventricular Restoration

Previous studies have demonstrated beneficial acute effects of surgical ventricular restoration (SVR) on mechanical dyssynchrony and left ventricular (LV) function, and improved mid- and long-term clinical parameters. However, chronic effects on systolic and diastolic LV function are still largely unknown. We studied 9 patients with ischemic dilated cardiomyopathy who underwent SVR. In all patients, invasive hemodynamic measurements by the conductance catheter (pressure-volume loops) were obtained during catheterization before and 6 months after surgery. In addition, NYHA classification, Minnesota Quality of Life (QoL)-score and 6-minute-hall-walk-test (6min-HWT) were assessed. At 6 months follow-up, all patients were alive and clinically significantly improved: NYHA class from 3.3±0.5 to 1.4±0.7, QoL-score from 46±22 to 15±15 and 6min-HWT from 302±123 to 444±78 m (all p<0.01). Hemodynamic data at fixed paced heart rate (80 bpm), showed improved cardiac output (4.8±1.4 to 5.6±1.1 L/min) (p =0.09), stroke work (6.5±1.9 to 7.1±1.4 mmHg.L) (p =0.05) and LV ejection fraction (36±10 to 46±10%) (p <0.001). LV surgical remodeling was sustained at 6 months: end-diastolic volume decreased from 246±70 to 180±48 mL and end-systolic volume from 173±77 to 103±40 mL (both p<0.001). LV mechanical dyssynchrony decreased from 29±6 to 26 ±3% (p<0.001) and ineffective internal LV flow fraction decreased from 58±30 to 42±18% (p<0.005). Early relaxation (tau, −dP/dt MIN ) was unchanged, but diastolic stiffness constant (K ED ) increased from 0.012±0.003 to 0.023±0.007 mL −1 (p<0.001) at 6 months follow-up. SVR leads to maintained LV volume reduction at 6 months follow-up. In addition, we observed improved systolic function and unchanged early diastolic function, but impaired passive diastolic properties. Clinical improvement, supported by decreased NYHA class, improved QoL-score and improved 6-min-HWT may be related to improved systolic function and reduced mechanical dyssynchrony.

Abstract 3059: Role of End Diastolic Volume on cardiac function induced changes by Surgical Ventricular Restoration

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marisa Di Donato ◽  
Fabio Fantini ◽  
Serenella Castelvecchio ◽  
Claudio Bussadori ◽  
Francesca Giacomazzi ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Volume Reduction ◽  
Surgical Volume ◽  
Single Patient ◽  
Surgical Ventricular Restoration ◽  
End Diastolic Volume ◽  
Post Surgery ◽  
Induced Changes ◽  
Ventricular Restoration

Background. LV-End diastolic volume (EDV) following surgical ventricular restoration (SVR) is highly dependent on surgical induced changes in ventricular chamber. Aim. To investigate the role of pre and post-operative EDV on SVR induced changes in cardiac function. Methods. We analyzed 298 patients submitted to SVR following an anterior MI. All had an echo study pre and post-operatively. SVR was conducted on arrested heart using an endoventricular sizing. Results. Post-op EDV was directly related to pre-op EDV, r=0.63; P<.001.The larger pre-op EDV the greater surgical volume reduction (average −32%) and the greater EF improvement. At a certain range of EDV (150 –200 ml) either pre or post surgery EF does not differ significantly (34±7% and 34±7%, ns), confirming the central role of EDV. Conclusions. EF improvement was relatively greater in patients with greater pre-op EDV and greater surgical reduction, although the absolute values of post-op EF are mainly linked to post-op EDV. Our results underline the need for a correct pre-op estimate of EDV reduction in each single patient. Tab. 1

A Hydrodynamic Efficiency Parameter as a Novel Left Ventricular Diastolic Dysfunction Diagnostic Metric

2008 ◽  
Author(s):  
Kelley C. Stewart ◽  
Rahul Kumar ◽  
John J. Charonko ◽  
Pavlos P. Vlachos ◽  
William C. Little
Keyword(s):  
Diastolic Dysfunction ◽  
Critical Role ◽  
Propagation Speed ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Ventricular Diastolic Dysfunction ◽  
Efficiency Parameter ◽  
Wave Propagation Speed ◽  
The Relationship

Numerous studies have shown that cardiac diastolic dysfunction and diastolic filling play a critical role in dictating overall cardiac health and demonstrated that the filling wave propagation speed is a significant index of the severity of diastolic dysfunction [1, 2]. However, the governing flow physics underlying the relationship between propagation speed and diastolic dysfunction are poorly understood. More importantly, currently there is no reliable metric to allow clinicians the ability to diagnose cardiac dysfunction on the basis of the wave filling speed.

Left Ventricular Vortex Ring Dynamics and Their Association to Early Diastolic Filling

2011 ◽  
Author(s):  
Kelley C. Stewart ◽  
John J. Charonko ◽  
Takahiro Ohara ◽  
William C. Little ◽  
Pavlos P. Vlachos
Keyword(s):  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Compensatory Mechanisms ◽  
Ring Dynamics ◽  
Ventricular Diastolic Dysfunction ◽  
Ventricular Filling ◽  
Early Filling

Diastolic dysfunction is the impairment of the filling in the left ventricle. Patients with left ventricular diastolic dysfunction (LVDD) lose the ability to adjust left ventricular filling properties without increasing left atrial pressure [1]. Although LVDD is very prevalent, it currently remains difficult to diagnose due to inherent atrioventricular compensatory mechanisms including increased heart rate, increased left ventricular (LV) contractility, and increased left atrial (LA) pressure. Although variations within the early diastolic filling velocity have been previously observed [2], the physical mechanism for the deceleration of the early filling wave is not understood.

Pathophysiology and causes of cardiac failure

2016 ◽  
Author(s):  
Alexandre Mebazaa ◽  
Mervyn Singer
Keyword(s):  
Stroke Volume ◽  
Diastolic Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Stroke Work ◽  
Compensatory Mechanisms ◽  
Ventricular Ejection Fraction

Organ congestion upstream of the dysfunctional left and/or right ventricle, with preserved stroke volume, is the most frequkeywordent feature of myocardial failure.Clinical manifestations do not necessarily correlate with the degree of left ventricular systolic dysfunction (i.e. left ventricular ejection fraction).Systolic and/or diastolic dysfunction may be present, with systolic dysfunction usually predominating.Pulmonary oedema is related to left ventricular diastolic dysfunction. Compensatory mechanisms (within the heart and/or periphery) may prove paradoxically disadvantageous on ventricular stroke work and stroke volume.

Minimally invasive left ventricular reconstruction of a postinfarction, anterior left ventricular scar (BioVentrix Revivent TC procedure)

2020 ◽  
Keyword(s):  
Left Ventricular ◽  
Surgical Ventricular Restoration ◽  
Surgical Ventricular Reconstruction ◽  
Normal Left Ventricular ◽  
Left Ventricular Reconstruction ◽  
Heart Lung Machine ◽  
Ventricular Reconstruction ◽  
Left Ventricular Shape ◽  
Lung Machine ◽  
Ventricular Restoration

Surgical ventricular reconstruction is a proven option for treating patients who have heart failure due to a postinfarction scar or an aneurysm of the left ventricle. The BioVentrix Revivent TC System offers a reliable alternative to the conventional, more invasive surgical ventricular restoration. The system requires no sternotomy, no heart–lung machine, and no cardioplegic arrest. In this video tutorial, we present our technique for using the Revivent TC System to reconstruct the normal left ventricular shape and volume in a patient with a postinfarction, anteroapical scar.

Sign in / Sign up

Export Citation Format

Share Document