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Failure modes of left ventricular reconstruction or the Dor procedure: a multi-institutional perspective
Jaishankar Raman1, Anand Dixit, Gil Bolotin
1Section of Cardiothoracic Surgery, Department of Surgery, University of Chicago Medical Center, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA. jraman@surgery.bsd.uchicago.edu
Insights
Complex ventricular reconstruction (CVR) is a robust surgical technique with lasting benefits. Identifying failure modes in CVR can help minimize risks and improve patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Complex ventricular reconstruction (CVR) is an increasingly utilized surgical technique pioneered by Dor.
- Limited data exists regarding the failure modes associated with CVR procedures.
- This study analyzes CVR outcomes and failure patterns across multiple centers.
Purpose of the Study:
- To investigate the failure modes of Complex Ventricular Reconstruction (CVR).
- To evaluate the safety and efficacy of CVR as an adjunct to other cardiac surgeries.
- To identify factors influencing CVR outcomes and potential areas for improvement.
Main Methods:
- A retrospective analysis of 284 patients undergoing CVR between 1997 and 2005 across three centers in Australia and the USA.
- CVR was performed adjunctively with coronary artery bypass grafting and/or valvular surgery.
- Patients were monitored clinically and echocardiographically, with failure modes classified as fatal or non-fatal.
Main Results:
- The overall operative mortality rate (OMR) was 8% (23 deaths), with causes including cardiogenic shock, stroke, and biventricular failure.
- Non-fatal failure modes (morbidity) occurred in 9% of patients, primarily due to persistent septal dyskinesis, mitral regurgitation, and ventricular tachycardia.
- Of the surviving patients, 76% achieved New York Heart Association (NYHA) Class I functional status.
Conclusions:
- Complex ventricular reconstruction (CVR) is a durable and effective surgical procedure.
- Identification of specific failure modes allows for targeted strategies to improve patient selection and procedural techniques.
- CVR offers significant long-term benefits for selected patients undergoing cardiac surgery.
Background:
Complex ventricular reconstruction (CVR) is now being employed increasingly thanks to the pioneering work of Dor. However, little is known about the failure mode of CVR. We present experience from three centres with CVR and an analysis of the failure modes.
Methods:
Between January 1997 and February 2005, 284 patients underwent CVR in three centres in Australia and USA. All of the procedures were performed as adjuncts to coronary artery surgery and/or valvular surgery. Patients were followed-up clinically and/or echocardiographically. Failure modes were classified as fatal or non-fatal. Non-fatal failure mode (NFM) was defined as either persistent heart failure, recurrence of LV scar, need for ventricular assistance, persistent ventricular arrhythmia, or a combination.
Results:
Operative mortality rate (OMR) was 8% (23 deaths). This fatal failure mode was most related to urgency of surgery and cardiogenic shock in 15 patients (5.3% of OMR), stroke in 5 patients (1.8%) or postoperative bi-ventricular failure (1%). Non-fatal failure modes accounted for morbidity in 26 patients (9%). This was predominantly due to persistent septal dyskinesis in 7 patients (2.46%), persistent mitral regurgitation in 5 (1.8%), postoperative ventricular tachycardia in 4 (1.4%), sub-optimal myocardial protection in 4 (1.4%) use of a large, stiff patch in 4 (1.4%). One hundred and ninety-nine of the surviving 261 patients (76%) were in NYHA Class I.
Conclusions:
Complex ventricular reconstruction is a robust technique that has lasting benefit. Failure modes have been identified and could be minimized by appropriate patient and procedure selection.
