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Efficacy of endoventricular circular patch plasty

Will this procedure improve the prognosis of patients with ischemic cardiomyopathy?

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Abstract

Objectives: We report hemodynamic and clinical results of our series of endoventricular circular patch plasty (Dor operation) and consider some advantages of this procedure for patients with ischemic cardiomyopathy. Methods: Between 1996 and 2001,23 consecutive patients with left ventricular aneurysm and/or ischemic cardiomyopathy after myocardial infarction who underwent Dor operation were included in this study. Hemodynamic and clinical results of Dor operation were analyzed periodically. Patients were divided into two groups according to the extent of asynergy, more than 60% or not, i.e., an ischemic cardiomyopathy group (ICM group) or a simple left ventricular aneurysm group (sLVA group). Results: Hospital mortality was 4.4%. Postoperative New York Heart Association functional class was improved in all survivors to class I or II. Postoperative ejection fraction (EF) increased and postoperative left ventricular (LV) volume decreased in all survivors. In both groups, early and 1 year postoperative EF increased significantly. Additionally, end-diastolic and end-systolic volumes decreased significantly in the early postoperative period. Postoperative LV volume had re-enlarged in the cases in which preoperative left ventricular end-systolic volume index was more than 90 mL/m2, though left ventricular ejection fraction was maintained or rather improved at 1 year postoperatively. The survival rates after 3 years of the operation in the sLVA and ICM groups were 85.7% and 81.3%. Conclusion: Though patients with ischemic cardiomyopathy with severe LV dysfunction may benefit the most from Dor operation, postoperative LV re-dilatation may deteriorate late mortality. At operation, whether optimal LV size and shape can be reconstructed and the timing of operation are the important issues because they affect prognoses.

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References

  1. Cooley DA, Henly WS, Amad KH, Chapman DW. Ventricular aneurysm following myocardial infarction: Results of surgical treatment. Ann Surg 1959; 150: 595–612.

    Article  PubMed  CAS  Google Scholar 

  2. Froehlich RT, Falsetti HL, Doty DB, Marcus ML. Prospective study of surgery for left ventricular aneurysm. Am J Cardiol 1980; 45: 923–31.

    Article  PubMed  CAS  Google Scholar 

  3. Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysm: A new surgical approach. Thorac Cardiovasc Surg 1989; 37: 11–9.

    Article  PubMed  CAS  Google Scholar 

  4. Dor V. Surgery for left ventricular aneurysm. Curr Opin Cardiol 1990; 5: 773–80.

    Article  PubMed  CAS  Google Scholar 

  5. Dor V, Sabatier M, Di Donato M, Maioli M, Toso A, Montiglio F. Late hemodynamic results after left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic aneurysm of the left ventricle. Thorac Cardiovasc Surg 1995; 110: 1291–301.

    Article  CAS  Google Scholar 

  6. Dor V, Sabatier M, Di Donato M, Montiglio F, Toso A, Maioli M. Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: Comparison with a series of large dyskinetic scars. J Thorac Cardiovasc Surg 1998; 116:50–9.

    Article  PubMed  CAS  Google Scholar 

  7. Dor V, Di Donato M, Sabatier M, Montiglio F, Civaia F, RESTORE Group. Left ventricular reconstruction by endoventricular circular patch plasty repair: A 17-year experience. Semin Thorac Cardiovasc Surg 2001; 13:435–437.

    PubMed  CAS  Google Scholar 

  8. Chapman CB, Baker O, Reynolds J, Bonte FJ. Use of biplane cinefluorography for measurement of ventricular volume. Circulation 1958; 18: 1105–7.

    PubMed  CAS  Google Scholar 

  9. Dor V. The endoventricular circular patch plasty (“Dor procedure”) in ischemic akinetic dilated ventricles. Heart Fail Rev 2001; 6: 187–93.

    Article  PubMed  CAS  Google Scholar 

  10. Mills NL, Everson CT, Hockmuth DR. Technical advances in the treatment of left ventricular aneurysm. Ann Thorac Surg 1993; 55: 792–800.

    Article  PubMed  CAS  Google Scholar 

  11. Di Donato M, Sabatier M, Dor V, Toso A, Maioli M, Fantini F. Akinetic versus dyskinetic postinfarction scar: Relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair. J Am Coll Cardiol 1997; 29: 1569–75.

    Article  PubMed  Google Scholar 

  12. Pfeffer MA, Pfeffer JM. Ventricular enlargement and reduced survival after myocardial infarction. Circulation 1987; 75 (Suppl IV): 93–7.

    Google Scholar 

  13. Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990; 81: 1161–72.

    PubMed  CAS  Google Scholar 

  14. Di Donato M, Toso A, Maioli M, Sabatier M, Stanley AW Jr, Dor V, et al. Intermediate survival and predictors of death after surgical ventricular restoration. Semin Thorac Cardiovasc Surg 2001; 13: 468–75.

    PubMed  Google Scholar 

  15. Linzbach AJ. Heart failure from the point of view of quantitative anatomy. Am J Cardiol 1960; 5: 370–82.

    Article  PubMed  CAS  Google Scholar 

  16. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987; 76:44–51.

    PubMed  CAS  Google Scholar 

  17. Weisman HF, Bush DE, Kallman CH, Weisfeldt ML, Bulkley BH. Cellular mechanism of infarct expansion: Stretch vs slippage. Circulation 1983; 68 (Suppl III): 253.

    Google Scholar 

  18. Klein MD, Herman MV, Gorlin R. A hemodynamic study of left ventricular aneurysm. Circulation 1967; 35: 614–30.

    PubMed  CAS  Google Scholar 

  19. Kawachi K, Kitamura S, Kawashima Y, Oyama C, Sakai K, Kobayashi H, et al. Changes in myocardial oxygen consumption and coronary sinus blood flow before and after resection of left ventricular aneurysm after myocardial infarction. J Thorac Cardiovasc Surg 1987; 94: 566–70.

    PubMed  CAS  Google Scholar 

  20. Taniguchi K, Sakurai M, Takahashi T, Imagawa H, Mitsuno M, Nakano S, et al. Postinfarction left-ventricular aneurysm: Regional stress, function, and remodeling after aneurysmectomy. Thorac Cardiovasc Surg 1998; 46: 253–9.

    Article  PubMed  CAS  Google Scholar 

  21. Kawachi K, Kitamura S, Kawata T, Morita R, Nishii T, Seki T, et al. Hemodynamic assessment during exercise after left ventricular aneurysmectomy. J Thorac Cardiovasc Surg 1994; 107: 178–83.

    PubMed  CAS  Google Scholar 

  22. Athanasuleas CL, Stanley AWH, Buckberg GD. Restoration of contractile function in the enlarged left ventricle by exclusion of remodeled akinetic anterior segment: Surgical strategy, myocardial protection, and angiographic results. J Card Surg 1998; 13: 418–28.

    Article  PubMed  CAS  Google Scholar 

  23. Athanasuleas CL, Stanley AWH, Buckberg GD, Dor V, Di Donato M, Blackstone EH. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. J Am Coll Cardiol 2001; 37: 1199–209.

    Article  PubMed  CAS  Google Scholar 

  24. Kawata T, Kitamura S, Kawachi K, Morita R, Yoshida Y, Hasegawa J. Systolic and diastolic function after patch reconstruction of left ventricular aneurysms. Ann Thorac Surg 1995; 59: 403–7.

    Article  PubMed  CAS  Google Scholar 

  25. Ohara K. Current surgical strategy for post-infarction left ventricular aneurysm—from linear aneurysmectomy to Dor’s operation. Ann Thorac Cardiovasc Surg 2000; 6: 289–94.

    PubMed  CAS  Google Scholar 

  26. Kim S, Yoshiyama M, Izumi Y, Kawano H, Kimoto M, Zhan Y, et al. Effects of combination of ACE inhibitor and angiotensin receptor blocker on cardiac remodeling, cardiac function, and survival in rat heart failure. Circulation 2001; 103: 148–54.

    PubMed  CAS  Google Scholar 

  27. Hamroff G, Katz SD, Mancini D, Blaufarb I, Bijou R, Patel R, et al. Addition of angiotensin II receptor blockade to maximal angiotensin-converting enzyme inhibition improves exercise capacity in patients with severe congestive heart failure. Circulation 1999; 99: 990–2.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. From the Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki

    Kiyokazu Kokaji MD, Masahiko Okamoto MD, Kentaro Hotoda MD, Tadaaki Maehara MD, Hiroya Kumamaru MD & Kiyoshi Koizumi MD

  2. the Department of Surgery II, National Defense Medical College, Tokorozawa, Saitama

    Tadaaki Maehara MD

  3. the Department of Surgery, Keio University, Tokyo, Japan

    Hiroya Kumamaru MD & Kiyoshi Koizumi MD

Authors
  1. Kiyokazu Kokaji MD
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  2. Masahiko Okamoto MD
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  3. Kentaro Hotoda MD
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  4. Tadaaki Maehara MD
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  5. Hiroya Kumamaru MD
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  6. Kiyoshi Koizumi MD
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Kokaji, K., Okamoto, M., Hotoda, K. et al. Efficacy of endoventricular circular patch plasty. Jpn J Thorac Caridovasc Surg 52, 1–10 (2004). https://doi.org/10.1007/s11748-004-0053-8

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  • DOI: https://doi.org/10.1007/s11748-004-0053-8

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