Left Ventricular Reconstruction after Dor—Sailing Close to the Wind?

Abstract

Postinfarction left ventricular aneurysm (LVA) still remains a complication after myocardial infarction with a poor prognosis. Its incidence has decreased due to improved treatment, however, it may have experienced a renaissance due to the coronavirus disease 2019 pandemic. In this retrospective, single-center cohort study, we analyzed n = 17 patients who underwent left ventricular reconstruction after Dor. The results show a mean intensive care unit stay of 8 ± 16 days and a 30-day mortality rate of 6%. Mean postoperative ejection fraction was 44 ± 8% indicating an increase in all but three cases. This suggests that patients with an LVA can be successfully treated, and it is safe when performed by experienced surgeons. Therefore, they should still be considered for surgery early on.

Keywords

heart failure - myocardial remodeling - aneurysm - myocardial infarction (includes complications; e.g. rupture)

Authors' Contribution

Conception and design: C.G., N.M., T.W., K.E. Data collection: C.G., N.M., T.W., K.E. Analysis and data interpretation: C.G., I.K., I.D., K.E. Statistical analysis: I.K., I.D., N.M. Drafting the manuscript: C.G., I.K., K.E., T.W. Critical revision of the article: C.G., I.K., I.D., N.M., T.W., K.E.

Publication History

Received: 09 February 2024

Accepted: 22 April 2024

Article published online:
15 May 2024

• References

• 1 Metra M, Teerlink JR. Heart failure. Lancet 2017; 390 (10106): 1981-1995
• 2 Buckberg G, Athanasuleas C, Conte J. Surgical ventricular restoration for the treatment of heart failure. Nat Rev Cardiol 2012; 9 (12) 703-716
• 3 Piperata A, Dor V, Civaia F, Eker A. Endoventricular circular patch repair: the “Dor procedure”. Multimed Man Cardiothorac Surg 2023;2023
• 4 Doenst T. Surgical approaches to left ventricular reconstruction: a matter of perspective. Heart Fail Rev 2013; 18 (01) 15-25
• 5 Ferrell BE, Jimenez DC, Ahmad D. et al. Surgical ventricular reconstruction for ischemic cardiomyopathy-a systematic review and meta-analysis of 7,685 patients. Ann Cardiothorac Surg 2022; 11 (03) 226-238
• 6 Buckberg G, Hoffman JI, Mahajan A, Saleh S, Coghlan C. Cardiac mechanics revisited: the relationship of cardiac architecture to ventricular function. Circulation 2008; 118 (24) 2571-2587
• 7 Gaudino M, Castelvecchio S, Rahouma M. et al. Long-term results of surgical ventricular reconstruction and comparison with the Surgical Treatment for Ischemic Heart Failure trial. J Thorac Cardiovasc Surg 2024; 167 (Suppl. 02) 713-715.e7
• 8 Liu Y, Cai Z, Xu L. et al. Concomitant valve surgery is associated with worse outcomes in surgical treatments of post-infarction ventricular aneurysm. Front Cardiovasc Med 2023; 10: 1194374
• 9 Nomoto T, Nishina T, Miwa S. et al. Angiotensin-converting enzyme inhibitor helps prevent late remodeling after left ventricular aneurysm repair in rats. Circulation 2002; 106 (12 Suppl 1): I115-I119
• 10 Wang Y, Zhou R, Lu C, Chen Q, Xu T, Li D. Effects of the angiotensin-receptor Neprilysin inhibitor on cardiac reverse remodeling: meta-analysis. J Am Heart Assoc 2019; 8 (13) e012272
• 11 Ma S, Chen L, Yan J. et al. Dapagliflozin attenuates residual cardiac remodeling after surgical ventricular reconstruction in mice with an enlarged heart after myocardial infarction. Biomed Pharmacother 2022; 156: 113765
• 12 Joshi S, Kazmi FN, Sadiq I, Azemi T. Post-MI ventricular septal defect during the COVID-19 pandemic. JACC Case Rep 2020; 2 (10) 1628-1632