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Mid-term changes of left ventricular geometry and function after Dor, SAVE, and Overlapping procedures

Tetsuya Ueno1, Ryuzo Sakata, Yoshifumi Iguro

  • 1Department of Thoracic and Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan. tueno@m.kufm.kagoshima-u.ac.jp

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 3, 2007
PubMed

Insights

The Overlapping procedure effectively reduced left ventricular (LV) volume and maintained an elliptical shape long-term, unlike Dor or SAVE procedures which showed adverse remodeling or persistent functional deficits. This offers a promising surgical option for ischemic heart disease.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • End-stage ischemic heart disease often necessitates left ventricular (LV) reconstruction.
  • Surgical techniques like Dor, septal anterior ventricular exclusion (SAVE), and Overlapping aim to remodel the LV.
  • Mid-term changes in LV geometry and function following these procedures require thorough investigation.

Purpose of the Study:

  • To investigate mid-term changes in left ventricular (LV) geometry and function after Dor, SAVE, and Overlapping ventricular remodeling procedures.
  • To compare the efficacy of these different LV reconstruction techniques.

Main Methods:

  • Forty-three patients with end-stage ischemic heart disease underwent LV reconstruction.
  • Patients were divided into Dor (n=15), SAVE (n=12), and Overlapping (n=16) groups.
  • Echocardiography assessed LV dimensions, volumes, ejection fraction, deceleration time, sphericity index, and mitral regurgitation preoperatively and postoperatively (immediate and mid-term).

Main Results:

  • Dor group: Significant LV volume reduction initially, followed by increase; increased sphericity index.
  • SAVE group: Significant reduction in deceleration time, with no later improvement.
  • Overlapping group: Significant and persistent LV volume reduction; maintained elliptical shape without significant change in sphericity index.

Conclusions:

  • Dor procedure associated with LV sphericity progression; SAVE procedure with persistent deceleration time reduction.
  • Overlapping procedure demonstrated significant LV volume reduction and maintenance of elliptical shape.
  • Overlapping procedure showed acceptable early and late mortality, suggesting it as a favorable option.
Abstract

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