Research article

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure

Marco Cirillo

Cardiovascular Department, Heart Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy

author email corresponding author email

Annals of Surgical Innovation and Research 2009, 3:6doi:10.1186/1750-1164-3-6

Published:	23 June 2009

Abstract

Background

The history of surgical reconstruction of the left ventricle after an anterior myocardial infarction shows an evolution of techniques which tend to a more and more physiologic restoration of ventricular shape and volume, with increasing attention to the orientation of myocardial fibers.

Methods

We set a new surgical procedure for endoventricular patch reconstruction technique with the aim to rebuild a physiologic shape and volume of the left ventricle caring about realignment of myocardial fibers orientation. Peculiarities of this reconstruction are the shape of the patch (reduction of minor axis compared with currently used oval-shaped patch) and the asymmetrical way of suturing it inside the ventricle.

Results

We present a detailed description of operative steps of this procedure, and we add some relevant surgical hints to clarify its peculiarities. Most of the patients operated on with this technique showed the original renewal of apical rotation and left ventricular torsion as specific index of the restoration of physiologic fiber orientation: we report an exemplary case of at-sight recovery of apical rotation in the operating room.

Conclusion

This technique can represent a reproducible new way to realign myocardial fibers in a near-normal setting, improving the physiological restoration of ischemically injured left ventricle. It could be also the basis to reconsider surgical treatment for heart failure.