title: Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of cardiac events after endoventricular circular patch plasty (Dor operation) by analyzing our experience with Dor operation.
  
  
  METHODS
  Thirty patients with left ventricular aneurysm and/or ischemic cardiomyopathy who underwent Dor operation were included in this study. Hemodynamic and clinical results were analyzed, and the predictors of cardiac events were examined.
  
  
  RESULTS
  Hospital mortality was 3.3%. Postoperative clinical status and left ventricular (LV) function in all survivors significantly improved. The survival rates at 1, 3, and 5 years after operation were 93%, 89% and 89%. The corresponding cardiac event-free rates were 75%, 67% and 49%. Pre- and postoperative LV function and volume did not differ significantly between patients with or without cardiac events. However, the proportion of reduced end-diastolic volume index (EDVI) (preoperative EDVI-postoperative EDVI) to preoperative EDVI was significantly higher in patients with cardiac events than in cardiac event-free patients. Postoperative LV volume re-increased in the cases with cardiac events during follow-up. Cox regression analysis confirmed that preoperative clinical premature ventricular contraction and end-systolic volume index (ESVI), postoperative EDVI, ESVI, and ejection fraction were independent predictors of late cardiac events. There was a significant positive correlation between preoperative ESVI and postoperative EDVI.
  
  
  CONCLUSIONS
  Though LV function significantly improved after Dor operation, LV reconstruction with excessive reduction can cause restarting LV remodeling and increasing mortality and morbidity. Therefore, LV reconstruction of appropriate sizes and shapes, considering the function of residual myocardium, has a significant effect on prognosis. It is highly reasonable to expect that preoperative ESVI can predict the optimal size of reconstructed left ventricle.
authors.affiliation: Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Kokaji
authors.forename: Hankei
authors.initials: H
authors.lastname: Shin
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hotoda
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Mori
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kumamaru
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yozu
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006322:Heart Aneurysm / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D013318:Stroke Volume; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling