c  2010 Wiley Periodicals, Inc. 147 Left Ventricular Aneurysm Using the Dor Technique: Mid-term Results Hayrettin Tek ¨ umit, M.D., * Adil Polat, M.D.,† Ibrahim Uyar, M.D.,† Kemal Uzun, M.D., * Cenk Tataro ˘ glu, M.D., * Ali Riza Cenal, M.D., * and Esat Akinci, M.D. * ∗ Avrupa Safak Hastanesi, Istanbul, Turkey; and †JFK Hospital, Istanbul, Turkey ABSTRACT Objective: We have retrospectively analyzed the early and the mid-term results of the operations for modified endoventricular circular patch plasty for left ventricular aneurysm (LVA) repair in our clinic. Patients and methods: Sixty-seven cases with anterior LVA were included in the study. Mean age of the pa- tients were 64.8 ± 8.9 (ranged from 51 to 74) years. Fifty-three patients were male and 14 female (M:F = 3.8). Preoperative left ventricular ejection fraction (LVEF) was 30.8% ± 4.5%, LV end-diastolic diameter (LVEDD) 6.0 ± 1.9 cm, and end-systolic diameter (LVESD) was 4.6 ± 0.8 cm in average. Coronary revascularization was performed in 61 patients and mitral ring annuloplasty in five patients. Results: Thirty-day mortality was 5.9%. The surviving 63 patients were followed up for 4.3 ± 2.3 years on average (ranged from 0.2 to 8.5 years), adding up to 267.8 patient/years. In the immediate postoperative and long-term follow-up, there was a significant improvement in LVEF, LVESD, LVEDD, and mitral valvular function. Four patients died in the follow-up with only a single patient due to cardiac causes. The five years survival was 87.7% ± 4.1% and the freedom from cardiac death was 98.2% ± 1.7%. Conclusion: LVA repair with Dor procedure can be performed with low mortality. With appropriate repair of LVA and coronary revascularization, patients may have benefit both for survival and also for clinical status. doi: 10.1111/j.1540-8191.2009.00971.x (J Card Surg 2010;25:147-152) Left ventricular aneurysm (LVA) has been strictly de- fined as a distinct area of abnormal left ventricular (LV) diastolic contour with systolic dyskinesia or akinesia that reduces left ventricular ejection fraction (LVEF). The incidence of LVA in patients suffering myocardial infarction (MI) has varied between 10% and 35%. Over 95% of true LVA cases result from transmural myocar- dial MI owing to acute occlusion of the left anterior descending artery (LAD) (88%) or dominant right coro- nary artery. 1 The techniques of the surgical treatment of LVA have been performed for nearly 50 years and can be grossly classified into two different categories: linear recon- struction (plication and linear repairs) or geometric re- construction (circular patch/endoventricular patch clo- sure and/or direct left ventricle reconstruction using multiple concentric purse string sutures) techniques. 2 Likoff and Bailey were among the pioneers in LVA surgery who, in 1955, placed a large clamp on a huge aneurysm that was resected and sutured. 3 Later on, Cooley et al. described a simple technique of lateral re- section and direct closure 4 that remained the usual way to correct any LVA up to the mid-1980s, when, inde- pendently, Jatene 5 and Dor et al. 6 reported two tech- niques that allowed a more anatomical reconstruction Address for correspondence: Adil Polat, M.D., JFK Hospital, Cardio- vascular Surgery, Talatpasa Bulvari, Begonya Sok No. 7-9, 34590, Bahcelievler, Istanbul, Turkey. Fax: +90 212 4411300; e-mail: adilpol@yahoo.com of LV shape for dyskinetic or akinetic areas following myocardial MI in the LAD territory. 7 In this study, we have retrospectively analyzed the early and the mid-term results of the patients who un- derwent modified endoventricular circular patch plasty (Dor procedure) for LVA repair in our clinic. PATIENTS AND METHODS Patients The study was approved by the Institutional Ethics Committee. Between February 2001 and June 2009, Dor procedure was performed in 76 patients. Seven cases had post-MI ventricular septal defect (VSD) with LVA who were reported in another study. 8 Another two patients with posterobasal aneurysm were also excluded from the study. The remaining 67 cases with anterior LVA due to transmural MI in the LAD territory were included in the study. Mean age of the patients were 64.8 ± 8.9 (ranged from 51 to 74) years. There were 53 male and 14 fe- male patients (M:F = 3.8). The preoperative character- istics of the patients are outlined in Table 1. The preop- erative functional status of the patients was New York Heart Association (NYHA) Class 3.0 ± 0.6 in average (median: Class 3). Three patients (4.5%) had a history of thromboembolism. The mean duration from the pa- tients having MI to the operation (years) is 8.6 ± 2.1 months (2 to 48 months). The location of the aneurysm was anterior due to anterior MI in all patients.