Surgery for Ventricular Tachycardia in Patients Undergoing Left Ventricular Reconstruction by the Dor Procedure

Sartipy, Ulrik; Albåge, Anders; Strååt, E.; Insulander, Per; Lindblom, Dan

doi:10.1016/j.athoracsur.2005.06.058

Cited by 52 publications

(36 citation statements)

References 31 publications

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“…A surgical procedure that can correct the underlying structural cardiac abnormality to the maximum extent may not only prevent recurrent arrhythmia but also offer additional improvements in quality of life as well as prolonged survival. 14,15,16 Therefore, we strongly recommend considering operative removal of aneurysms and surgical treatment of tachyarrhythmia for preventing sudden cardiac death and improving cardiovascular conditions in selected patients with large aneurysms. We selected surgery for the patient described herein because of the recurrent episodes of ventricular tachycardia and his history of heart failure symptoms.…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic cardiomyopathy with apical aneurysm: left ventricular reconstruction and cryoablation for ventricular tachycardia

Osawa

Fujimatsu

Takai

et al. 2011

Gen Thorac Cardiovasc Surg

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This is a case study of a 58-year-old patient with hypertrophic cardiomyopathy, mid-ventricular obstruction, and apical aneurysm who had an episode of syncope due to ventricular tachycardia. Cardiovascular magnetic resonance imaging revealed asymmetrical left ventricular hypertrophy with mid-ventricular obstruction and an apical aneurysm. His coronary angiography was normal, and his ventricular tachycardia was induced by hypertrophic cardiomyopathy without ischemia. Apical aneurysmectomy, left ventricular reconstruction, and cryoablation at the rim of the aneurysm were performed. Fifteen days after the operation, an automatic implantable cardioverter-defibrillator was implanted. The postoperative course was uneventful, and ventricular tachyarrhythmia did not recur during 18 months of follow-up.

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Section: Discussionmentioning

confidence: 99%

Hypertrophic cardiomyopathy with apical aneurysm: left ventricular reconstruction and cryoablation for ventricular tachycardia

Osawa

Fujimatsu

Takai

et al. 2011

Gen Thorac Cardiovasc Surg

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“…Ventricular arrhythmias are further reduced by relieving ischemia through complete revascularization and improving mechanical resynchronization. So far, different groups have reported a marked reduction of inducible arrhythmias and a very low incidence of sudden death after SVR [20,[65][66][67]. This may limit the need for ICD implantation in patients who undergo SVR.…”

Section: Svr and Arrhythmiasmentioning

confidence: 99%

Surgical Ventricular Restoration to Reverse Left Ventricular Remodeling

Castelvecchio¹,

Menicanti²,

Donato³

2009

CCR

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Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.

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“…All patients were operated electively. Twenty-four patients underwent preoperative programmed electrical stimulation and 18 patients had inducible VT preoperatively [5]. Three patients had preoperative episodes of spontaneous VT.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Surgical ventricular restoration was performed according to the Dor technique, as previously described [5,9]. Mitral valve repair was performed in four patients.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Surgical ventricular restoration (SVR) by the Dor procedure is a surgical option designed to restore LV shape and volume in patients with ischemic heart disease and heart failure [3,4]. SVR includes complete revascularization, LV reconstruction to restore near-normal shape and volume and, when necessary, mitral valve repair and surgery for ventricular tachycardia [5]. The brain natriuretic peptide (BNP) and amino terminal pro-brain natriuretic peptide (NTpro-BNP) have been recognized as valuable biomarkers of cardiac function and prognosis in clinical practice [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Changes in B-type natriuretic peptides after surgical ventricular restoration

Sartipy

Albåge

Larsson

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: The aim of this study was to prospectively investigate changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NTpro-BNP) in relation to functional status after surgical ventricular restoration (SVR). Methods: Between March 2003 and May 2006, 29 patients (20 men and 9 women, mean age 65 years, mean ejection fraction 24%) with post-infarction left ventricular aneurysm and depressed left ventricular function underwent SVR according to the Dor technique at our institution. Twenty-two patients (76%) were in New York heart association (NYHA) functional class III or IV. Multi-vessel disease was present in 26 patients. Natriuretic peptides, functional status, ejection fraction and left ventricular volumes were analyzed at baseline, after 6 months, and late postoperatively. Results: There was no early mortality. Survival at 24 months was 93%. Six months postoperatively 25/29 (86%) patients were in NYHA class I and II ( p < 0.001) and at late (mean 21 months) follow-up, all patients were in NYHA class I and II. There was a persistent reduction of NT-pro-BNP (2406 pg/ml vs 1510 pg/ml; p = 0.03 and 975 pg/ml; p = 0.03) and BNP (312 pg/ml vs 228 pg/ml; p = 0.12 and 191 pg/ml; p = 0.20) 6 months postoperatively and at late follow-up, respectively. Ejection fraction improved from 24% to 37% ( p < 0.001) at 6 months. End-diastolic (110 ml/m 2 vs 90 ml/m 2 , p = 0.009) and end-systolic (75 ml/m 2 vs 52 ml/m 2 , p = 0.006) volume index were reduced at 6 months. Functional improvement correlated significantly with reduction in BNP (r = 0.61, p = 0.01) and NT-pro-BNP (r = 0.58, p = 0.003) 6 months after surgery. Ejection fraction correlated inversely with BNP (r = À0.58, p = 0.02) and NTpro-BNP (r = À0.51, p = 0.04), and end-systolic volume correlated with BNP (r = 0.65, p = 0.03) and NT-pro-BNP (r = 0.62, p = 0.03) 6 months after surgery. Conclusions: Heart failure secondary to post-infarction left ventricular remodeling can be reversed by SVR. Improvement in these patients was associated with reduced levels of B-type natriuretic peptides 6 months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up. #

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Surgery for Ventricular Tachycardia in Patients Undergoing Left Ventricular Reconstruction by the Dor Procedure

Cited by 52 publications

References 31 publications

Hypertrophic cardiomyopathy with apical aneurysm: left ventricular reconstruction and cryoablation for ventricular tachycardia

Hypertrophic cardiomyopathy with apical aneurysm: left ventricular reconstruction and cryoablation for ventricular tachycardia

Surgical Ventricular Restoration to Reverse Left Ventricular Remodeling

Changes in B-type natriuretic peptides after surgical ventricular restoration

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