PMID- 25146325
OWN - NLM
STAT- MEDLINE
DCOM- 20150629
LR  - 20141025
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 19
IP  - 5
DP  - 2014 Nov
TI  - Personalized surgical repair of left ventricular aneurysm with computer-assisted 
      ventricular engineering.
PG  - 801-6; discussion 806
LID - 10.1093/icvts/ivu219 [doi]
AB  - OBJECTIVES: 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.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Hartyanszky, Istvan
AU  - Hartyanszky I
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary 
      drharist@gmail.com.
FAU - Toth, Attila
AU  - Toth A
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Berta, Balazs
AU  - Berta B
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Polos, Miklos
AU  - Polos M
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Veres, Gabor
AU  - Veres G
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Merkely, Bela
AU  - Merkely B
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Szabolcs, Zoltan
AU  - Szabolcs Z
AD  - Semmelweis University Heart and Vascular Center, Budapest, Hungary.
FAU - Pepper, John
AU  - Pepper J
AD  - Royal Brompton Hospital, London, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140821
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/*methods
MH  - *Computer Simulation
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Aneurysm/diagnosis/*surgery
MH  - *Heart Ventricles
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Retrospective Studies
MH  - Surgery, Computer-Assisted/*methods
MH  - *User-Computer Interface
OTO - NOTNLM
OT  - Ischaemic heart disease
OT  - Left ventricular geometry
OT  - Surgical restoration of left ventricle
EDAT- 2014/08/26 06:00
MHDA- 2015/06/30 06:00
CRDT- 2014/08/23 06:00
PHST- 2014/08/23 06:00 [entrez]
PHST- 2014/08/26 06:00 [pubmed]
PHST- 2015/06/30 06:00 [medline]
AID - ivu219 [pii]
AID - 10.1093/icvts/ivu219 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2014 Nov;19(5):801-6; discussion 806. doi: 
      10.1093/icvts/ivu219. Epub 2014 Aug 21.