It is necessary that preoperative factors predicting the postoperative course be easily and precisely documented. Left ventricular aneurysm lva is a serious complication of myocardial infarction and reduces the chances of survival. Early and midterm results of endoventricular circular patch plasty dor procedure concomitant with total arterial revascularization were studied. The patient underwent surgery where left ventricular volume reduction using endoventricular circular patch plasty evcpp and mitral valve replacement mvr were performed. Endoventricular circular patch plasty for endstage. The geometric reconstruction of the left ventricle with intraventricular patch dors operation is also performed in ischemic cardiomyopathy with a large area of akinesia or dyskinesia of the.
Its use in a patient resulted in an almost normal shaped. Left ventricular reconstructive surgery mclaren health care. Lv reconstruction or surgical ventricular restoration svr by means of the dor. This retrospective study attempted to relate surgical outcome with the extent and type of preoperative wall motion asynergy in patients with postinfarction myocardial scar who underwent endoventricular circular patch plasty repair and associated coronary grafting.
Postinfarction ventricular septal perforation repair with. In the present study, we analyzed left ventricular energetics in patients who underwent the dor procedure. Ventricular reconstruction was performed using endoventricular circular patch. We investigated the preoperative predictors and defined the indications of endoventricular circular patch plasty evcpp in patients with ischemic cardiomyopathy icm. Certain patients who present following a transmural anterior wall myocardial infarct with an akinetic or dyskinetic wall segment, have been shown to benefit from endoventricular circular patch plasty as described by dor. Both morphology and hemodynamic of left ventricle, are improved. Original article preoperative parameters predicting the. Left ventricular lv pump function improvement is difficult to predict. The endoventricular circular patch plasty dor procedure applies to patients with a left ventricular dysfunction due to an ischemic dilated ventricle.
Learn more about it from the nations top ranked heart center. Application of circular patch plasty dor procedure or. The dor procedure is a medical technique used as part of heart surgery and originally introduced by the french cardiac surgeon vincent dor b. Dor procedure or the endoventricular circular patch plasty evccp, is an operation, introduced by vincent dor, in 1985. The first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a surgical method to rebuild left ventricular lv geometry made more spheric after myocardial infarction. The consequence is dilated ischemic cardiomyopathy. Modified endoventricular circular plasty dor procedure. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to its normal, elliptical geometry. This study evaluates clinical and hemodynamic results of endoventricular circular patch plasty in patients with either large akinetic scar n 51 or large dyskinetic scar n 49 and depressed left ventricular function ejection fraction endoventricular circular patch plasty evcpp. This technique restores circular ventricular architecture by excluding the septal scar and, by means of the laplace relationship, reducing the cavity to restore wall tension toward normal and thereby improve hemodynamic status.
The mean age of the patients at the time of surgery was 63 years old. We studied the effects of patch downsizing in different shapes within one plane on lv volume and lv performance. The various drawbacks related to this technique can be offset by a modification based on a mathematical hypothesis, which should result in a more physiological ventricular geometry, with consequent late reverse remodeling and. Between 1996 and 2001,23 consecutive patients with left ventricular aneurysm andor ischemic cardiomyopathy after. All seven patients had anterior left ventricular aneurysms following old myocardial infarction. Early results after surgical treatment of left ventricular. We performed the dacron patch fixation to the left. Dor and associates see page 50 have provided this in their recognition of the cause and consequences of a left ventricular lv scar after myocardial infarction and their method of reversing this sequence with the endoventricular circular patch plasty evcpp technique or, more correctly, the dor procedure. Surgical management of left ventricular aneurysms by the endoventricular circular patch plasty technique. Controversy still exists regarding the optimal surgical technique for lva repair. Dor operation endoventricular circular patch plasty. Surgical management of left ventricular aneurysms by the. The procedure itself is a viable method of restoring a dilated left ventricle to its normal eliptical geometry.
The surgical ventricular restoration svr procedure may also be referred to as ventricular remodeling, surgical anterior ventricular endocardial restoration saver, left ventricular reconstructive surgery, left ventricular aneurysmectomy reconstruction, endoventricular circular plasty, or the dor procedure. Endoventricular circular patch plasty repair dor, or modified dor, procedure to credit vincent dor, md, who authored many articles on the procedure he began performing in the early 1980s surgical ventricular restoration. Surgical ventricular restoration svr with different techniques has been performed to treat lv aneurysm. Surgical ventricular restoration definition of surgical.
Ideally, an endoventricular patch can be adjusted per and post operatively in size and shape to titrate an optimal lv volume and geometry. We report hemodynamic and clinical results of our series of endoventricular circular patch plasty dor operation and consider some advantages of this procedure for patients with ischemic cardiomyopathy. Dor operation endoventricular circular patch plasty youtube. Left ventricular reconstruction by endoventricular circular patch plasty repair. The endoventricular circular patch plasty dor procedure. Endoventricular circular patch plasty dor operation. Endoventricular circular patch plasty dor operation vumedi. Endoventricular patch plasty dor procedure has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We investigated the preoperative predictors and defined the.
Following endoventricular circular plasty, patching of the remaining ventricular opening may be important for patients with large ventricular aneurysms. Left ventricular aneurysm resection and remodeling dor. Citeseerx document details isaac councill, lee giles, pradeep teregowda. A 17year experience vincent dar, marisa di donato, michel sabatier, franfoise montiglio, filippo civaia, and the restore group the first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a surgical method to rebuild left ventricular lv geometry made more. Preoperative parameters predicting the postoperative course of endoventricular circular patch plasty keiichiro kondo, md, yoshihide sawada, md, and shinjiro sasaki, md, phd it is necessary that preoperative factors predicting the postoperative course be easily and precisely documented. In 1985, vincent dor, md, introduced endoventricular circular patch plasty evcpp, or the dor procedure, as a viable method for restoring a dilated left ventricle to its normal, elliptical geometry. Left ventricular reconstruction by endoventricular. The dor procedure, which uses a circular suture and a dacron patch to correct lv aneurysms and exclude scarred parts of the septum and ventricular wall, would prove to be the. Dor procedure definition of dor procedure by medical. Pre and postoperative 1, 2, 6, and 12month clinical outcomes of the patients mean. In this procedure, the lv volume is reduced and the lv chamber is reconstructed using an endoventricular circular. All patients underwent svr by means of the dor procedure endoventricular circular patch plasty, and 99 patients had concomitant cabg with. We analyze the efficacy of two techniques, linear vs. Endoventricular circular patch plasty dor procedure has been reported to be a surgical method that applies to patients with a left ventricular lv dysfunction after a myocardial infarction for either akinesia or dyskinesia 1.
The technique of surgical ventricular restoration employed in the stich trial was circular endoventricular patch plasty. The endoventricular circular patch plasty dor procedure in. The addition of coronary revascularization to the surgical treatment of the lv. Left ventricular reconstructive surgery modified dor procedure.
Left ventricular reconstructive surgery modified dor. Left ventricular reconstructive surgery, modified dor procedure, is a surgical treatment for heart failure. We tested the hypotheses that the dor procedure increases systolic circumferential shortening and longitudinal shortening in noninfarcted left ventricular regions in sheep. The aim of this our study is to indicate that the endoventricular circular patch plasty evcpp which is recommended by dor can be performed with a simpler and more hemostatic suture technique. Between july 1987 and march 1996, 562 patients underwent endoventricular patch plasty repair and coronary grafting for postinfarction lv aneurysm at the cardiothoracique center of monaco. Left ventricular reconstruction was performed with endoventricular circular patch plasty evcpp dor procedure or linear repair technique. We present here a case of endstage nonischemic valvular dilated cardiomyopathy dcm associated with mitral regurgitation mr. What the anesthesiologist should know before the operative procedure left ventricular lv aneurysm resection and lv repair were introduced by cooley and colleagues in 1958, who described a linear. In anterior infarction, the free lv wall and septum are scarred and become dyskinetic or akinetic. This allows to exclude all asynergic areas of the left ventricular wall and reshape the remaining wall. The first experience with endoventricular circular patch plasty evcpp was. Between 1996 and 2001, 23 consecutive patients with left ventricular aneurysm and or ischemic cardiomyopathy after. Our study group consists of 12 patients which were operated on with the diagnossis of left ventricular aneurysm. Preoperative parameters predicting the postoperative.
Lessons from a mathematical hypothesis modification of. Sixtyone patients who underwent the dor procedure for ischemic dyskineticakinetic left ventricle were studied with mean followup of 26. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to. Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction. We describe a technique for repairing the ventricular septal perforation 10 days post acute anteroseptal myocardial infarction using the modified infarction exclusion method. Seven patients with ischemic cardiomyopathy who underwent elective endoventricular circular patch plasty evcpp were included in this study. The dor procedure, which uses a circular suture and a dacron patch to correct lv aneurysms and exclude scarred parts of the septum and ventricular. Endoventricular circular patch plasty for endstage valvular cardiomyopathy kenji kuwaki department of thoracic and cardiovascular surgery, sapporo medical university school of medicine. From 1984 to 2000, 950 left ventricular ischemic asynergy dyskinetic or akinetic were operated using the endoventricular circular patch plasty technique. Endoventricular circular patch plasty or septoexclusion. Read at the seventyseventh annual meeting of the american association for thoracic surgery, washington, d. Left ventricular reconstruction by endoventricular circular patch. A 17year experience vincent dor marisa di donato michel saba tier franfoise montiglio filippo civaia and the restore group the first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a surgical method to rebuild left ventricular lv geometry made more. Department of cardiology and cardiac surgery, university g.
The repair involves endoventricular circular patch plasty and application of gelatinresorcinolformaldehyde biological glue in the space between a teflon felt patch on the infarcted septum and a bovine pericardial patch in the left ventricular cavity. Application of circular patch plasty dor procedure or linear. It is also known as endoventricular circular patch plasty evcpp. The repair involves endoventricular circular patch plasty and application of gelatinresorcinolformaldehyde biological glue in the space between a teflon felt patch on the infarcted septum and a bovine pericardial patch. Ismics resizable lv endoventricular patch plasty in the. Endoventricular circular patch plasty or septoexclusion, journal of cardiac surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Coronary artery stenosis and anatomy were evaluated using coronary angiography and a coronary luminal stenosis. Department of cardiovascular surgery of mc erebouni first time in armenia began to carry out cardiac surgery forpostinfarction heart aneurysm. Extent of threedimensional applical reverse remodeling during endoventricular circular patch plasty dor procedure for anterior left ventricular aneurysm predicts the degree of global function improvement. Surgical management of left ventricular aneurysms by the endoventricular circular patch plasty technique vincent dor in 1958, cooley resected a left ventricular aneurysm lva while using cardiopulmonary bypass to sustain the systemic circulation, thereby ushering in the mod ern era of surgery for left ventricular aneurysms. Ventricular energetics in endoventricular circular patch. The dor procedure, which uses a circular suture and a dacron patch to correct lv aneurysms and exclude scarred parts of the septum and ventricular wall, would prove to be the best option amongst. Modified endoventricular circular plasty dor procedure ctsnet.
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