Directed Epicardial Assistance in Ischemic Cardiomyopathy: Flow and Function Using Cardiac Magnetic Resonance Imaging Jeremy R. McGarvey, MD, Norihiro.

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Presentation transcript:

Directed Epicardial Assistance in Ischemic Cardiomyopathy: Flow and Function Using Cardiac Magnetic Resonance Imaging Jeremy R. McGarvey, MD, Norihiro Kondo, MD, Manabu Takebe, MD, Kevin J. Koomalsingh, MD, Walter R.T. Witschey, PhD, Alex J. Barker, PhD, Michael Markl, PhD, Satoshi Takebayashi, MD, PhD, Toru Shimaoka, MD, Joseph H. Gorman, MD, Robert C. Gorman, MD, James J. Pilla, PhD The Annals of Thoracic Surgery Volume 96, Issue 2, Pages 577-585 (August 2013) DOI: 10.1016/j.athoracsur.2013.04.012 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Intraoperative view of postinfarction heart after device placement. The inflation bladder has been positioned centrally within the infarct area and secured to the surrounding borderzone with polypropylene mesh and suture. The driveline is seen exiting the imaging as it is tunneled through the chest wall. (B) Schematic of magnetic resonance imaging (MRI) equipment. Green line represents pressure signal received from left ventricle pressure catheter; red line represents driveline powering the inflation bladder. The Annals of Thoracic Surgery 2013 96, 577-585DOI: (10.1016/j.athoracsur.2013.04.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Cine magnetic resonance imaging time lapse of assisted state (top panel) and unassisted state (bottom panel) in a single subject. Dynamic movement of the posterolateral wall in synchrony remote myocardium is observed while receiving epicardial assistance. Red line demarcates left ventricle epicardium; white arrow identifies posterolateral infarct and inflation bladder position. The Annals of Thoracic Surgery 2013 96, 577-585DOI: (10.1016/j.athoracsur.2013.04.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Left ventricular volume analysis in healthy controls (blue bars), unassisted postinfarct animals (red bars), and assisted postinfarct animals (green bars). ∗Denotes p < 0.05 when compared with healthy weight-matched controls by unpaired t test. §Denotes p < 0.05 when compared with the unassisted state by paired t test. (EDV = end-diastolic volume; EF = ejection fraction; ESV = end-systolic volume; SV = stroke volume.) The Annals of Thoracic Surgery 2013 96, 577-585DOI: (10.1016/j.athoracsur.2013.04.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Velocity-encoded particle tracings during assisted state (top panel) and unassisted state (bottom panel) in the same animal. Three phases of the cardiac cycle are shown: (A) early systole, (B) late systole, and (C) early diastole. In assisted systole (top panel A and B), there is efflux of blood in all directions away from the posterolateral scar. In contrast, during unassisted systole (bottom panel A and B) there is discoordinate movement of blood toward the infarct. Assisted systole (top panel C) shows augmentation of mitral inflow through the posterolateral toward the apex. Little movement of blood is identified during unassisted diastole (bottom panel C). Large flow voids are also visible along the unassisted posterolateral wall, which was improved after device activation. Bracket indicates posterolateral wall/device position. (Ao = aortic root; Ap = apex; LA = left atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2013 96, 577-585DOI: (10.1016/j.athoracsur.2013.04.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Normalized regional blood velocities of all subjects during assisted state (blue diamonds) and unassisted state (red triangles). (A) Posterolateral blood velocity was significantly improved with assistance throughout the cardiac cycle. (B) Remote anteroseptal blood velocity did not change with assistance. Green dashed line denotes aortic flow. The Annals of Thoracic Surgery 2013 96, 577-585DOI: (10.1016/j.athoracsur.2013.04.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions