2012 annual meeting & cardiothoracic forum - Society for ...

ACTA-SCTS JOINT MEETING • Manchester Central Conference Centre
170 Personalised Surgical Repair of Left Ventricle Aneurysm With
Computer Assisted Ventricular Engineering
Authors: István Hartyánszky 1 A.T. Tóth 2 B.B. Berta 2 M.P. Polós 1 G.V. Veres 1 B.M.
Merkely 2 F.H. Horkay 1 J.P. Pepper 3
1 Semmelweis University, Department Cardiac Surgery, Hungary; 2 Semmelweis
University, Heart Center, Budapest, Hungary; 3 Royal Brompton and Harefield NHS
Trust, London, United Kingdom
Objectives: Although circular ventricle resection techniques are the gold standard
of left ventricle restoration, these techniques can lead to suboptimal results.
Postoperative systolic resection can be inadequate, as it must be planned on a
heart stopped in diastole. Low cardiac output due to insufficient left ventricular
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
ventricle restoration.
Methods: We have 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 was not an exclusion criteria.
Results: 41 procedures (12 concomitant mitral valve plasty) were done on
consecutive patients on a one surgeon experience. There has been no mortality
during follow-up (average follow-up time was 26±6 months). MACE incidence was
32% postoperatively (n=13). Control MRI showed a significant improvement in
ejection fraction (18,3±4,3vs.31,3±3, 3 p=0,04). All patients improved NYHA class
postoperatively (41 patients NYHA III/IV vs.39 NYHA I/II).
Conclusions: Using this model we were able to find the optimal resection line
providing excellent postoperative result, thus minimizing the risk of low cardiac
syndrome.
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