Ventricular reconstruction results in improved left ventricular function and amelioration of mitral insufficiency

• Published in: Annals of surgery Vol. 235; no. 6; pp. 828 - 832
• Main Authors: KAZA, Aditya K, PATEL, Mayank R, FISER, Steven M, LONG, Stewart M, KERN, John A, TRIBBLE, Curtis G, KRON, Irving L
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-06-2002
• Subjects: Biological and medical sciences; Cardiac Surgical Procedures - methods; Female; Heart Function Tests; Humans; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - surgery; Myocardial Ischemia - complications; Myocardial Ischemia - surgery; Polyethylene Terephthalates; Prostheses and Implants; Retrospective Studies; Scientific Papers; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - surgery; Human; Mitral valve; Wall; Cardiomyopathy; Cardiovascular disease; Coronary heart disease; Myocardial disease; Vascular disease; Plasty; Ischemia; Cardiac valvular disease; Dysfunction; Surgery; Mitral regurgitation; Myocardium; Biological effect; Left ventricle performance
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200206000-00010

Surgical restoration of the left ventricular wall (Dor procedure) has been advocated as a therapy for left ventricular dysfunction due to ischemic cardiomyopathy. This procedure involves placement of an endoventricular patch through a ventriculotomy.
We reviewed our series of patients that underwent the Dor procedure within the past 4 years and examined their pre and postoperative ventricular function and mitral valve function. Pre and postoperative ejection fraction and degree of mitral regurgitation were analyzed using the paired Student t-test. We hypothesized that this procedure would result in improved ventricular function and that it would also help improve mitral valve function.
Thirty-four patients underwent this procedure, with one death. Of these, 30 patients underwent concomitant coronary artery bypass grafting and 8 patients had mitral intervention (seven had an Alfieri repair of the mitral valve, and one had mitral valve annuloplasty). The average preoperative ejection fraction among these patients was 26.8% (range 10-45%). The postoperative ejection fraction was significantly higher at 35.4% (range 25-52%) (P <.001). We noted an improvement in ejection fraction in 27 patients (82%). We also noted that 21 of 33 patients (64%) had improvement in the degree of mitral regurgitation based on echocardiography data (P <.001).
We conclude that the Dor procedure results in improvement in the left ventricular function. Furthermore, we also note that this procedure ameliorates mitral regurgitation in a majority of these patients even in the absence of associated mitral valve procedures, probably due to reduction in the size of the ventricle and improved orientation of the papillary muscles.