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Susan I. Nicholas
Philip C. Crawford
Mark B. Ratcliffe
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J Thorac Cardiovasc Surg 2007;134:1017-1024
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep

Peng Zhang, MD, PhDa,b, Julius M. Guccione, PhDa,b,*, Susan I. Nicholas, MDa, Joseph C. Walker, PhDc, Philip C. Crawford, CCPa, Amin Shamal, MDb,d, Gabriel Acevedo-Bolton, PhDb,e, Michael A. Guttman, MSf, Cengizhan Ozturk, MD, PhDf, Elliot R. McVeigh, PhDf, David A. Saloner, PhDb,e, Arthur W. Wallace, MD, PhDb,d, Mark B. Ratcliffe, MDa,b

a Department of Surgery, University of California, San Francisco, Calif
c Department of Bioengineering, University of California, San Francisco, Calif
d Department of Anesthesia, University of California, San Francisco, Calif
e Department of Radiology, University of California, San Francisco, Calif
b Department of Veterans Affairs Medical Center, San Francisco, Calif
f Laboratory of Cardiac Energetics, National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Md.

Received for publication October 11, 2006; revisions received February 8, 2007; accepted for publication March 14, 2007.

* Address for reprints: Julius M. Guccione, PhD, Division of Surgical Services (112D), San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121. (Email: julius.guccione{at}med.va.gov).

Objective: Endoventricular patch plasty (Dor procedure) has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We tested the hypotheses that the Dor procedure increases systolic circumferential shortening and longitudinal shortening in noninfarcted left ventricular regions in sheep.

Methods: In 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from the apex to the base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Two weeks before and 2 and 6 weeks after the Dor procedure, animals underwent magnetic resonance imaging with tissue tagging in multiple short-axis and long-axis slices. Fully three-dimensional strain analyses were performed. All 6 end-systolic strain components were compared in regions 1 cm, 2 cm, 3 cm, and 4 cm below the valves, as well as in the anterior, posterior, and lateral left ventricular walls and the interventricular septum.

Results: Circumferential shortening increased from before the Dor procedure to 6 weeks after repair in nearly every left ventricular region (13/16). The greatest regional change in circumferential shortening was found in the equatorial region or 2 cm below the base and in the posterior wall (from 9.0% to 18.4%; P < .0001). Longitudinal shortening increased 2 weeks after the Dor procedure but then returned near baseline by 6 weeks after the Dor procedure.

Conclusion: The Dor procedure significantly increases systolic circumferential shortening in nearly all noninfarcted left ventricular regions in sheep.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; LV = left ventricle(ular); MI = myocardial infarction; MR = magnetic resonance; MRI = magnetic resonance image(ing); STICH trial = Surgical Treatment for Ischemic Heart failure trial; SVR = surgical ventricular restoration


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