Current surgical strategy for post-infarction left ventricular aneurysm--from linear aneurysmecomy to Dor's operation

The surgical strategy for left ventricular (LV) aneurysm after myocardial infarction has been changing recently. Conventionally, linear aneurysmectomy has been widely performed as a standard procedure for post-infarction LV aneurysm. However, this technique remains unsatisfactory because LV distortion occurs postoperatively and an akinetic or dyskinetic area persists in the ventricular septum, resulting in limited improvement of cardiac function. To overcome these problems, Dor and associates excluded all akinetic or dyskinetic myocardium from the left ventricle including the septum and placed a tight circumferential suture around the aneurysmal base to reduce the LV volume and return the LV contour to near normal (endoventricular circular patch plasty: EVCPP). As an alternative to conventional linear aneurysmectomy, EVCPP (Dor's operation) is now being performed more widely for the treatment of post-infarction LV aneurysm, and it achieves better postoperative cardiac function. Recently, EVCPP has attracted interest as a treatment for post-infarction large akinetic scars and ischemic cardiomyopathy (ICM), both of which have a poor prognosis. In this article, based on the author's clinical experience and on the literature, EVCPP is reviewed with respect to its indications for patients with post-infarction LV aneurysm or large akinetic scars, and pointers and results for this technique are discussed.