Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery

Donato, Marisa Di; Sabatier, M.; Dor, Vincent; Gensini, Gian Franco; Toso, Anna; Maioli, Mauro; Stanley, Alfred W.H.; Athanasuleas, Constantine L.; Buckberg, Gerald D.

doi:10.1067/mtc.2001.111379

Cited by 175 publications

(109 citation statements)

References 25 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…Literature dealing with ischemic cardiomyopathy comprehends many non-randomized studies reporting outcomes in patients treated with or without ventricular reconstruction and with or without endoventricular patch, using different indexes of left ventricular performance [3][4][5][6][7][8][9][10][11]20,23,24]. The ongoing Surgical Treatment for Ischemic Heart Failure trial will address open issues about surgical correction of ischemic left ventricular dysfunction and which will be the role of surgical ventricular restoration in this disease.…”

Section: Study Limitationsmentioning

confidence: 99%

“…Although a number of surgical techniques are still sub judice [3][4][5], current opinions underline the importance of rebuilding a more physiological ventricular chamber. Reported outcomes vary widely [6][7][8][9], demonstrating that surgical treatment is the starting point of a complex remodeling process characterized by the uncertainty of long-term LV geometrical changes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

Cirillo¹,

Amaducci²,

Villa³

et al. 2008

SciVee

View full text Add to dashboard Cite

Background: Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible.

show abstract

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

Cirillo¹,

Amaducci²,

Villa³

et al. 2008

SciVee

View full text Add to dashboard Cite

show abstract

“…The coronary artery bypass grafting patch trial demonstrated no direct benefit for an ICD in addition to revascularisation in patients with poor LVEF for long-term arrhythmia free survival [18]. It has previously been demonstrated that ventricular arrhythmias are inducible with mechanical loading [19]. Thus LVR would normalise and with time as the LV further remodels reduce the risk of ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgical Ventricular Restoration on Cardiac Function, Ischaemic Mitral Regurgitation and Long-term Survival

Flemming¹

2015

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

Objectives: Adverse cardiac remodelling is a major cause of morbidity and mortality post myocardial infarction. The role of surgical ventricular restoration compared to medical and electrophysiological treatments has recently come under intense scrutiny. We aimed to evaluate 10-year clinical outcomes of surgical ventricular restoration in our institution. Methods:From January 2001 to 2011, surgical ventricular restoration was performed in 126 consecutive patients (M2.3: 1F), mean age 65.5 (44-86) years. All patients presented with angina, heart failure and/or ventricular tachycardia. Post-infarction left ventricular aneurysm was present in all patients and ischemic dilated cardiomyopathy with a large akinetic left ventricle in 11.6%. The preoperative left ventricular ejection fraction was 33.1 ± 8.9%. Multi-vessel disease was present in 117/126(93%) patients. Mitral regurgitation more than grade+2 was found in 39/126(31%). The mean Logistic EuroSCORE was 13.8 ± 5.9%. A minimum of two-year post-operative follow-up was obtained on all patients.Results: Most patients underwent endoventricular or elliptical patch repair; 94% had concomitant coronary revascularisation with a median of 2 grafts and 5% had mitral valve repair. Intra-aortic balloon pump was placed preoperatively in 24/126 (19%) patients while 21/126 (17%) needed inotropic support for more than 24 h. Postoperative stroke occurred in 2 patients. In-hospital mortality was 7/126 (5.5%). All cause cardiovascular mortality at ten years was 12/126 (9.5%). Mean follow-up in operative survivors was 8.2 ± 1.2 years. Actuarial survival was 95.3%, 90.6%, 86.3% and 79.1% at 1-month, 1, 5 and 10-years. Echocardiographic follow-up demonstrated a reduction in the mean left ventricular end-diastolic volume and left atrial diameter. Ejection fraction improved over first year from 33.1 ± 8.9 to 45 ± 8.6% (P<0.006). Conclusions:Left ventricular reconstruction surgery is a good surgical option for treatment of post-infarction left ventricular aneurysm.

show abstract

“…The causes of the postoperative remodelling are unclear but may include progression of the underlying biologic disease process and failure of the repair to reduce wall stress in the border zone and remote uninfarcted myocardium. Di Donato and colleagues 29 revealed that some changes of LV shape after the procedure contribute to the enlargement of LV sphericity. More importantly, the sphericity index in their series increased linearly after the operation, potentially causing a progressive increase in LV wall tension and energy consumption.…”

Section: Researchmentioning

confidence: 99%

Off-pump anteroapical aneurysm plication following left ventricular postinfarction aneurysm: effect on cardiac function, clinical status and survival

Huang

Gu²,

Yang³

et al. 2013

cjs

View full text Add to dashboard Cite

Background:In patients with coronary disease and aneurysm, ventricular reconstruction with revascularization is a surgical option. Details of patient selection and optimal surgical technique are still debated. We report our results with off-pump aneurysm plication after ventricular aneurysm with relative wall thinning. Methods:We retrospectively reviewed the records of 248 patients who had an operation for postinfarction left ventricular aneurysm. Reconstruction was accomplished by off-pump anteroapical aneurysm plication. The following variables were recorded: preoperative clinical, angiographic and echocardiographic findings and operative procedures. Outcomes were early mortality, long-term survival and poor 5-year result, defined as the need for transplantation or repeated hospitalization for congestive heart failure. Risk factors were pinpointed using the t test and survival curves. Independent risk factors were identified using Cox regression methods.Results: Hospital mortality was low (2.0%). Mean follow-up was 5.8 (standard deviation [SD] 3.8) years. Actuarial survival at 1 and 5 years was 94% and 84%. Among the 232 survivors, 200 were in functional class I or II, and the average increase in ejection fraction was 14.0% (SD 3.1%). As determined by multivariable analysis, factors predicting poor outcome were advanced age, ejection fraction less than 0.35, conicity index less than 1, end-systolic volume index greater than 80 mL/m 2 , advanced New York Heart Association functional class and congestive heart failure. Conclusion:Using wall thinning as a criterion for patient selection, the technique of off-pump anteroapical aneurysm plication can be performed with low operative mortality and provides good symptomatic relief and long-term survival.Contexte : Chez les patients atteints de coronaropathie et d'un anévrisme, la reconstruction ventriculaire avec revascularisation est une option chirurgicale envisageable. Les détails concernant la sélection des patients et la technique opératoire optimale ne font pas l'unanimité. Nous faisons état des résultats que nous avons obtenus avec une technique de plicature de l'anévrisme sans circulation extracorporelle (CEC) après la survenue d'un anévrisme ventriculaire associé à un amincissement relatif de la paroi.Méthodes : Nous avons analysé de manière rétrospective les dossiers de 248 patients qui ont subi une intervention pour correction d'anévrisme ventriculaire gauche consécutif à un infarctus. La reconstruction a été réalisée par plicature antéroapicale de l'anévrisme sans CEC. Les variables suivantes ont été enregistrées : signes cliniques, angiographiques et échocardiographiques préopératoires et protocole opératoire. Les résultats ont été mortalité précoce, survie prolongée et résultats insatisfaisants à 5 ans, définis par le recours à la greffe ou des hospitalisations répétées pour insuffisance cardiaque congestive. Les facteurs de risque ont été reconnus à l'aide du test t et des courbes de survie. La méthode de régression de Cox a permis de relever les facteu...

show abstract

Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery

Cited by 175 publications

References 25 publications

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

Impact of Surgical Ventricular Restoration on Cardiac Function, Ischaemic Mitral Regurgitation and Long-term Survival

Off-pump anteroapical aneurysm plication following left ventricular postinfarction aneurysm: effect on cardiac function, clinical status and survival

Contact Info

Product

Resources

About