title: Ventricular reconstruction results in improved left ventricular function and amelioration of mitral insufficiency.
abstract: BACKGROUND
  Surgical restoration of the left ventricular wall (Dor procedure) has been advocated as a therapy for left ventricular dysfunction due to ischemic cardiomyopathy. This procedure involves placement of an endoventricular patch through a ventriculotomy.
  
  
  METHODS
  We reviewed our series of patients that underwent the Dor procedure within the past 4 years and examined their pre and postoperative ventricular function and mitral valve function. Pre and postoperative ejection fraction and degree of mitral regurgitation were analyzed using the paired Student t-test. We hypothesized that this procedure would result in improved ventricular function and that it would also help improve mitral valve function.
  
  
  RESULTS
  Thirty-four patients underwent this procedure, with one death. Of these, 30 patients underwent concomitant coronary artery bypass grafting and 8 patients had mitral intervention (seven had an Alfieri repair of the mitral valve, and one had mitral valve annuloplasty). The average preoperative ejection fraction among these patients was 26.8% (range 10-45%). The postoperative ejection fraction was significantly higher at 35.4% (range 25-52%) (P <.001). We noted an improvement in ejection fraction in 27 patients (82%). We also noted that 21 of 33 patients (64%) had improvement in the degree of mitral regurgitation based on echocardiography data (P <.001).
  
  
  CONCLUSIONS
  We conclude that the Dor procedure results in improvement in the left ventricular function. Furthermore, we also note that this procedure ameliorates mitral regurgitation in a majority of these patients even in the absence of associated mitral valve procedures, probably due to reduction in the size of the ventricle and improved orientation of the papillary muscles.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville 22908, USA. akaza1@yahoo.com
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.forename: Mayank R
authors.initials: MR
authors.lastname: Patel
authors.forename: Steven M
authors.initials: SM
authors.lastname: Fiser
authors.forename: Stewart M
authors.initials: SM
authors.lastname: Long
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Tribble
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D011093:Polyethylene Terephthalates; D019736:Prostheses and Implants; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000601:surgery*
chemical_list: D011093:Polyethylene Terephthalates