Mechanical synchrony: Role of surgical ventricular restoration in correcting LV dyssynchrony during chamber rebuilding

M. Di Donato, A. Toso, Vincent Dor, M. Sabatier, L. Menicanti, F. Fantini, Gerald Buckberg

Research output: Contribution to journalArticle

Abstract

Cardiac failure is frequently complicated by intra and or interventricular conduction delay that results in dyssynchronized cardiac contraction and relaxation. In contrast to an electrical intervention by biventricular pacing, this study tests the capacity of geometric rebuilding by surgical ventricular restoration (SVR) to restore a more synchronous contractile pattern through mechanical reconstruction without exogenous pacing input. Thirty patients (58 ± 8 years) undergoing SVR at the Cardiothoracic Center of Monaco were prospectively evaluated with a protocol which uses simultaneous measurements of ventricular volumes and pressure to construct pressure/volume (P/V) and pressure/length (P/L) loops. Mean QRS duration was within normal limits (100 ± 17 ms) preoperatively. Preoperative LV contraction was highly asynchronous. Endocardial time motion was either early or delayed at the end-systolic phase, yielding P/L loops with abnormal in size, shape, and orientation. Postoperatively, SVR resulted in leftward shifting of P/V loops and increased area; endocardial time motion and P/L loops almost normalized. The hemodynamic consequences of SVR included improved ejection fraction; reduced end-diastolic and end-systolic volume index; more rapid peak filling rate; peak ejection rate and mechanical efficiency resulting in mechanical intraventricular resynchronization that improves LV performance.

Original languageEnglish
Pages (from-to)307-315
Number of pages9
JournalHeart Failure Reviews
Volume9
Issue number4
DOIs
Publication statusPublished - Oct 2005

Keywords

  • Cardiac resynchronization
  • Surgical ventricular restoration
  • Ventricular remodelling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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