Residual Stress Impairs Pump Function After Surgical Ventricular Remodeling: A Finite Element Analysis Joe Luis Pantoja, Zhihong Zhang, Mehrzad Tartibi,

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Residual Stress Impairs Pump Function After Surgical Ventricular Remodeling: A Finite Element Analysis Joe Luis Pantoja, Zhihong Zhang, Mehrzad Tartibi, PhD, Kay Sun, PhD, Warrick Macmillan, Julius M. Guccione, PhD, Liang Ge, PhD, Mark B. Ratcliffe, MD The Annals of Thoracic Surgery Volume 100, Issue 6, Pages 2198-2205 (December 2015) DOI: 10.1016/j.athoracsur.2015.05.119 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 VIRTUAL-DOR procedure using virtual sutures. (A) Virtual sutures (black) are attached to the edge of the patch (blue) and endocardium at each of the 32 node points. (B) The left ventricle (LV) after virtual sutures are tightened. (C) An expanded view of virtual sutures with the infarct zone (transparent yellow) removed. (BZ1 = near border zone (red); BZ2 = far border zone (brown); IZ = infarct zone (transparent yellow); PA = patch (blue); RZ = remote myocardium (green); SU = sutures (black).) The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Surface plot of fiber stress at end-systole with (A) optimized mesh and successive mesh refinements at (B) two times and (C) three times the mesh density with respect to the optimized mesh. The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Average end-systolic pressure-volume relationship linearly fit to P = EESV + P0 where EES and P0 are linear fit parameters. Preoperative values are shown as filled circles; virtual Dor procedure with residual stress is shown as open circles; and virtual Dor procedure without residual stress is shown as filled triangles. The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Average end-diastolic pressure-volume relationship curve fit to P = Ae(BV) + C where A, B, and C are curve-fitting parameters. Preoperative values are shown as filled circles; virtual Dor procedure with residual stress is shown as open circles; and virtual Dor procedure without residual stress is shown as filled triangles. The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Average Starling curve relationship curve fit to SV = S1P2 + S2P + S3 where S1, S2, and S3 are quadratic fit parameters. Preoperative values are shown as filled circles; virtual Dor procedure with residual stress is shown as open circles; and virtual Dor procedure without residual stress is shown as filled triangles. The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Behavior of the Guccione passive [23] and active [22] material property laws under tension and compression. Stress and strain were obtained analytically. Passive or diastolic stress-strain relationship is in blue, and the active or end-systolic stress-strain relationship is in red. Strains greater than 0 represent tension on the myocardium and strains less than 0 represent compression. In each case, the effect of additional residual stress is shown, ie, A→A′ for passive tension. The Annals of Thoracic Surgery 2015 100, 2198-2205DOI: (10.1016/j.athoracsur.2015.05.119) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions