Short- and Long-Term Outcomes after Left Ventricular Reconstruction According to Dor: A Single Centre 10-Year Experience

Background: Endoventricular circular patch plasty (EVCPP) technique according to Dor is an established surgical option for patients with postinfarction left ventricular aneurysm or ischemic cardiomyopathy. The aim of our study is to evaluate the 10-year outcome of patients undergoing EVCPP in our institution.

Methods: We assessed 121 patients who underwent EVCPP procedure with concomitant coronary artery bypass grafting (CABG) from 2010 to 2020. The data was collected retrospectively from the clinic system and the patients and their physicians were contacted for follow-up. The follow-up till date was possible by 114 patients (94%).

Results: The mean age was 64 (42–83) years, among them there were 98 males. Emergency surgery was performed in 60 patients whereas the other 61 patients underwent planned surgery. The median follow-up was 63.5 months. Mean preoperative left ventricular ejection fraction (LVEF) was reported to be 32.3% ± 11.7. An additional mitral valve procedure (reconstruction or replacement) was performed by 27 patients (22%). 30-days mortality was 9.9% (12 Patients), which included 9.09% (11 Patients) emergency and 0.82% elective surgeries (1 Patient). Intra-aortic balloon pump (IABP) or ECMO was required postoperatively in 3 cases. Postoperative stroke occurred in 2 patients. The mean stay in the intensive care unit was 6 ± 6.93 days and mean hospital stay was 12 ± 7,42 days. The median survival rate was 124 months. Survival after 3 years was 81,6% and after 5 years 71% with an increase in the LVEF from 32.3% ± 11.7 (32.5 median) to 36.8% ± 11.9 (37.5 median) postoperatively (p < 0.001). A pre-operative LVEF< 30% and emergency surgeries were associated with increased mortality rates. Patients who required postoperative mechanical circulatory support (ECMO / IABP) also had increased early mortality.

Conclusion: EVCPP is a considerably safe procedure that can improve the LVEF along with myocardial revascularization. Furthermore, it comes along with good long-term results, particularly when used in aneurysmatically altered ventricles. However, these combination procedures should be performed in specialized centers with sufficient volume and expertise.

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Artikel online veröffentlicht:
13. Februar 2024