[Efficacy of additional Dor approach to coronary bypass grafting in severe left ventricular dysfunction with large...

Area of Science:

• Cardiovascular Surgery
• Cardiac Resynchronization Therapy
• Heart Failure Management

Context:

• Severe left ventricular dysfunction poses significant challenges in cardiac surgery.
• Coronary artery bypass grafting (CABG) is a common procedure, but outcomes can be limited in patients with extensive myocardial damage.
• Akinetic scars resulting from myocardial infarction can impair left ventricular function.

Purpose:

• To evaluate the efficacy and safety of the Dor endoventricular patch plasty as an adjunct to CABG in patients with severe left ventricular dysfunction and large akinetic antero-septal scars.
• To compare the outcomes of CABG with the Dor approach versus CABG alone or with mitral annuloplasty in this patient population.

Summary:

• Sixteen patients with left ventricular ejection fraction (LVEF) ≤ 40% underwent surgical procedures.
• Four patients received CABG with the Dor approach (group D), while eleven had CABG or CABG with mitral annuloplasty (group C).
• Group D showed significant improvement in LVEF (31.5% to 62.5%, p < 0.01) and reduced end-diastolic volume index (118 to 74 ml/m2, p < 0.01) without complications. Group C had no significant functional improvement and one mortality.

Impact:

• The Dor approach is a safe and effective surgical option for improving cardiac function in patients with severe left ventricular dysfunction and akinetic antero-septal segments.
• This technique offers a potential solution for enhancing outcomes in complex cardiac surgical cases.
• Improved LVEF and reduced ventricular volumes suggest better long-term prognosis for patients undergoing the Dor approach with CABG.