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Published on: May 18, 2021
Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty
Kiyokazu Kokaji1, Hankei Shin, Kentaro Hotoda
1Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
Insights
Predictors of cardiac events after the Dor operation were identified. Excessive left ventricular volume reduction during reconstruction can increase mortality and morbidity, emphasizing the need for appropriate sizing for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Heart Failure Management
Background:
- Left ventricular aneurysm and ischemic cardiomyopathy often require surgical intervention.
- The Dor operation (endoventricular circular patch plasty) is a reconstructive procedure for these conditions.
- Predicting cardiac events post-Dor operation is crucial for patient management.
Purpose of the Study:
- To identify predictors of cardiac events following the Dor operation.
- To analyze the long-term outcomes and complications associated with the Dor procedure.
- To establish guidelines for optimal left ventricular reconstruction during the Dor operation.
Main Methods:
- A retrospective analysis of 30 patients who underwent the Dor operation for left ventricular aneurysm and/or ischemic cardiomyopathy.
- Evaluation of pre- and postoperative hemodynamic and clinical data.
- Statistical analysis, including Cox regression, to identify predictors of cardiac events.
Main Results:
- Hospital mortality was 3.3%; significant improvements in clinical status and left ventricular function were observed in survivors.
- 1, 3, and 5-year survival rates were 93%, 89%, and 89%, respectively.
- Predictors of late cardiac events included preoperative premature ventricular contraction, preoperative end-systolic volume index (ESVI), postoperative end-diastolic volume index (EDVI), postoperative ESVI, and ejection fraction.
Conclusions:
- While the Dor operation improves left ventricular function, excessive volume reduction can lead to adverse remodeling, increasing mortality and morbidity.
- Optimal left ventricular reconstruction size and shape, considering residual myocardial function, significantly impact prognosis.
- Preoperative ESVI may predict the optimal size for reconstructed left ventricles, guiding surgical decisions.
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, ESVI, 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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