Giuseppe Petrone
Heart Centre, Italy
Title: Anatomic and functional respect in ventriculoplasty: the Twist Technique
Biography
Biography: Giuseppe Petrone
Abstract
Background: Since 1996, we have developed an innovative technique of ventriculoplasty, the “Twist Technique”(TT). The procedure performed has the purpose of preserving not only the volume and the shape of the LV but, above all, to restore the physiologic counterclockwise (CCW) twist of the cardiac apex through a rearrangement of its fibers, rebuilding the natural apical vortex of the LV. We present our experience in LV remodeling.
Methods: From 1996 to 2015, 289 patients with post-infarction LV aneurysm underwent reconstructive procedures. Mean age was 56.4 ± 7.3 years. Average LV ejection fraction (EF) was 38.9% ± 11.6%. LV reconstruction was performed by using the TT in 265 patients (91.7%). Jatene technique is performed. Afterwards, the orifice closure is obtained performing the TT: a running 2-0 polypropylene suture orients cardiac fibers remodeling heart apex in a cone shape; stitches are outdistanced of 1 cm on the lateral side of the endocardial wall and of 1/2 cm on the endocardial septum. The distal and akinetic portion of the septum is folded and therefore excluded. In 257 patients (88.9%) concomitant myocardial revascularization was performed.
Results: Perioperative mortality was 2.4%. Mean follow-up was 8.45 ± 4.2 years. Actuarial survival rate at 13 years was 73 %. The physiological movement of the new apex, that unfolds in a natural CCW twist, considerably improved LV EF. Mean post-operatively EF was 46.1 ± 9.3 %.
Conclusion: LV remodeling using the TT reproduces physiological CCW torsion of the cardiac apex, it is a safe surgical procedure with low perioperative mortality and excellent long-term survival.