Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function

Author:

Lee Lik Chuan12,Wenk Jonathan F.3,Zhong Liang4,Klepach Doron12,Zhang Zhihong1,Ge Liang12,Ratcliffe Mark B.12,Zohdi Tarek I.5,Hsu Edward6,Navia Jose L.7,Kassab Ghassan S.8,Guccione Julius M.12

Affiliation:

1. Department of Surgery, University of California, San Francisco, California;

2. Department of Bioengineering, University of California, San Francisco, California;

3. Department of Mechanical Engineering and Surgery, University of Kentucky, Lexington, Kentucky;

4. Department of Cardiology, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore;

5. Department of Mechanical Engineering, University of California, Berkeley, California;

6. Department of Bioengineering, The University of Utah, Salt Lake City, Utah;

7. Cleveland Clinic, Cleveland, Ohio; and

8. Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indiana

Abstract

Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial ( 20 ) for the neutral outcome, that “the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility.”

Publisher

American Physiological Society

Subject

Physiology (medical),Physiology

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