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. The consequence is dilated ischemic cardiomyopathy. Left ventricular reconstruction by endoventricular circular patch plasty repair. 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. Endoventricular circular patch plasty dor operation vumedi. Not only is the aneurysm no longer present, but the diameter of the ventricular cavity is decreased in both diastole and systole and there is a noticeable improvement in overall ventricular function. Left ventricular angiogram rao view in the same patient during diastole c and systole d after an evcpp. Doublepatch technique for postinfarction ventricular. In anterior infarction, the free lv wall and septum are scarred and become dyskinetic or akinetic. Both morphology and hemodynamic of left ventricle, are improved. Patients with a large akinetic scar and severely depressed pump function bene. The dor procedure is a medical technique used as part of heart surgery and originally introduced by the french cardiac surgeon vincent dor. Dor procedure or the endoventricular circular patch plasty evccp, is an operation, introduced by vincent dor, in 1985.
Relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair. This study evaluates clinical and hemodynamic results of endoventricular circular patch plasty in patients with either large akinetic scar n 51 or. Between 1996 and 2001,23 consecutive patients with left ventricular aneurysm andor ischemic cardiomyopathy after. Dor operation endoventricular circular patch plasty youtube. The surgical technique of linear endoventricular patch plasty. Dors endoventricular circular patch plasty was then performed. 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. 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.
From 1984 to 2000, 950 left ventricular ischemic asynergy dyskinetic or akinetic were operated using the endoventricular circular patch plasty. Left ventricular lv pump function improvement is difficult to predict. We tested the hypotheses that the dor procedure increases systolic circumferential shortening and longitudinal shortening in noninfarcted left ventricular regions in sheep. The mean age of the patients at the time of surgery was 63 years old. We investigated the preoperative predictors and defined the. A modified infarctexclusion technique for postinfarction ventricular septal perforation is presented. The geometric reconstruction of the left ventricle with intraventricular patch dors operation is also performed in ischemic. It is also known as endoventricular circular patch plasty evcpp. Dor v, saab m, coste p, kornaszewska m, montiglio i. This was the most common procedure for this indication until the late 1980s, when vincent dor and his colleagues introduced endoventricular patch plasty evpp. The dor procedure is a medical technique used as part of heart surgery and originally introduced by the french cardiac surgeon vincent dor b. 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.
Systemic embolism in chronic left ventricular aneurysm. Few modifications in his technique of simple resection and. The dor procedure, or endoventricular circular patch plasty, was first described in 1985 as a method to restore a dilated left ventricle back to its normal elliptical geometry. Surgical management of left ventricular aneurysms by the. Controversy still exists regarding the optimal surgical technique for lva repair. Modified endoventricular circular plasty dor procedure. We performed a retrospective analysis of patients who underwent an endoventricular circular patch plasty dor procedure between 1998 and 2001. In this procedure, the lv volume is reduced and the lv chamber is reconstructed using an endoventricular circular patch. Left ventricular aneurysm resection and remodeling dor.
Left ventricular reconstruction was performed with endoventricular circular patch plasty evcpp dor procedure or linear repair technique. Dor operation endoventricular circular patch plasty. 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. We analyze the efficacy of two techniques, linear vs. 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. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to its normal, elliptical geometry. 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.
Aneurysm repair techniques have evolved to geometric repair by exclusion of the aneurysmal area with a circular patch. Endoventricular circular patch plasty for endstage. Left ventricular reconstructive surgery modified dor procedure. Left ventricular reconstruction by endoventricular. Dor, or modified dor, procedure to credit vincent dor, md, who authored many articles on the. The beating heart approach is not necessary for the dor procedure. Dor and associates 27 first described the technique of endoventricular circular patch plasty evcpp, which is used to treat patients with postinfarction left ventricular scarring. Biventricular pacing with coronary bypass and dors. This procedure excludes the scarred areas of the septum and ventricular wall, and covers the defect using a circular synthetic patch. A 66yearold male patient was admitted to our hospital for treatment of nyha class iv heart failure.
Endoventricular circular patch plasty for endstage valvular cardiomyopathy kenji kuwaki department of thoracic and cardiovascular surgery, sapporo medical university school of. All seven patients had anterior left ventricular aneurysms following old myocardial infarction. Following endoventricular circular plasty, patching of the remaining ventricular opening may be important for patients with large ventricular aneurysms. This study evaluates clinical and hemodynamic results of endoventricular circular patch plasty in patients with either large akinetic scar n 51 or large. An example of a circular patch plasty is shown in figure 2. Department of cardiology and cardiac surgery, university g. We describe a technique for repairing the ventricular septal perforation 10 days post acute anteroseptal myocardial infarction using the modified infarction exclusion method. 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. It is also known as endoventricular circular patch plasty. Dor operation endoventricular circular patch plasty video. Application of circular patch plasty dor procedure or.
It is also known as endoventricular circular patch plasty ecpp. Endoventricular patch plasty dor procedure has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. 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. 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.
The endoventricular circular patch plasty dor procedure in ischemic akinetic dilated ventricles. Surgical treatment of congestive heart failure gregoric. D endoventricular patch anchorage with the same suture and closure of excluded areas. We have repaired both akinetic and aneurysmal dyskinetic segments with endoventricular circular patch plasty evcpp.
We performed the dacron patch fixation to the left. 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. Modified endoventricular circular plasty dor procedure ctsnet. He points out, wenever used the term dor procedure, and i prefer to say l v reconstruction by endoventricular cir cular patch plasty. Suboptimal early and unsatisfactory late results after linear closure of left ventricular aneurysms, have focused attention on more physiologic concepts of aneurysmectomy, like endoventricular patch plasty. Postinfarction ventricular septal perforation repair with.
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. Left ventricular reconstructive surgery modified dor. Endoventricular circular patch plasty dor operation. The patch stuck to the infarcted septum, and no residual shunt was observed in any patient because the wide. 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. The impact of this technique, says dr dor, was to exclude from the ventricular cavity the asyner. The procedure involves placement of a circular synthetic or autologous. Dilated cardiomyopathy, endoventricular circular patch plasty. For some of these patients, the remaining ventricular cavity may become too small to. The dor procedure endoventricular circular patch plasty repair of the left ventricle with associated coronary grafting is a relatively new surgical technique.
In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to. Long term follow up of left ventricular function after. 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. Left ventricular aneurysm lva is a serious complication of myocardial infarction and reduces the chances of survival. From 1984 to 2000, 950 left ventricular ischemic asynergy dyskinetic or akinetic were operated using the endoventricular circular patch plasty technique. For bvp, a permanent screwintype epicardial lead 507155, medtronic, minneapolis, mn was fixed on the posterolateral wall near the atrioventricular groove, and the other two leads 5075 and 4951m53, medtronic, minneapolis, mn were placed near the right ventricular. Pre and postoperative 1, 2, 6, and 12month clinical outcomes of the patients mean. Ventricular reconstruction was performed using endoventricular circular patch plasty dor procedure n48. Left ventricular reconstructive surgery mclaren health care. Preoperative parameters predicting the postoperative. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle to its normal, elliptical geometry. Ventricular energetics in endoventricular circular patch. The endoventricular circular patch plasty dor procedure.
Our study group consists of 12 patients which were operated on with the diagnossis of left ventricular aneurysm. Early results after surgical treatment of left ventricular. Initial valve surgery was an aortic valve replacement avr with mechanical tilting disc valve for rheumatic aortic. 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. Dor procedure university of medicine and dentistry of. Left ventricular aneurysm and pseudoaneurysm following. The perforation is closed directly by a small patch next to the conventional patch, and biological glue is applied between the patches to induce stable polymerization. Endoventricular circular patch plasty or septoexclusion. The dor procedure is a cardiac surgery developed by dr vincent dor, a french cardiac surgeon, in 1985. Surgical outcome of endoventricular circular patch plasty repair for postinfarction myocardial scar relates to the extent of lv asynergy rather than to the presence or absence of dyskinesia. The dor procedure uses a circular suture and a dacron patch to. Seven patients with ischemic cardiomyopathy who underwent elective endoventricular circular patch plasty evcpp were included in this study. Didonato m, sabatier m, dor v, toso a, maioli m, fantini f. Department of cardiovascular surgery of mc erebouni first time in armenia began to carry out cardiac surgery forpostinfarction heart aneurysm.
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