Endoventricular Circular Patch Plasty (Dor Procedure) for Ischemic Left Ventricular Dysfunction

Cho, Kwang Ree; Lim, Cheong; Choi, Jae Sung; Hong, Jang Mee; Kim, Hyeong Ryul; Kim, Ki Bong

Abstract

Background
We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure concomitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141+/-64, 69+/-24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p<0.01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32+/-9% to 52+/-11% (p<0.01). The asynergy portion decreased from 57+/-12% to 22+/-9%, and LVEDV/LVESV indexes improved from 125+/-39 mL/m2, 85+/-30mL/m2 to 66+/-23 mL/m2, 32+/-16 mL/m2 (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase.
Conclusion
After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.