Surgical ventricular reconstruction for ischemic or idiopathic dilated cardiomyopathy

Background: Any disturbance of the functional cardiac anatomy will impair ventricular function and cardiac output. It has been postulated that the Dor surgical ventricular reconstruction procedure for patients with ventricular dysfunction after an infarction for either left ventricular akinesia or dyskinesia results in better clinical outcome than classic aneurysmectomy or conservative medical therapy. The reason is the focus of this procedure on restoring the physiological dimensions of the remodeled ventricle by excluding noncontracting segments of the heart, including the scarred septum, replacing the area with an endoventricular patch to redirect normal muscle orientation, and reducing ventricular size, wall tension and volume. The theory that this procedure might also be applied to other causes of cardiac remodeling has introduced this application to patients with idiopathic dilated cardiomyopathy (DCM). The purpose of this retrospective study was to analyze the clinical outcome and long-term survival of patients who underwent the Dor surgical ventricular reconstruction (SVR) procedure. <br>Methods: Mortality, cardiac function, and long-term survival were analyzed retrospectively in a cohort of patients with DCM, a ventricular aneurysm, or scar after a myocardial infarction who underwent surgical ventricular reconstruction. <br>Results: The results of this study show an overall 85% three-year survival for patients after the Dor surgical ventricular reconstruction. In-hospital mortality was 4%. Patients who underwent the Dor SVR procedure after postinfarction left ventricular aneurysm demonstrated a survival of 89% at a median follow-up of 19 months (2-36 months). Importantly, patients with associated coronary grafting to the Dor SVR procedure demonstrated a 96% survival rate over a 73% for non-CABG patients. Significant improvement in EF and NYHA functional class was also demonstrated in the ventricular aneurysm group. Patients operated on for left ventricular akinesia had an overall survival of 67% at a median follow-up of 10.5 months (1-20 months) and demonstrated the most impressive improvement in NYHA functional class. The five DCM patients who underwent the Dor surgical reconstruction procedure revealed no long-term benefit from the operation. The efficacy of surgical left ventricular reconstruction is currently being investigated by a multicenter international randomized study funded by the National Institutes of Health. The belief is that patients with a remodeled ventricle as a result of ischemic cardiomyopathy will benefit significantly in clinical outcome and survival when the physiological cardiac anatomy is surgically restored.

Author dc:creator

• Ahn-Veelken, Lynda

Contributors dc:contributor

• Beyersdorf, Friedhelm

• Dor-Operation
• Remodelling
• Batista-Operation
• dor operation
• Batista operation

Repository record source_url

https://freidok.uni-freiburg.de/data/1617

OAI identifier oai:identifier

oai:freidok.uni-freiburg.de:1617