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Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty

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Abstract

Objective: The aim of this study was to identify predictors of cardiac events after endoventricular circular patch plasty (Dor operation) by analyzing our experience with Dor operation. Methods: Thirty patients with left ventricular aneurysm and/or ischemic cardiomyopathy who underwent Dor operation were included in this study. Hemodynamic and clinical results were analyzed, and the predictors of cardiac events were examined. Results: Hospital mortality was 3.3%. Postoperative clinical status and left ventricular (LV) function in all survivors significantly improved. The survival rates at 1, 3, and 5 years after operation were 93%, 89% and 89%. The corresponding cardiac event-free rates were 75%, 67% and 49%. Pre- and postoperative LV function and volume did not differ significantly between patients with or without cardiac events. However, the proportion of reduced end-diastolic volume index (EDVI) (preoperative EDVI-postoperative EDVI) to preoperative EDVI was significantly higher in patients with cardiac events than in cardiac event-free patients. Postoperative LV volume re-increased in the cases with cardiac events during follow-up. Cox regression analysis confirmed that preoperative clinical premature ventricular contraction and end-systolic volume index (ESVI), postoperative EDVI, ESVL and ejection fraction were independent predictors of late cardiac events. There was a significant positive correlation between preoperative ESVI and postoperative EDVI. Conclusion: Though LV function significantly improved after Dor operation, LV reconstruction with excessive reduction can cause restarting LV remodeling and increasing mortality and morbidity. Therefore, LV reconstruction of appropriate sizes and shapes, considering the function of residual myocardium, has a significant effect on prognosis. It is highly reasonable to expect that preoperative ESVI can predict the optimal size of reconstructed left ventricle.

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References

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

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  3. 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. J Thorac Cardiovasc Surg 1995; 110: 1291–301.

    Article  PubMed  CAS  Google Scholar 

  4. Dor V, Sabatier M, Di Donato M, Montiglio F, Toso A, Maiori 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 

  5. 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: 435–47.

    PubMed  CAS  Google Scholar 

  6. Menicanti L, Di Donato M. The Dor procedure: What has changed after fifteen years of clinical practice? J Thorac Cardiovasc Surg 2002; 124:886–90.

    Article  PubMed  Google Scholar 

  7. Di Donato M, Sabatier M, Toso A, Barletta G, Baroni M, Dor V, et al. Regional myocardial performance of non-ischemic zones remote from anterior wall left ventricular aneurysm: Effects of aneurysmectomy. Eur Heart J 1995; 16: 1285–92.

    PubMed  Google Scholar 

  8. Pfeffer MA, Pfeffer JM. Ventricular enlargement and reduced survival after myocardial infarction. Circulation 1987; 75 (5 Pt 2): IV 93–7.

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. 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 

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

    PubMed  CAS  Google Scholar 

  13. Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo HW. Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 1986; 74:293–305.

    PubMed  CAS  Google Scholar 

  14. Chapman CB, Baker O, Reynolds J, Bonte FJ. Use of biplane cinefluorography for measurement of ventricular volume. Circulation 1958; 18: 1105–17.

    PubMed  CAS  Google Scholar 

  15. 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 

  16. Dor V, Sabatier M, Montiglio F, Rossi P, Toso A, Di Donato M. Results of nonguided subtotal endocardi-ectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias. J Thorac Cardiovasc Surg 1994; 107: 1301–8.

    PubMed  CAS  Google Scholar 

  17. Di Donato M, Sabatier M, Dor V; RESTORE Group. Surgical ventricular restoration in patients with postinfarction coronary artery disease: Effectiveness on spontaneous and inducible ventricular tachycardia. Semin Thorac Cardiovasc Surg 2001; 13: 480–5.

    PubMed  Google Scholar 

  18. 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 

  19. Kokaji K, Okamoto M, Hotoda K. Atrophic degeneration and loss of myocytes of residual left ventricular myocardium after Dor operation for ischemic cardio-myopathy associated with left ventricular remodeling. Jpn J Thorac Cardiovasc Surg 2003; 51: 634–7.

    PubMed  Google Scholar 

  20. Di Donato M, Sabatier M, Dor V, Gensini GF, Toso A, Maioli M, et al. Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery. J Thorac Cardiovasc Surg 2001; 121: 91–6.

    Article  PubMed  Google Scholar 

  21. Di Donato M, Toso A, Maioli M, Sabatier M, Stanley A, 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 

  22. 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 

  23. Hamer AW, Takayama M, Abraham KA, Roche AH, Kerr AR, Williams BF, et al. End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function. Circulation 1994; 90: 2899–904.

    PubMed  CAS  Google Scholar 

  24. Yamaguchi A, Ino T, Adachi H, Murata S, Kamio H, Okada M, et al. Left ventricular volume predicts postoperative course in patients with ischemic cardio-myopathy. Ann Thorac Surg 1998; 65: 434–8.

    Article  PubMed  CAS  Google Scholar 

  25. Calafiore AM, Gallina S, Di Mauro M, Pano M, Teodori G, Di Giammarco G, et al. Left ventricular aneurysmectomy: Endoventricular circular patch plasty or septoexclusion. J Card Surg 2003; 18: 93–100.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

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

    Kiyokazu Kokaji MD

  2. Department of Cardiovascular Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan

    Kiyokazu Kokaji MD, Hankei Shin MD, Kentaro Hotoda MD, Mitsuharu Mori MD, Hiroya Kumamaru MD & Ryohei Yozu MD

Authors
  1. Kiyokazu Kokaji MD
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  2. Hankei Shin MD
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  3. Kentaro Hotoda MD
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  4. Mitsuharu Mori MD
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  5. Hiroya Kumamaru MD
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  6. Ryohei Yozu MD
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Additional information

Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Panel Discussion, Tokyo, November 19–21,2003.

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Kokaji, K., Shin, H., Hotoda, K. et al. Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty. Jpn J Thorac Caridovasc Surg 52, 551–559 (2004). https://doi.org/10.1007/s11748-004-0022-2

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  • DOI: https://doi.org/10.1007/s11748-004-0022-2

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