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ENDOVENTRICULAR CIRCULAR PATCH PLASTY FOR LEFT VENTRICULAR RECONSTRUCTION

Ani Raynova, Simona Panteleymonova, Plamen Panayotov

Abstract

Introduction: The incidence of heart failure (HF) has increased in the developed countries. Decompensated HF has advanced structural cardiac disease despite optimal medical therapy and carries an extremely poor prognosis. Endoventricular circular patch plasty, or the Dor procedure, is a surgical option in patients with coronary artery disease (CAD), postinfarction aneurysm or ischemic dilated cardiomyopathy. The aim of this study was to evaluate the 9-year experience of this procedure in the Department of Cardiac Surgery at St. Marina University Hospital, Varna.

Materials and Methods: Retrospective analysis was conducted by a review of patient records. From March 2008 to March 2017, endoventricular circular patch plasty was performed in 23 patients (17 males and 6 females), mean age 63.2 (52-75) years. All patients presented with heart failure and/or angina. Postinfarction left ventricular (LV) aneurysm was present in all patients. Multivessel CAD was diagnosed in 18 patients (78.3%). Moderate to severe mitral regurgitation was found in 10 patients (43.5%). In five cases (21.7%), surgery was performed on emergency or urgent basis.

Results: All patients underwent the Dor procedure. Coronary artery bypass grafting was performed in 20 patients (87%). Aortic valve replacement was performed in one.  Endocardectomy  for treatment of ventricular tachycardia was performed in one. Intra-aortic balloon pumping was used postoperatively in 7 patients. The mean LV ejection fraction was 28% (16% to 46%) preoperatively and 39.2% (27% to 49%) at discharge. The mean LV end-diastolic volume decreased from 190ml (106 to 320ml) to 113.8ml (56 to 185ml) postoperatively. The survival rate was 82.6%. The mean postoperative hospital stay was 13.4 days (7-24).

Conclusion: Endoventricular circular patch plasty successfully restores the LV geometry and function. Results from the Dor procedure show an improvement in cardiac and clinical status and in the survival rate.


Keywords

left ventricle aneurysm, surgical ventricular reconstruction, Dor procedure, coronary artery disease, heart failure


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