Surgery for ventricular tachycardia in patients undergoing left ventricular reconstruction by the Dor procedure.
BACKGROUND
Surgical ventricular restoration (the Dor procedure) is an option in patients with coronary artery disease and postinfarction left ventricular aneurysm. The procedure can be extended to treat ventricular tachycardia (VT). The aim of this study was to evaluate the Dor procedure including VT surgery in our institution.


METHODS
From July 1997 to December 2003, 53 consecutive patients with left ventricular aneurysm and VT underwent surgical ventricular restoration including nonguided endocardiectomy and cryoablation. Twenty-four patients had at least one preoperative episode of spontaneous VT, of which 8 were survivors of sudden cardiac death. Twenty-nine patients had inducible-only VT. In 45 patients, who underwent preoperative programmed stimulation, sustained uniform VT could be initiated. Arrhythmia control was evaluated by programmed stimulation or analysis of events registered by implanted defibrillators and by review of patient's records.


RESULTS
Early mortality was 2 of 53 (3.8%). Mean follow-up was 3.7 years. At 1, 3, and 5 years overall actuarial survival was 94%, 80%, and 59%, respectively. Surgical success rate in patients with preoperative spontaneous VT was 91%. Inducible VT was found in 5 of 35 patients who underwent postoperative programmed stimulation. There was no arrhythmia-related late death and there was no loss to follow-up.


CONCLUSIONS
The Dor procedure including VT surgery is an effective treatment for postinfarction left ventricular aneurysm and VT and eliminates the need for an implantable defibrillator in most patients. Early and long-term results are good in terms of survival and arrhythmia control.
Sartipy
Ulrik
U
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. ulrik.sartipy@karolinska.se
Albåge
Anders
A
Strååt
Eva
E
Insulander
Per
P
Lindblom
Dan
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D001026:Coronary Artery Bypass; D003452:Cryosurgery; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000209:etiology / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome