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[Dor operation for end-stage ischemic cardiomyopathy]
1Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kanagawa.
Insights
The Dor operation effectively treats end-stage ischemic cardiomyopathy by excluding akinetic areas, improving ejection fraction and reducing heart failure symptoms in surgical candidates.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Surgery
Context:
- End-stage dilated ischemic cardiomyopathy presents significant challenges in treatment.
- Patients often have reduced ejection fraction and severe heart failure symptoms.
- The Dor operation offers a potential surgical solution for these complex cases.
Purpose:
- To evaluate the efficacy of the endoventricular circular patch plasty (Dor operation) in treating end-stage dilated ischemic cardiomyopathy.
- To assess the perioperative and long-term outcomes of the Dor procedure combined with other cardiac surgeries.
Summary:
- The Dor procedure was performed on 13 patients with end-stage ischemic cardiomyopathy, often combined with coronary artery bypass grafting and mitral valve surgery.
- No perioperative deaths occurred, and while three in-hospital deaths were reported, survivors showed significant improvements.
- Ejection fraction increased from 22% to 36%, with reduced ventricular volumes and pulmonary capillary wedge pressure post-surgery.
Impact:
- The Dor operation demonstrates effectiveness in improving cardiac function and New York Heart Association (NYHA) class in patients with severe ischemic cardiomyopathy.
- It serves as a viable surgical alternative for patients who might otherwise be candidates for heart transplantation.
- The procedure leads to significant functional recovery and reduced heart failure burden.
Abstract:
Endoventricular circular patch plasty (Dor operation) was used to treat end-stage dilated ischemic cardiomyopathy in 13 patients from January to December, 1997. There were 10 men and three women aged from 57 to 78 years (mean 63 years). Single, double, triple and left main trunk coronary disease was present in one, two, eight and two patients, respectively. Mean ejection fraction was 22% (6-30%) and signs of congestive heart failure were clear in all patients [New York Heart Association (NYHA) class III in eight patients and class IV in five patients]. Angina pectoris was present in five patients. Six patients had associated significant mitral regurgitation. Coronary artery bypass grafting (mean 3.2 grafts) was used in 11 patients and mitral valve reconstruction was performed in 6 patients (4: replacement and 2: repair) combined with akinetic area exclusion by the Dor technique. All patients were successfully weaned from cardiopulmonary bypass without mechanical support and no perioperative death occurred. Three patients died in hospital at 1-2 postoperative months due to pneumonia, stroke and heart failure, respectively. Two patients died during the late period due to stroke and sudden death. Among the eight survivors, six patients were in NYHA class I-II and two patients in class III. Ejection fraction increased from 22% to 36%, end-diastolic and systolic volume indices decreased from 168 +/- 58 to 123 +/- 39 ml/m2 and from 131 +/- 60 to 81 +/- 33 ml/m2, respectively. Pulmonary capillary wedge pressure decreased from 19 +/- 10 to 14 +/- 5 mmHg. The Dor procedure is an effective surgical alternative for patients with end-stage ischemic cardiomyopathy who are considered to be candidates for cardiac transplantation.