EARLY EXPERIENCE WITH THE DOR PROCEDURE IN THE TREATMENT OF VENTRICULAR TACHYCARDIA
|Department of 1Cardiothoracic Surgery; 2Anesthesiology; 3Department of Cardiology, Karolinska Institute at Huddinge University Hospital, Sweden|
Objective: Ventricular tachycardia (VT) is a common complication of post-infarction left ventricular (LV) aneurysm and carries a high mortality. Current surgical procedures include mapping-guided subendocardial resection or ICD-implantation. Vincent Dor has described a non-guided method of subtotal endocardiectomy.
Methods: Ten patients (5 males) with a mean age of 66 yr (range 49--74 yr) with an antero-apical LV aneurysm and clinical (n = 5) or only inducible (n = 5) VT underwent a Dor-type LV reconstruction. The mean global ejection fraction was 23% (range 7--40%). All patients had CABG (mean 2.3 grafts) and the left internal thoracic artery was used in all (LAD was grafted in 9/10 patients). Four patients also underwent mitral valve reconstruction. An endoventricular patch plasty with septal exclusion was performed in all patients and in 8/10 patients it was possible to perform a well-defined subtotal endocardiectomy which was supplemented with a series of cryoablations. The mean aortic cross-clamp time was 116 min and the mean cardiopulmonary bypass time was 190 min.
Results: There was no early mortality and no major complications. Two patients needed postoperative pharmacological inotropic support and one patient needed intra-aortic balloon pumping postoperatively. There has been no instances of postoperative VT. Nine patients underwent postoperative electrophysiologic testing. VT was no longer inducible in 7/9 patients, including all five patients with preoperatively clinical VT.
Conclusion: The Dor procedure can be performed with a low morbidity and mortality even in patients with severely depressed LV function and offers an effective treatment against VT in pats with LV aneurysm.