DOCSLIB.ORG

A Single Center's Experience with Total Arterial Revascularization and Spiral

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Single Center's Experience with Total Arterial Revascularization and Spiral Heart and Vessels (2019) 34:906–915 https://doi.org/10.1007/s00380-018-1317-z ORIGINAL ARTICLE A single center’s experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac disease Ilias P. Doulamis1 · Despina N. Perrea1 · George Mastrokostopoulos2 · Konstantina Drakopoulou2 · Konstantinos Voutetakis3 · Aspasia Tzani1 · Ioannis A. Chloroyiannis3 Received: 5 September 2018 / Accepted: 30 November 2018 / Published online: 6 December 2018 © Springer Japan KK, part of Springer Nature 2018 Abstract The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocar- dial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modifcation of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efcacy of this surgical modality. Keywords Total arterial revascularization · Aneurysmorrhaphy · Ischemic heart disease · Left ventricular aneurysm Introduction tension of the left ventricle (LV) [2]. This mechanical wall stress results in increased oxygen demand, hypoperfusion The term “ischemic cardiomyopathy” was frst introduced of the subendocardial heart tissue and decreased systolic approximately half a century ago for characterization of a LV function [2]. Results from the Coronary Artery Surgery poorly functioning left ventricle as a result of myocardial Study (CASS) showed improved survival with surgery in ischemia [1]. According to Laplace’s law, chamber enlarge- heart failure patients with LV aneurysm and multi-vessel ment due to ischemic remodeling leads to increased wall coronary artery disease [3]. The superiority of total arte- rial revascularization (TAMR) over coronary artery bypass grafting (CABG) with the use of vein grafts is prominent, * Ilias P. Doulamis therefore TAMR represents the optimal surgical modality [email protected] for the treatment of advanced ischemic coronary artery dis- 1 Laboratory for Experimental Surgery and Surgical Research ease [4, 5]. Coronary revascularization is considered a suit- “N.S Christeas”, Athens Medical School, National able option in patients with ischemic cardiomyopathy if the and Kapodistrian University of Athens, Agiou Thoma Str., viability of the ventricle has remained intact. However, re- 15b, Goudi, 11527 Athens, Greece establishment of the coronary circulation alone may not be 2 Department of Cardiac Anesthesia, Euroclinic of Athens, sufcient to reverse the remodeling process and restore the Athens, Greece normal geometry of a ventricle that has undergone irrevers- 3 Department of Cardiac Surgery, Euroclinic of Athens, ible ischemic injury [6]. Athens, Greece Vol:.(1234567890)1 3 Heart and Vessels (2019) 34:906–915 907 For reconstruction of the LV, a variety of procedures have Materials and methods been proposed. Dor’s procedure (use of a patch) is the most commonly used, followed by linear aneurysmorrhaphy [7]. Study design Although Dor’s procedure seems to be associated with bet- ter post-operative outcomes, it is an invasive and technically From April 2003 to December 2015, a total of 113 patients challenging technique [8]. On these grounds, we suggest a with advanced heart failure (New York Heart Association modifcation of the linear aneurysmorrhaphy which could (NYHA) score of 3 or higher) due to ischemic cardiomyo- be utilized for the restoration of small-sized LV aneurysms pathy were treated surgically at the Department of Cardiac with a diameter less than 5 cm. By this technique, the edges Surgery, Euroclinic of Athens, Greece. Of them, 101 patients of the transition zone surrounding the scar tissue are brought underwent spiral aneurysmorrhaphy for reconstruction of together in a spiral manner. In this way, enhanced reinforce- the left ventricle and total arterial revascularization(Fig. 1). ment of the suturing line is achieved when compared with 31patients presented with an aneurysm on the posterior sur- the linear technique, while also avoiding the invasive nature face of the left ventricle, while 70 patients had anterior aneu- of Dor’s procedure. rysm. Patient data including demographic characteristics, Although a combination of CABG and LV reconstruction comorbidities, pre-operative diagnosis, pre-operative ejec- seems to be the optimal approach for advanced ischemic tion fraction (EF), operative procedure and post-operative cardiac disease, this hypothesis was not validated by the course during hospitalization were reviewed. STITCH trial [9], the frst randomized control trial examin- All surgeries were performed by the same surgeon (I.C.), ing this rationale. On the other hand, data from large-scale so that confounding efects regarding surgeon’s experience registries [2] and case series from referral centers [10–12] and skills will be avoided. are promising and suggest the application of this combined procedure. Total arterial revascularization Given the availability of various surgical modalities and the controversy of the existing literature, we sought to exam- Criteria for revascularization were stenosis>60% and vessel ine the feasibility of TMAR and spiral aneurysmorrhaphy in diameter > 1.5 mm. Out of the total population, 91 patients the treatment of ischemic heart disease. underwent a complete revascularization. All the anastomoses Fig. 1 Flowchart of the study. CABG coronary artery bypass grafting, AVR aortic valve replacement, MV Mitral valve 1 3 908 Heart and Vessels (2019) 34:906–915 made are explicitly tabulated in Table 1. Briefy, left internal which is characterized by a whitish tissue that represents mammary artery (LIMA) was anastomosed to left anterior the thin scar. Most of the times vacuum forms a circular or descending artery (LAD) in approximately half of the occa- elliptic transition line. Using the transition line as a guide, sions (52.48%), while a sequential anastomosis of LIMA to a double row purse string of 3–0 prolene is applied in an diagonal branch (D) and LAD was performed in 14.85% of overcovered mode and then tied after release of the vacuum. the patients. Right internal mammary artery (RIMA) was Therefore, there is an approach of thick to thick myocar- most commonly anastomosed to obtuse marginal branch dium and exclusion of the scar (Fig. 2). This very simple, (OM) (54.46%) and right posterior descending artery not time-consuming and safe technique may contribute to a (RPDA) (13.86%). Left radial artery (LRA)–RPDA and small decrease of left ventricular diameter. Yet, according to LRA-–right posterolateral branch (RPL) anastomoses were Laplace’s law, even the smallest amount of decrease in the performed in 30.69% and 11.88% of the cases, respectively. diameter of left ventricle may decrease the left ventricular Right radial artery (RRA) was used in one patient and was wall tension. Moreover, when thick parts of non-infarcted anastomosed to RPDA. Moreover, IMAs were in situ, all myocardium are approximated, the left ventricular pressure RRAAs were to the aorta and the RIMA to OM was under- is applied to a thicker wall. The law of Laplace principally neath the aorta. states that “the tension within the wall of a sphere flled to a particular pressure depends on the thickness of the sphere. Spiral aneurysmorrhaphy: surgical technique Consequently, even at a constant pressure, the tension within a flled sphere can be decreased simply by increasing the This technique may be applied on pump for reconstruction thickness of the sphere’s wall”. Thus said, it is essential to of small aneurysms with a diameter less than 5 cm, whereas decrease the diameter and increase the thickness of the left ventricles with larger aneurysms are opened and treated ventricular wall to decrease the tension which may decrease using Dor’s reconstruction. Inferior left ventricular aneu- oxygen consumption. rysms were the result of the occlusion of dominant right coronary artery, while anterior aneurysms resulted from dominant left anterior descending coronary artery occlu- Statistical analysis sion. First, we evacuate all blood from left ventricle through a needle vent inserted in the ascending
Load more

Recommended publications
  • Curriculum Vitae Takahiro Shiota, MD, Phd, FACC, FESC, FASE, FAHA
    1 Curriculum Vitae Takahiro Shiota, MD, PhD, FACC, FESC, FASE, FAHA Office Address: Cedars-Sinai Medical Center Heart Institute 127 S. San Vicente Blvd., A3411 Los Angeles, CA 90048 (310) 423-6889 Office Email: [email protected] EDUCATION: 1991 Ph.D. in Cardiology. Faculty of Medicine, University of Tokyo, Tokyo, Japan 1977-1983 M.D. Faculty of Medicine, University of Tokyo, Tokyo, Japan 1972-1976 B.S. in Physics. Faculty of Science, University of Tokyo, Tokyo, Japan LICENSURE AND CERTIFICATION National Board of Echocardiography (#2000-252) California Medical License (#000015) Ohio Medical License (#35. 080318) ECFMG (#0-576-045-9) Japanese Medical License (#274951) PROFESSIONAL EXPERIENCE 1/2009-present Associate Director Division of Noninvasive Cardiology Cedars-Sinai Heart Institute Los Angeles, CA 12/2001-12/2008 Clinical Staff Department of Cardiovascular Medicine Cleveland Clinic, Cleveland, OH 7/1999-11/2001 Advanced Cardiac Department of Cardiovascular Medicine Imaging Fellow Cleveland Clinic, Cleveland, OH 9/1997- 6/1999 Project Staff Department of Cardiovascular Medicine 2 Cleveland Clinic, Cleveland, OH 8/1992- 8/1997 Research Director Cardiac Imaging Laboratory, Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland, OR PROFESSIONAL ACTIVITIES: Academic Appointment 7/2009-present Professor of Medicine, Department of Medicine, Cedars-Sinai, Los Angeles, CA 8/2008-present Clinical Professor of Medicine, David Geffen School of Medicine at UCLA 7/2007-12/2008 Professor of Medicine, Cleveland
    [Show full text]
  • Surgical Ventricular Restoration for Post Infarction Left Ventricular Aneurysm
    Medical Group International Journal of Vascular Surgery and Medicine ISSN: 2455-5452 DOI CC By JR Vijay Kumar, HS Natraj Setty*, Case Report Rajiv Ananthakrishna, Rahul Patil, Seetharama PS Bhat and CN Surgical Ventricular Restoration Manjunath Sri Jayadeva Institute of Cardiovascular Sciences for Post infarction Left Ventricular and Research, Bengaluru, Karnataka, India Dates: Received: 01 January, 2017; Accepted: 21 Aneurysm February, 2017; Published: 24 February, 2017 *Corresponding author: Natraj Setty HS, Doctor, Sri Jayadeva Institute of Cardiovascular Sciences and Abstract Research Bangalore, #493, 4th Cross, 7th Main, JP. Nagar, 3rd Phase, Bangalore – 69, Karnataka, India, Tel: Surgical ventricular restoration is a procedure designed to restore or remodel the left ventricle. Surgical + 9845612322;+ 080-26580051; Fax: + 080-22977261; ventricular restoration by means of the Dor procedure is a surgical option in patients with coronary artery E-Mail: disease, postinfarction left ventricular aneurysm (LV aneurysm) or ischemic dilated cardiomyopathy Keywords: Left ventricular aneurys; Dor procedure; with or without ventricular tachycardia. Postinfarction left ventricular remodeling is characterized by 2D Echo LV dilatation and abnormal geometry leading to systolic and diastolic dysfunction. Development of a left ventricular aneurysm is a serious long-term complication of Acute Myocardial Infarction. We report https://www.peertechz.com a 69 year old male presented with haemodynamically signifi cant ventricular tachycardia, successfully underwent DOR Procedure with complete recovery. Case Profi le by Dor and colleagues [3]. Was introduced to improve geometric reconstruction with respect to standard linear repair in Left A 69 year- old- male, presented with hemodynamically ventricle aneurysm. Subsequently, Dor and colleagues [4]. signifi cant ventricular tachycardia.
    [Show full text]
  • An Extensive Calcified Left Ventricular Aneurysm: Case Report
    OLGU SUNUMU An Extensive Calcified Left Ventricular Aneurysm: Case Report İhsan ALUR, a ABSTRACT A calcified left ventricular aneurysm (CLVA) is a rare, serious complication of acute Tevfik GÜNEŞ, a myocardial infarction. It can lead to angina pectoris, thromboembolism of ventricular origin, ven - a tricular arrhythmia, ventricular pseudoaneurysm or rupture, progressively enlarging aneurysms, Gökhan Yiğit TANRISEVER, congestive heart failure, and death. Treatment is surgical for symptomatic or asymptomatic LVAs a Bilgin EMRECAN larger than 5 cm, particularly when there is comorbid coronay artery disease. Its standard treatment is a ventriculoplasty and aneurysmectomy using the Dor technique. The aim of surgical treatment aDepartment of Cardiovascular Surgery, of an LVA is to reduce oxygen consumption in the LV by reducing end-diastolic volume (EDV), cre - Pamukkale University ating the ideal ventricle geometry, and preventing thrombus formation. The surgical results are Faculty of Medicine, Denizli often good. This article presents a patient with CLVA in whom we performed surgery. Ge liş Ta ri hi/ Re ce i ved: 12.02.2016 Key Words: Heart ventricles; heart aneurysm; thoracic surgery Ka bul Ta ri hi/ Ac cep ted: 04.04.2016 ÖZET Kalsifik sol ventrikül anevrizması (KSVA) akut miyokard infarktüsünün nadir ve ciddi bir Ya zış ma Ad re si/ Cor res pon den ce: komplikasyonudur. Bu komplikasyon anjina pektoris, ventriküler kaynaklı tromboemboli, ventri - İhsan ALUR küler aritmi, ventriküler psödoanevrizma veya rüptür, progresif genişleyen anevrizma ve konjestif Pamukkale University kalp yetersizliği gibi fatal kardiyak olaylara yol açabilir. Semptomatik veya asemptomatik, 5 cm’den Faculty of Medicine, büyük SVA’ların, özellikle eşlik eden koroner arter hastalığı da varsa tedavisi cerrahidir.
    [Show full text]
  • The Memory of the Heart
    Journal of Cardiovascular Development and Disease Review The Memory of the Heart Marco Cirillo Heart Failure Surgery Unit, Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Via Leonida Bissolati 57, 25125 Brescia, Italy; [email protected]; Tel.: +39-030-351-8088 Received: 2 October 2018; Accepted: 8 November 2018; Published: 11 November 2018 Abstract: The embryological development of the heart is one of the most fascinating phenomena in nature and so is its final structure and function. The various ontogenetic passages form the evolutive basis of the final configuration of the heart. Each key step can be recognized in the final features, as the heart maintains a kind of “memory” of these passages. We can identify the major lines of development of the heart and trace these lines up to the mature organ. The aim of this review is to identify these key parameters of cardiac structure and function as essential elements of the heart’s proper functioning and bases for its treatment. We aim to track key steps of heart development to identify what it “remembers” and maintains in its final form as positively selected. A new vision based on the whole acquired knowledge must guide an in-depth scientific approach in future papers and guidelines on the topic and a complete, farsighted therapeutic conduct able to ensure the physiological correction of cardiac pathologies. The application of this modern, functional vision of the heart could improve the clinical treatment of heart disease, filling the gaps still present. Keywords: heart embryology; myocardial structure; interlaced myocardial fibers; cardiomyopathy; left ventricular reconstruction; heart failure; valve disease; mitral regurgitation; guidelines; cardiac resynchronization 1.
    [Show full text]
  • Surgical Ventricular Restoration
    Surgical Ventricular Restoration Policy # 00184 Original Effective Date: 01/26/2006 Current Effective Date: 06/14/2021 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the “Company”), unless otherwise provided in the applicable contract. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically. Services Are Considered Investigational Coverage is not available for investigational medical treatments or procedures, drugs, devices or biological products. Based on review of available data the Company considers surgical ventricular restoration (SVR) for the treatment of ischemic dilated cardiomyopathy to be investigational.* Policy Guidelines Surgical ventricular restoration involves increased physician work compared with standard ventriculectomy. For example, the procedure includes evaluation of the ventricular septum and reshaping of the geometry of the heart. Surgical ventricular restoration is described as a global treatment of left ventricular failure, while conventional left ventricular aneurysmectomy represents a local treatment of a transmural infarct. Background/Overview Surgical ventricular restoration is also known as surgical anterior ventricular endocardial restoration, left ventricular reconstructive surgery, endoventricular circular plasty, or the Dor procedure. Named after the surgeon who pioneered the expansion of techniques for ventricular reconstruction and is credited with treating heart failure patients with SVR and coronary artery bypass grafting. SVR is usually performed after coronary artery bypass grafting and may precede or be followed by mitral valve repair or replacement and other procedures such as endocardectomy and cryoablation for treatment of ventricular tachycardia. A key difference between SVR and ventriculectomy (ie, for aneurysm removal) is that, in SVR, circular “purse string” suturing is used around the border of the aneurysmal scar tissue.
    [Show full text]
  • Medical Policy Surgical Ventricular Restoration
    Medical Policy Surgical Ventricular Restoration Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 544 BCBSA Reference Number: 7.01.103 Related Policies None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Surgical ventricular restoration is INVESTIGATIONAL for the treatment of ischemic dilated cardiomyopathy or post-infarction left ventricular aneurysm. Prior Authorization Information Commercial Members: Managed Care (HMO and POS) This is NOT a covered service. Commercial Members: PPO, and Indemnity This is NOT a covered service. Medicare Members: HMO BlueSM This is NOT a covered service. Medicare Members: PPO BlueSM This is NOT a covered service. CPT Codes / HCPCS Codes / ICD-9 Codes The following codes are included below for informational purposes. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member. A draft of future ICD-10 Coding related to this document, as it might look today, is included below for your reference. 1 Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. CPT Codes CPT codes: Code Description
    [Show full text]
  • Surgical Treatment of Heart Failure
    MEDICAL POLICY POLICY TITLE SURGICAL TREATMENT OF HEART FAILURE POLICY NUMBER MP-1.082 Original Issue Date (Created): 8/23/2002 Most Recent Review Date (Revised): 4/22/2021 Effective Date: 9/1/2021 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY I. POLICY Partial Left Ventriculectomy Partial left ventriculectomy is considered not medically necessary. Surgical Ventricular Restoration Surgical ventricular restoration is considered investigational for the treatment of ischemic dilated cardiomyopathy or post-infarction left ventricular aneurysm, as there is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with this procedure. Cross-reference: MP-1.026 Total Artificial Hearts and Implantable Ventricular Assist Devices II. PRODUCT VARIATIONS Top This policy is only applicable to certain programs and products administered by Capital BlueCross please see additional information below, and subject to benefit variations as discussed in Section VI below. FEP PPO: Refer to FEP Benefit Brochure for information on Surgical treatment of heart failure: https://www.fepblue.org/benefit-plans/benefit-plans-brochures-and-forms Note* - The Federal Employee Program (FEP) Service Benefit Plan does not have a medical policy related to these services. Page 1 MEDICAL POLICY POLICY TITLE SURGICAL TREATMENT OF HEART FAILURE POLICY NUMBER MP-1.082 III. DESCRIPTION/BACKGROUND Top Partial Left Ventriculectomy Partial left ventriculectomy (PLV) is a surgical procedure aimed at improving the hemodynamic status of patients with end-stage congestive heart failure (CHF) by directly reducing left ventricular size, and thereby improving the pump function of the left ventricle (LV). This surgical approach to the treatment of congestive heart failure (CHF) (also known as the Batista procedure, cardio-reduction, or left ventricular remodeling surgery) is primarily directed at patients with an underlying non-ischemic dilated cardiomyopathy.
    [Show full text]
  • 398955542006.Pdf
    Brazilian Journal of Cardiovascular Surgery ISSN: 0102-7638 ISSN: 1678-9741 Sociedade Brasileira de Cirurgia Cardiovascular Kaya, Ugur; Çolak, Abdurrahim; Becit, Necip; Ceviz, Munacettin; Kocak, Hikmet Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms Brazilian Journal of Cardiovascular Surgery, vol. 33, no. 2, 2018, March-April, pp. 135-142 Sociedade Brasileira de Cirurgia Cardiovascular DOI: 10.21470/1678-9741-2017-0093 Available in: http://www.redalyc.org/articulo.oa?id=398955542006 How to cite Complete issue Scientific Information System Redalyc More information about this article Network of Scientific Journals from Latin America and the Caribbean, Spain and Journal's webpage in redalyc.org Portugal Project academic non-profit, developed under the open access initiative ORIGINAL ARTICLE Braz J Cardiovasc Surg 2018;33(2):135-42 Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms Ugur Kaya1, MD; Abdurrahim Çolak1, MD; Necip Becit1, MD; Munacettin Ceviz1, MD; Hikmet Kocak1, MD DOI: 10.21470/1678-9741-2017-0093 Abstract anterior descending (LAD) disease in 34 (38.2%) patients were Objective: The aim of this study was to evaluate early clinical identified. Five (5.6%) patients underwent aneurysmectomy outcomes and echocardiographic measurements of the left alone, while the remaining 84 (94.3%) patients had ventricle in patients who underwent left ventricular aneurysm aneurysmectomy with bypass. The mean number of grafts per repair using two different techniques associated to myocardial patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the revascularization.
    [Show full text]
  • (Dor Procedure) Or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms
    ORIGINAL ARTICLE Braz J Cardiovasc Surg 2018;33(2):135-42 Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms Ugur Kaya1, MD; Abdurrahim Çolak1, MD; Necip Becit1, MD; Munacettin Ceviz1, MD; Hikmet Kocak1, MD DOI: 10.21470/1678-9741-2017-0093 Abstract anterior descending (LAD) disease in 34 (38.2%) patients were Objective: The aim of this study was to evaluate early clinical identified. Five (5.6%) patients underwent aneurysmectomy outcomes and echocardiographic measurements of the left alone, while the remaining 84 (94.3%) patients had ventricle in patients who underwent left ventricular aneurysm aneurysmectomy with bypass. The mean number of grafts per repair using two different techniques associated to myocardial patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the revascularization. linear repair technique. In-hospital mortality occurred in 4.1% Methods: Eighty-nine patients (74 males, 15 females; mean and 7.3% in group A and group B, respectively (P>0.05). age 58±8.4 years; range: 41 to 80 years) underwent post- Conclusion: The results of our study demonstrate that post- infarction left ventricular aneurysm repair and myocardial infarction left ventricular aneurysm repair can be performed revascularization performed between 1996 and 2016. Ventricular with both techniques with acceptable surgical risk and with reconstruction was performed using endoventricular circular satisfactory hemodynamic improvement. patch plasty (Dor procedure) (n=48; group A) or linear repair Keywords: Heart Ventricles/Surgery. Heart Aneurysm. technique (n=41; group B). Myocardial Revascularization. Coronary Artery Bypass. Cardiac Results: Multi-vessel disease in 55 (61.7%) and isolated left Surgical Procedures/Methods.
    [Show full text]
  • Surgical Treatment of Ischemic Heart Failure the Dor Procedure
    REVIEW Cardiovascular Surgery Circ J 2009; Suppl A: A-1 – A-5 Surgical Treatment of Ischemic Heart Failure The Dor Procedure Marisa Di Donato, MD*,**; Serenella Castelvecchio, MD*; Lorenzo Menicanti, MD* Despite the improvements in the treatment of myocardial infarction that have translated into a decline in mortality rates, the incidence of heart failure has increased and, because of the limited number of cardiac donors, non- transplant heart surgery has developed in the past 10 years. Surgical ventricular reconstruction was launched by Dor and defined as endoventricular circular patch plasty repair. It represents a relatively novel surgical approach aiming to restore (bring back to normal) the dilated, distorted left ventricular (LV) cavity in order to improve function. The term ‘surgical ventricular reconstruction/restoration’ includes operative methods that reduce LV volume and restore its shape. The concept of reducing wall stress through surgical restoration of chamber size and geometry remains the guiding principle behind this innovative technique. Results from different Institutions are uniform and show an improvement in cardiac and clinical status and in survival. The present review will approach the rationale to re-shape the heart on the basis of pathophysiology and cardiac architecture, and will describe the efficacy of the Dor procedure in ischemic dilated cardiomyopathy, as well as some technical aspects and patient selection pathway. (Circ J 2009; Suppl A: A-1 – A-5) Key Words: Ischemic heart failure; Patient selection; Surgical ventricular restoration oronary artery disease in Western countries is respon- or have comorbidities that preclude transplantation; more- sible for more than 75% of heart failure (HF) over, the scarce number of donors makes the treatment C cases.1,2 Despite the improvement in the treatment unavailable for most patients on a waiting list.
    [Show full text]
  • (Dor Operation) in a Patient with Aortic Valve Stenosis and Severe Ischemic Cardiomyopathy
    Case Aortic Valve Replacement Combined with Endoventricular Circulatory Patch Plasty Report (Dor Operation) in a Patient with Aortic Valve Stenosis and Severe Ischemic Cardiomyopathy Kei Horiguchi, MD, Shigeaki Ohtake, MD, Goro Matsumiya, MD, Yoshiki Sawa, MD, Motonobu Nishimura, MD, Hisashi Satou, MD,* Nobuyoshi Kawai, MD, and Hikaru Matsuda, MD A 58-year-old woman with ischemic cardiomyopathy and aortic valve stenosis, underwent aortic valve replacement and simultaneous endoventricular circulatory patch plasty (Dor operation). She underwent coronary artery bypass grafting for severe triple vessel disease 10 years ago. Recently she started to show severe congestive heart failure. Aortic valve stenosis with a pressure gradient of 85-mmHg was also found. Coronary bypasses were all patent, but the left ventricle (LV) was severery dilated (LVDd/Ds=71/61 mm) and the ischemic car- diomyopathy was considered as the cause. She successfully underwent aortic valve replace- ment and endoventricular circulatory patch plasty. The initial postoperative course was complicated with intractable ventricular arrhythmia, but the subsequent course was smooth and the patient was discharged with improved symptoms (New York Heart Association, NYHA Class II). Postoperative catheterization showed decreased left ventricular volume and improved contractility. This case implies the role of LV remodeling procedure in the ischemic cardiomyopathy combined with aortic valve lesion. (Ann Thorac Cardiovasc Surg 2001; 7: 170–4) Key words: ischemic cardiomyopathy, endoventricular
    [Show full text]
  • Endoventricular Patch Plasty for Dyskinetic Anteroapical Left Ventricular Aneurysm Increases Systolic Circumferential Shortening in Sheep
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Zhang et al Cardiopulmonary Support and Physiology provided by Elsevier - Publisher Connector Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep Peng Zhang, MD, PhD,a,b Julius M. Guccione, PhD,a,b Susan I. Nicholas, MD,a Joseph C. Walker, PhD,c Philip C. Crawford, CCP,a Amin Shamal, MD,b,d Gabriel Acevedo-Bolton, PhD,b,e Michael A. Guttman, MS,f Cengizhan Ozturk, MD, PhD,f Elliot R. McVeigh, PhD,f David A. Saloner, PhD,b,e Arthur W. Wallace, MD, PhD,b,d and Mark B. Ratcliffe, MDa,b Objective: Endoventricular patch plasty (Dor procedure) has gained favor as a See related editorial on page surgical treatment for heart failure associated with large anteroapical myocardial 844. infarction. We tested the hypotheses that the Dor procedure increases systolic circumferential shortening and longitudinal shortening in noninfarcted left ventric- Supplemental material is avail- ular regions in sheep. able online. Methods: In 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from the apex to the base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Two weeks before and 2 and 6 weeks after the Dor procedure, animals underwent magnetic resonance imaging with tissue tagging in multiple short-axis and long-axis slices. Fully three-dimensional strain analyses were performed. All 6 end-systolic strain compo- nents were compared in regions 1 cm, 2 cm, 3 cm, and 4 cm below the valves, as well as in the anterior, posterior, and lateral left ventricular walls and the interven- tricular septum.
    [Show full text]