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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. 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. INTRODUCTION Abbreviations, acronyms & symbols Other than very rare etiological causes, such as CABG = Coronary artery bypass grafting cardiomyopathy, trauma and syphilis, ventricle aneurysms CCS = Canadian Cardiovascular Society occur following ischemic heart diseases, particularly transmural ECG = Electrocardiography myocardial infarction. While they can occur immediately after EuroSCORE = European System for Cardiac Operative Risk Evaluation acute myocardial infarction, they can also arise weeks or months EVCPP = Endoventricular circular patch plasty later and are frequently seen in the anteroapical, apical and IABP = Intra-aortic balloon pump septal regions. Aneurysms occur in 3.5 to 38% of the cases due to INR = International normalized ratio insufficient replacement of necrotic myocardial tissue after acute LAD = Left anterior descending transmural myocardial infarction with scar tissue in about six LIMA = Left internal mammary artery weeks[1-4]. Aneurysm disrupts the normal ellipsoid geometrical LV = Left ventricle structure of the left ventricle (LV), leading to a dilated spherical [5-7] LVEDD = Left ventricular end-diastolic diameter ventricle with limited contractility and filling capacity . The LVEDV = Left ventricular end-diastolic volume clinical presentation is usually congestive heart failure, angina LVEF = Left ventricular ejection fraction pectoris, treatment-resistant ventricular arrhythmias, and arterial embolization[8]. The addition of coronary revascularization to the LVESD = Left ventricular end-systolic diameter surgical treatment of the LV aneurysms improves the surgical NYHA = New York Heart Association outcome in these patients[9,10]. 1Atatürk University, Erzurum, Turkey. Correspondence Address: Ugur Kaya This study was carried out at the Department of Cardiovascular Surgery, Atatürk Atatürk Üniversitesi Kampüsü, 25030 – Yakutiye, Erzurum – Turkey University Faculty of Medicine, Erzurum, Turkey. E-mail: [email protected] No financial support. Article received on May 9th, 2017. No conflict of interest. Article accepted on September 12th, 2017. 135 Brazilian Journal of Cardiovascular Surgery Kaya U, et al. - Ventricular Aneurysm Braz J Cardiovasc Surg 2018;33(2):135-42 The main goal of surgery in the LV aneurysms is to remove additional hypothermia was established with cold crystalloid the scar tissue to maintain the normal filling volume and the potassium cardioplegia. Reperfusions were performed with geometric configuration of the ventricle, to prevent excessive cold blood cardioplegia every 20 min. Before opening the filling in the diastole, and to remove the contractile paradox aortic clamp, reperfusion was performed with low potassium movement of the ventricle wall along the systole, thereby, fixing warm blood cardioplegia. The patient’s body temperature the function of the LV[11,12]. was maintained between 28 and 32o C. Distal anastomoses of The aim of this study was to compare surgical techniques coronary lesions other than LIMA to left anterior descending in patients who underwent ventricular aneurysm repair and/or (LAD) artery anastomoses were completed. myocardial revascularization, and to evaluate early and late stage The decision on which technique to use in the repair was clinical outcomes of surgery with echocardiographic findings of based on the size of the aneurysm during surgery and on the the LV. extent of the scar tissue. In the case of smaller lesions without a marked aneurysmal sac, linear repair was preferred, whereas METHODS endoaneurysmorrhaphy was performed in case of larger lesions with a marked neck and fibrotic sac. An approval was obtained from the local Ethics Committee In patients who underwent surgery with the Dor technique, for this study. A written informed consent was obtained from a vertical incision was made in the anterior wall towards 2 to 3 each patient. The study was conducted in accordance with the cm lateral from the LAD artery to reach the aneurysmal sac. Once principles of the Declaration of Helsinki. the aneurysm was opened and the aneurysm wall and, if present, Surgical outcomes, pre- and postoperative clinical data the thrombus was removed, and a Dacron patch fitting to the and clinical outcomes at one year after the procedure, and alive and scar tissue margins was prepared. After the diastolic echocardiography results of 89 patients who underwent post- volume was measured with a balloon, the ventricular diastolic infarction LV aneurysm repair and myocardial revascularization cavity was measured and the patch was implanted to the fibrous were retrospectively analyzed based on the inpatient clinical tissue at the border using 3/0 propylene continuous suture follow-up results. Patients underwent surgical techniques other (Figure 1). The ventriculotomy margins on the ventricular wall than Dor procedure and linear repair were excluded. All patients were closed using two Teflon felts 1 to 2 cm wide and 6 to 7 cm were evaluated in terms of age, sex, angina intensity, functional long and with 2/0 propylene to retrace all layers. In patients who capacity, LV ejection fraction (LVEF), number of coronary lesions, underwent surgery with linear repair technique, the aneurysmal aneurysm location, aneurysm repair technique, comorbidities sac was opened and the LAD artery was preserved and, then the and morbidity and mortality rates. The outcomes of the thrombus was removed, if present. While paying attention not to applied ventricular aneurysm repair technique were statistically reduce the ventricular cavity, the aneurysmal wall was resected analyzed. to preserve the scar tissue (Figure 2). The aneurysmal tissue was Coronary artery stenosis and anatomy were evaluated using closed with 2/0 Ethicon U stitches reinforced by two long Teflon coronary angiography and a coronary luminal stenosis ≥ 50% patches. Mannequin balloon was used for measurement of the was considered significant, and bypass was performed. Left left ventricular volume in both groups. The balloon was inserted ventricular reconstruction was performed with endoventricular into the left ventricular cavity and the left ventricular balloon was circular patch plasty (EVCPP) (Dor procedure) or linear repair inflated with normal saline as 40 cc/m2. technique. Pre- and postoperative 1-, 2-, 6-, and 12-month Based on the hemodynamics of each patient, medical clinical outcomes of the patients (mean: 12.9±3.8 months), treatment was prescribed. An intra-aortic balloon pump (IABP) echocardiographic LVEF measurements, end-systolic and end- diastolic volumes and diameters were recorded. Based on the surgical technique used, Dor procedure patients were assigned to group A (n = 48), while those who underwent linear repair were assigned to group B (n = 41). Angina intensity was based on the Canadian Cardiovascular Society (CCS) classification and functional capacity was based on the New
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