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J Thorac Cardiovasc Surg 1998;116:50-59
© 1998 Mosby, Inc.

Surgery For Adult Cardiovascular Disease

Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars

V. Dor, MDa, M. Sabatier, MDa, M. Di Donato, MDb, F. Montiglio, MDa, A. Toso, MDb, M. Maioli, MDb

From the Centre Cardiothoracique de Monaco, Monaco,a and the Department of Cardiology, University of Florence, Florence, Italy.b

Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.

Received for publication May 12, 1997. Revisions requested July 15, 1997. Accepted for publication March 16, 1998. Address for reprints: Centre Cardiothoracique de Monaco, 11 Bis Av. D'Ostende, 98400 Monaco Cedex.

Background: Many believe that dyskinesia is the only predictor of favorable surgical outcome after large myocardial infarction and that akinetic scars do not recover well in patients with globally depressed ventricular function.
Methods: 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 <30%). Groups were comparable for symptoms, indication for operation, and delay from myocardial infarction. Heart failure was a major indication for operation in both groups. Coronary grafting was performed in 98% of patients: 10 had mitral valve repair or replacement, and 47 patients with preoperative ventricular arrhythmias had cryotherapy. In-hospital mortality was 12% (five patients in the akinetic group [10%] and seven in the dyskinetic group [14%]).
Results: Results showed an early and late improvement in New York Heart Association functional class and ejection fraction (from 23% ± 5% to 31% ± 11% to 40% ± 13% in akinetic patients and from 23% ± 6% to 41% ± 10% to 41% ± 12% in dyskinetic patients). Ventricular tachycardia was reduced significantly in both groups early and late after the operation.
Conclusion: We conclude that in patients with either large akinetic or dyskinetic scar and severe left ventricular dysfunction, endoventricular circular patch plasty associated with coronary grafting and cryotherapy, when indicated, provides surviving patients with significant improvement in cardiac function. This approach can be considered as an alternative to heart transplantation in patients with severe left ventricular dysfunction. (J Thorac Cardiovasc Surg 1998;116:50-9)




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L. L. Mickleborough, N. Merchant, Y. Provost, S. Carson, and J. Ivanov
Ventricular reconstruction for ischemic cardiomyopathy
Ann. Thorac. Surg., June 1, 2003; 75(90060): S6 - 12.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. Menasche
Cell transplantation in myocardium
Ann. Thorac. Surg., June 1, 2003; 75(90060): S20 - 28.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
T. Isomura, H. Suma, A. Yamaguchi, T. Kobashi, and A. Yuda
Left ventricular restoration for ischemic cardiomyopathy - comparison of presence and absence of mitral valve procedure
Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 614 - 619.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
Y. Tanoue, H. Ando, F. Fukumura, M. Umesue, T. Uchida, K. Taniguchi, and J. Tanaka
Ventricular energetics in endoventricular circular patch plasty for dyskinetic anterior left ventricular aneurysm
Ann. Thorac. Surg., April 1, 2003; 75(4): 1205 - 1208.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. Mizuno, H. Tanaka, S. Makita, N. Tabuchi, H. Arai, and M. Sunamori
Biventricular pacing with coronary bypass and Dor's ventriculoplasty
Ann. Thorac. Surg., March 1, 2003; 75(3): 998 - 999.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
G. D. Buckberg
Congestive heart failure: Treat the disease, not the symptom--return to normalcy
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S41 - 49.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D. Burkhoff
New heart failure therapy: The shape of things to come?
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S50 - 52.
[Full Text] [PDF]

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 Card Surg AdultHome page
D. D. Glower and J. E. Lowe
Left Ventricular Aneurysm
Card. Surg. Adult, January 1, 2003; 2(2003): 771 - 788.
[Full Text]

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 Card Surg AdultHome page
V. Badhwar and S. F. Bolling
Nontransplant Surgical Options for Heart Failure
Card. Surg. Adult, January 1, 2003; 2(2003): 1515 - 1526.
[Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
L. Menicanti and M. Di Donato
The Dor procedure: What has changed after fifteen years of clinical practice?
J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 886 - 890.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. A. Carr, B. E. Haithcock, G. Paone, A. F. Bernabei, and N. A. Silverman
Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction
Ann. Thorac. Surg., November 1, 2002; 74(5): 1531 - 1536.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
T. Nomoto, T. Nishina, S. Miwa, H. Tsuneyoshi, I. Maruyama, K. Nishimura, and M. Komeda
Angiotensin-Converting Enzyme Inhibitor Helps Prevent Late Remodeling After Left Ventricular Aneurysm Repair in Rats
Circulation, September 24, 2002; 106(12_suppl_1): I-115 - I-119.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
Y. Sakakibara, K. Tambara, F. Lu, T. Nishina, G. Sakaguchi, N. Nagaya, K. Nishimura, R.-K. Li, R. D. Weisel, and M. Komeda
Combined Procedure of Surgical Repair and Cell Transplantation for Left Ventricular Aneurysm: An Experimental Study
Circulation, September 24, 2002; 106(12_suppl_1): I-193 - I-197.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
R. Tavakoli, D. Bettex, A. Weber, H. Brunner, M. Genoni, R. Pretre, R. Jenni, and M. Turina
Repair of postinfarction dyskinetic LV aneurysm with either linear or patch technique
Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 129 - 134.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
L. Menicanti, M. Di Donato, A. Frigiola, G. Buckberg, C. Santambrogio, M. Ranucci, and D. Santo
Ischemic mitral regurgitation: Intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration
J. Thorac. Cardiovasc. Surg., June 1, 2002; 123(6): 1041 - 1050.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
M. K. Pasque
Mathematic modeling and cardiac surgery
J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 617 - 620.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. H. Artrip, M. C. Oz, and D. Burkhoff
Left ventricular volume reduction surgery for heart failure: A physiologic perspective
J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 775 - 782.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. T. Cope, A. K. Kaza, C. C. Reade, K. S. Shockey, J. A. Kern, C. G. Tribble, and I. L. Kron
A cost comparison of heart transplantation versus alternative operations for cardiomyopathy
Ann. Thorac. Surg., October 1, 2001; 72(4): 1298 - 1305.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
T. Nishina, K. Nishimura, S. Yuasa, S. Miwa, T. Nomoto, Y. Sakakibara, N. Handa, I. Hamanaka, Y. Saito, and M. Komeda
Initial Effects of the Left Ventricular Repair by Plication May Not Last Long in a Rat Ischemic Cardiomyopathy Model
Circulation, September 18, 2001; 104 (2009): I-241 - I-245.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D. Burkhoff
New heart failure therapy: The shape of things to come?
J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 421 - 423.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
H. Suma, T. Isomura, T. Horii, and K. Hisatomi
Left ventriculoplasty for ischemic cardiomyopathy
Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 319 - 323.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
T. Isomura, H. Suma, T. Horii, T. Sato, T. Kobashi, H. Kanemitsu, J. Hoshino, and K. Hisatomi
Left ventricle restoration in patients with non-ischemic dilated cardiomyopathy: risk factors and predictors of outcome and change of mid-term ventricular function
Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 684 - 689.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
A. Franco-Cereceda, P. M. McCarthy, E. H. Blackstone, K. J. Hoercher, J. A. White, J. B. Young, and R. C. Starling
Partial left ventriculectomy for dilated cardiomyopathy: Is this an alternative to transplantation?
J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 879 - 893.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
P. F.A. Bakker, F. de Lange, R. N.W. Hauer, R. Derksen, and J. M.T. de Bakker
Sequential map-guided endocardial resection for ventricular tachycardia improves outcome
Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 448 - 454.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
C. L. Athanasuleas, A. W. H. Stanley Jr., G. D. Buckberg, V. Dor, M. DiDonato, E. H. Blackstone, and the RESTORE group
Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction
J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1199 - 1209.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
G. D. Buckberg
Congestive heart failure: Treat the disease, not the symptom--Return to normalcy
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 628 - 637.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
L. L. Mickleborough, S. Carson, and J. Ivanov
Repair of dyskinetic or akinetic left ventricular aneurysm: Results obtained with a modified linear closure
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 675 - 682.
[Abstract] [Full Text] [PDF]

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 HeartHome page
G. DREYFUS and S. MIHEALAINU
The Batista procedure
Heart, January 1, 2001; 85(1): 1 - 2.
[Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
M. Di Donato, M. Sabatier, V. Dor, G. F. Gensini, A. Toso, M. Maioli, A. W. H. Stanley, C. Athanasuleas, and G. Buckberg
Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery
J. Thorac. Cardiovasc. Surg., January 1, 2001; 121(1): 0091 - 96.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
M. Sawazaki, T. Ito, K. Yasuura, Y. Ogawa, S.-i. Mizutani, H. Ishikawa, A. Miura, R. Hashizume, M. Sawazaki, T. Ito, et al.
Endoventricular Left Ventriculoplasty: Overlap Technique for Akinetic Scar
Asian Cardiovasc Thorac Ann, December 1, 2000; 8(4): 311 - 314.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
H. Suma, T. Isomura, T. Horii, T. Sato, N. Kikuchi, K. Iwahashi, and J. Hosokawa
NONTRANSPLANT CARDIAC SURGERY FOR END-STAGE CARDIOMYOPATHY
J. Thorac. Cardiovasc. Surg., June 1, 2000; 119(6): 1233 - 1245.
[Abstract] [Full Text] [PDF]

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 HeartHome page
S. Westaby
HEART FAILURE: Non-transplant surgery for heart failure
Heart, May 1, 2000; 83(5): 603 - 603.
[Full Text]

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 Eur. J. Cardiothorac. Surg.Home page
T. Isomura, H. Suma, T. Horii, T. Sato, and N. Kikuchi
Partial left ventriculectomy, ventriculoplasty or valvular surgery for idiopathic dilated cardiomyopathy - the role of intra-operative echocardiography
Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 239 - 245.
[Abstract] [Full Text] [PDF]


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