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.
