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Eur J Cardiothorac Surg 2006;30:347-352
© 2006 Elsevier Science NL
a Section of Cardiothoracic Surgery, Department of Surgery, University of Chicago Medical Center, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA
b Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Heidelberg, Vic., Australia
c Department of Cardiothoracic Surgery, Royal Hobart Hospital, University of Hobart, Hobart, Tasmania, Australia
Received 30 September 2005; received in revised form 27 March 2006; accepted 29 March 2006.
* Corresponding author. Address: Section of Cardiothoracic Surgery, Department of Surgery, University of Chicago Medical Center, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA. Tel.: +1 773 702 2500; fax: +1 773 702 4187. (Email: jraman{at}surgery.bsd.uchicago.edu).
Background: Complex ventricular reconstruction (CVR) is now being employed increasingly thanks to the pioneering work of Dor. However, little is known about the failure mode of CVR. We present experience from three centres with CVR and an analysis of the failure modes. Methods: Between January 1997 and February 2005, 284 patients underwent CVR in three centres in Australia and USA. All of the procedures were performed as adjuncts to coronary artery surgery and/or valvular surgery. Patients were followed-up clinically and/or echocardiographically. Failure modes were classified as fatal or non-fatal. Non-fatal failure mode (NFM) was defined as either persistent heart failure, recurrence of LV scar, need for ventricular assistance, persistent ventricular arrhythmia, or a combination. Results: Operative mortality rate (OMR) was 8% (23 deaths). This fatal failure mode was most related to urgency of surgery and cardiogenic shock in 15 patients (5.3% of OMR), stroke in 5 patients (1.8%) or postoperative bi-ventricular failure (1%). Non-fatal failure modes accounted for morbidity in 26 patients (9%). This was predominantly due to persistent septal dyskinesis in 7 patients (2.46%), persistent mitral regurgitation in 5 (1.8%), postoperative ventricular tachycardia in 4 (1.4%), sub-optimal myocardial protection in 4 (1.4%) use of a large, stiff patch in 4 (1.4%). One hundred and ninety-nine of the surviving 261 patients (76%) were in NYHA Class I. Conclusions: Complex ventricular reconstruction is a robust technique that has lasting benefit. Failure modes have been identified and could be minimized by appropriate patient and procedure selection.
Key Words: Left ventricular reconstruction • Dor procedure • Failure mode • Heart failure • Septal plication • Endo-ventricular repair
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