ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Ulrik Sartipy
Anders Albåge
Dan Lindblom
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sartipy, U.
Right arrow Articles by Lindblom, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sartipy, U.
Right arrow Articles by Lindblom, D.
Related Collections
Right arrow Electrophysiology - arrhythmias

Ann Thorac Surg 2006;81:65-71
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Surgery for Ventricular Tachycardia in Patients Undergoing Left Ventricular Reconstruction by the Dor Procedure

Ulrik Sartipy, MD a , * , Anders Albåge, MD, PhD a , Eva Strååt, MD b , Per Insulander, MD b , Dan Lindblom, MD, PhD a

a Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
b Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

Accepted for publication June 22, 2005.

* Address correspondence to Dr Sartipy, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden (Email: ulrik.sartipy{at}karolinska.se).


Adult cardiac surgery: To participate in The Annals of Thoracic Surgery CME Program, please visit http://cme.ctsnetjournals.org.

 

   Abstract
Top
 Abstract
Introduction
 Patients and Methods
 Results
 Comment
 Acknowledgments
 References
 
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.

Left ventricular aneurysm (LVA) is a serious complication of acute myocardial infarction (MI) associated with congestive heart failure and ventricular tachycardia (VT). Ventricular arrhythmias after MI are associated with high mortality and risk for sudden cardiac death [1–3]. Left ventricular aneurysm represents an independent predictor of late sudden cardiac death after acute MI [4]. Sustained VT induced by programmed electrical stimulation (PES) is also associated with increased mortality risk in patients with left ventricular (LV) ejection fraction less than 0.40 [5]. Recent studies indicate that monomorphic premature ventricular contractions originating from the scar border zone in ischemic cardiomyopathy can be triggers for ventricular fibrillation [6]. Early surgical attempts to treat refractory VT have been associated with high failure rates [7, 8]. Coronary artery bypass graft surgery alone does not eliminate the risk of ventricular arrhythmias in ischemic heart disease, especially not in the presence of poor LV function [9, 10].

In 1994, Dor and associates presented an addition to the original operation [11] for patients with VT, and a success rate of greater than 90% in curing VT was achieved [12]. Other centers have reported similar results using a map-guided approach and the Dor procedure [13]. In contrast, a recent report indicates that there is a high incidence of sudden death (37% of 19 deaths during median follow-up of 3.7 years) late after anterior LVA repair if concomitant antiarrhythmic surgery was not performed [14.] The aim of the present study was to evaluate the Dor procedure including VT surgery for postinfarction LVA and spontaneous or inducible VT and describe our 7-year experience of this procedure.


   Patients and Methods
Top
 Abstract
 Introduction
 Patients and Methods
Results
 Comment
 Acknowledgments
 References
 
Patient Selection
Our experience with surgical ventricular restoration (SVR) by means of the Dor procedure started in 1994 and is described elsewhere [15]. Patients were considered suitable for the Dor procedure if they demonstrated an enlarged either dyskinetic or akinetic LV accompanied by LV dysfunction after MI and had symptoms of angina or heart failure. In 1997 we were faced with a patient with ischemic cardiomyopathy (ejection fraction 0.07) and very frequent episodes of VT refractory to medical treatment. The patient underwent SVR including a nonguided subtotal endocardiectomy and cryoablation described in 1994 by Dor and colleagues [12]. Encouraged by the successful result in this patient, we included PES to our preoperative investigation protocol for patients eligible for SVR and performed the Dor procedure including VT surgery in all cases with preoperative spontaneous or inducible VT. The main reason for performing preoperative PES even in patients with preoperative spontaneous VT was to be able to evaluate the antiarrhythmic effect of the operation. However, some patients were considered unsuitable for PES because of their clinical status, and therefore preoperative PES was not performed in those patients. In patients with preoperative spontaneous VT, postoperative PES was conducted before discharge from the hospital. In patients with inducible-only VT, postoperative PES was performed 0.5 to 6 months after the operation. To study the antiarrhythmic efficiency of this procedure, we analyzed the outcome in 53 consecutive patients with preoperative spontaneous or inducible VT who underwent the Dor procedure including VT surgery.

Preoperative Investigations
Coronary angiography was performed in all patients, and the diagnosis and assessment of the LV was made by ventriculography. Transthoracic or transesophageal echocardiography was subsequently used to assess LV dimensions and function, as well as valvular function. Programmed electrical stimulation was performed before surgery and 0.5 to 6 months after surgery using a standard protocol including double or triple extra stimuli, three stimulation rates, and two locations. The protocol was terminated if sustained VT was induced. Sustained VT was defined as a tachycardia lasting more than 30 seconds or clinically requiring intervention before that.

Patient Characteristics
From July 1997 to December 2003, 53 consecutive patients underwent the Dor procedure including VT surgery for postinfarction dyskinetic LVA and VT. Follow-up was completed on October 15, 2004. Baseline patient characteristics and indications for surgery are presented in Tables 1 and 2. Go All patients were operated on electively, although 14 patients with spontaneous VT were hospitalized before the operation owing to life-threatening arrhythmias. All patients had a confirmed diagnosis of VT preoperatively, and 24 of these had spontaneous VT. Eight patients with spontaneous VT were survivors of sudden cardiac death. Forty-six patients underwent preoperative PES, and of these, 45 had inducible VT. Medication at preoperative PES was amiodarone (n = 4), sotalol (n = 1), other ß-blockers (metoprolol, atenolol, or carvedilol, n = 27), digoxin (n = 3), no antiarrhythmic medication (n = 9), and unknown in one case.


View this table:
[in this window]
[in a new window]
  		Table 1. Preoperative Patient Characteristics and Indications for Surgery a
 

View this table:
[in this window]
[in a new window]
  		Table 2. Preoperative Cardiac Performance a
 
In total, this study includes 53 patients of which 24 had spontaneous VT and 29 had inducible-only VT. Postoperative PES data will be presented separately for these two groups.

Surgical Technique
The operative procedure has been presented in detail elsewhere [15]. The specific antiarrhythmic technique consists of a subtotal nonguided endocardiectomy, which was conducted on the septum and anterior wall. Linear cryo lesions (Frigitronics CCS-200, CooperSurgical, Inc, Trumbull, CT) were applied at the edge of the endocardial resection [12]. The LV was reconstructed with a bovine pericardial patch.

Follow-Up
All patients were followed until mid-October 2004. Follow-up consisted of review of patients' records (including analysis of implantable cardioverter-defibrillator [ICD] stored device data when applicable) and our clinic's database and data from the Total Register of the Swedish Population, Statistics Sweden, and the Cause of Death Register, Centre for Epidemiology at the National Board of Health and Welfare, Sweden. No patient was lost to follow-up.

Statistical Analysis
Continuous variables are reported as mean ± standard deviation or median and range. Cumulative survival rates were calculated by Kaplan-Meier estimation. Differences between survival curves were analyzed by using the log-rank test. All analysis was performed with SPSS 13.0 (SPSS Inc, Chicago, IL).

Ethical Considerations
The present study was approved by the regional Human Research Ethics Committee, Stockholm, Sweden.


   Results
Top
 Abstract
 Introduction
 Patients and Methods
 Results
Comment
 Acknowledgments
 References
 
Operative Data
Operative data are summarized in Table 3. One patient who did not have revascularization had previously undergone coronary artery bypass grafting and had patent grafts. Mitral valve surgery was performed in 15 patients, using predominantly the Alfieri edge-to-edge technique [16] by the transventricular approach.


View this table:
[in this window]
[in a new window]
  		Table 3. Perioperative Data a
 
Early Findings
Early mortality was 2 of 53 patients (3.8%). There were no intraoperative deaths, but 2 patients died in the intensive care unit (1 and 50 days after primary operation) as a result of heart failure/low output syndrome and multiple organ failure, respectively. Postoperative stroke occurred in 1 patient who had complete regression of symptoms in 2 months. A summary of postoperative data is presented in Table 4.


View this table:
[in this window]
[in a new window]
  		Table 4. Postoperative Data a
 
Long-Term Findings
Mean follow-up of operative survivors (n = 51) was 3.7 ± 2.0 years (range, 0.1 to 7.0 years). The actuarial survival (including early mortality) is shown in Figure 1. Overall survival was 94% at 1 year, 80% at 3 years, and 59% at 5 years. There was no difference in survival between patients with preoperative spontaneous or inducible VT. Late causes of death were cardiac in 8 cases (congestive heart failure [n = 6], acute MI + stroke [n = 1] and congestive heart failure + breast cancer [n = 1]), noncardiac in 2 cases (stroke [n = 1] and renal failure [n = 1]), and undetermined in 5 cases. There was no arrhythmia-related death or sudden cardiac death. There was no loss to follow-up. One patient underwent mitral valve replacement 4 months after the primary operation because of mitral regurgitation. That patient did not undergo a mitral valve procedure at the primary operation. Mean ejection fraction, assessed by echocardiography 1 to 6 months after the operation, was 0.33 ± 0.095 (0.15–0.50).



View larger version (15K):
[in this window]
[in a new window]
  		Fig 1. Overall actuarial survival after the Dor procedure including ventricular tachycardia surgery. Dotted curves are upper and lower 95% confidence intervals.

 
Freedom From Postoperative Arrhythmia
Surgical success in terms of arrhythmia control was defined as freedom from postoperative spontaneous VT in operative survivors. Five patients had spontaneous VT postoperatively; thus overall success rate was 90% (46 of 51 patients). Postoperative PES was conducted in 35 patients and showed another 5 patients with inducible-only VT. Two of the patients with postoperative inducible-only VT were noted among the 5 patients with posterior aneurysm. Medication at postoperative PES was amiodarone (n = 3), sotalol (n = 9), other ß-blockers (metoprolol, atenolol or carvedilol, n = 9), digoxin (n = 2), no antiarrhythmic medication (n = 10), and unknown in two cases.

Patients With Preoperative Spontaneous Ventricular Tachycardia
Detailed results in patients with preoperative spontaneous VT are shown in Figure 2 and Table 5. Fifteen of 18 patients who underwent postoperative PES were noninducible at the postoperative study (Fig 2). Further, 4 of 5 patients without postoperative PES were also considered cured from VT (Table 5). Finally, 2 of 3 patients with inducible VT at postoperative PES were considered cured because one of them was noninducible at repeat PES and the other did not have any VT detected by the ICD that was implanted postoperatively. The success rate in these patients was 91% (15 + 4 + 2 = 21 of 23).



View larger version (46K):
[in this window]
[in a new window]
  		Fig 2. Detailed results in patients with preoperative spontaneous ventricular tachycardia (VT; n = 24) undergoing the Dor procedure including ventricular tachycardia surgery for left ventricular aneurysm and ventricular tachycardia. (ICD = implantable cardioverter-defibrillator; Med = antiarrhythmic medication; OP = operation; PES = programmed electrical stimulation.)

 

View this table:
[in this window]
[in a new window]
  		Table 5. Results in Patients With Preoperative Spontaneous Ventricular Tachycardia Who Did Not Undergo Postoperative Programmed Electrical Stimulation (n = 5)
 
Patients With Preoperative Inducible-Only Ventricular Tachycardia
In the group of patients with inducible-only VT (n = 29), postoperative PES was performed in 17 of 28 operative survivors, and 12 patients were noninducible. Inducible VT was found in 5 patients, and 2 of those also had postoperative spontaneous VT. One patient who did not undergo postoperative PES had spontaneous VT. Postoperative PES was not conducted in another 10 patients for various reasons; none of these had spontaneous VT. Four patients received an ICD. In conclusion, success rate in patients with preoperative inducible VT was 89% (25 of 28 patients).


   Comment
Top
 Abstract
 Introduction
 Patients and Methods
 Results
 Comment
Acknowledgments
 References
 
This study describes our results in a consecutive series of patients (n = 53) with preoperative findings of spontaneous or inducible VT who underwent SVR and nonguided endocardiectomy and cryoablation at our institution. Our total experience (n = 101) of SVR by means of the Dor procedure is presented elsewhere [15]. The overall survival in patients who underwent VT surgery in addition to SVR was not different from the group of patients who underwent SVR alone. Freedom from postoperative spontaneous VT was achieved in 90% of operative survivors.

Mechanisms of Ventricular Arrhythmia and Value of Programmed Electrical Stimulation
The ability to reproducibly initiate an arrhythmia by PES is considered a characteristic of reentrant arrhythmia and is the mechanism of sustained uniform VT associated with coronary artery disease [17]. Both nonsustained and sustained polymorphic arrhythmias, including ventricular fibrillation, can be induced even in persons without cardiac disease. However, in a person with cardiac disease or even a history of cardiac arrest, induction of polymorphic VT can have a clinical significance because a cardiac arrest may be initiated by a polymorphic VT. More importantly, the induction of a sustained uniform tachycardia only occurs in patients with spontaneous VT or cardiac arrest or in the presence of a substrate known to be arrhythmogenic such as an LVA or recent MI [18]. The possibility of inducing VT increases with decreasing LV function, and patients with depressed LV function and inducible sustained VT have a higher risk of spontaneous VT than those who do not have inducible VT [1, 3].

Does Revascularization Alone Prevent Recurrence of Ventricular Tachycardia?
In patients with inducible sustained monomorphic VT and scars as a result of prior MI, surgical revascularization alone will usually not be sufficient to prevent postoperative induction of the same arrhythmia, especially not in the presence of poor LV function [9, 10, 17].

Effectiveness of Surgical Ventricular Restoration and Concomitant Endocardiectomy or Cryoablation
In 1994 Dor and associates [12] reported excellent results of nonguided subtotal endocardiectomy and LV reconstruction in a series of 106 patients with spontaneous (n = 49) or inducible (n = 57) VT. In 67 of those, cryoablation was also added. Early (n = 96) and 1-year (n = 37) postoperative PES showed freedom from inducible VT at about 90%.

Mickleborough and coworkers [19] recently published their large experience of LV reconstruction in which 108 patients with preoperative VT included visually directed endocardial excision and peripheral cryoablation. Postoperative freedom from VT or sudden death was outstanding, and excluding patients receiving an ICD (n = 9), freedom from VT or sudden death was 99%, 97%, and 94% at 1, 5, and 10 years, respectively. The authors concluded that the combination of revascularization, LV reconstruction, and visually directed VT ablation appears to be very effective in preventing arrhythmias [19]. Other authors have reported good antiarrhythmic results after cryoablation or endocardial resection and various techniques for aneurysm repair with or without intraoperative mapping [13, 20–24].

Is Endocardiectomy and Cryoablation Necessary in Patients With Ventricular Tachycardia Undergoing Surgical Ventricular Restoration?
The goal of the Dor procedure is to achieve complete coronary revascularization, reduce LV volume, and restore LV shape to relieve ischemia and reduce wall tension. Inasmuch as it has been shown that myocardial stretch is arrhythmogenic [25], it is plausible that ventricular reconstruction, restoring near-normal LV size and form and thus reducing wall tension, should have a beneficial effect on electrical instability. It has recently been reported that SVR creates a mechanical intraventricular resynchronization in patients with ischemic cardiomyopathy and with no preoperative electrical conduction delay [26]. It has also been shown in patients with ischemic cardiomyopathy that cardiac resynchronization therapy reduces both inducibility of VT [27] and frequency of VT episodes [28, 29]. Thus, it seems that intraventricular resynchronization, either by SVR or biventricular pacing, reduces ventricular arrhythmias in the dilated heart. The mechanism for this improvement may be related to the beneficial effects on LV synchrony, because improved synchrony will not only improve LV hemodynamics but also homogenize regional wall stress and reduce regional prestretch, which is potentially arrhythmogenic [30]. In contrast to these theories, a recent report [14] found a high incidence of sudden death late after surgery for LVA without concomitant antiarrhythmic surgery. However, according to these authors, a limitation of their study was the lack of postoperative data on LV dimensions. Mapping studies by Mickleborough and coworkers [31] in patients with recurrent VT showed that ease of arrhythmia induction was related to mechanical loading conditions. One possible explanation for late recurrences of ventricular arrhythmias after LV reconstruction might therefore be progressive remodeling and LV enlargement. In our opinion, the Dor procedure including endocardiectomy and cryoablation is the method of choice to ensure postoperative arrhythmia control.

Preferred Treatment in Case of Antiarrhythmic Surgical Failure
In cases with postoperative confirmed spontaneous or inducible VT, a prophylactic ICD should be the recommended option. Recently published data from the Sudden Cardiac Death in Heart Failure Trial Investigators demonstrate that amiodarone has no favorable effect on survival whereas ICD therapy reduces mortality in patients with symptoms of heart failure and LV dysfunction [32].

Should All Patients Undergoing Surgical Ventricular Restoration Have a Prophylactic Implantable Cardioverter-Defibrillator Postoperatively?
Patients with coronary artery disease and previous acute MI are at risk for recurrent coronary events such as development of heart failure, ventricular arrhythmias, and sudden cardiac death. The MADIT-II trial (Multicenter Automatic Defibrillator Trial II) reported that prophylactic implantation of a defibrillator improved survival in patients with a prior MI and severe LV dysfunction [33, 34]. It also showed that new or worsened heart failure requiring hospitalization was more frequent in the defibrillator group than in the conventional-therapy group. The authors argue that patients saved from malignant ventricular arrhythmias by the ICD live longer than conventionally treated patients and thus would have more time for heart failure to develop. Also, ICD shocks might contribute to rehospitalization and myocardial injury, and backup ventricular pacing may impair LV function [33, 34]. Because ICD therapy does not address the problem of the substrate of VT, merely the consequences, it is desirable to achieve abolishment of malignant ventricular arrhythmias. In our view, implantation of an ICD after the Dor procedure including VT surgery is considered a surgical failure. For these reasons, it is our policy to only recommend ICD implantation for patients with documented antiarrhythmic surgical failure. There has been no arrhythmia-related death during follow-up in our series, suggesting that over time, this treatment policy is valid.

Limitations of the Study
The lack of a control group is the major limitation of this study. Another limitation is the lack of postoperative PES in some patients, and that the preoperative and postoperative PES was not always conducted in patients completely free from antiarrhythmic medication. We have not had complete follow-up of concurrent medication, but all patients have had regular contact with a cardiologist or family physician. The use of ß-blockers and angiotensin-converting enzyme inhibitors for patients with LV dysfunction was common during the study period. However, the preoperative, perioperative, and postoperative data have been prospectively gathered in our clinic's database and no patient was lost to follow-up.

Clinical Implication
These severely ill patients with critical prognosis represent a surgical challenge by presenting with multiple symptoms such as angina, heart failure, and life-threatening arrhythmias. In our opinion, a thorough preoperative assessment and a focused surgical strategy can improve outcome in these patients. This concept was introduced by Dor and associates and consists of complete revascularization to relieve ischemia, ventricular reconstruction to restore normal shape and volume to reduce LV wall tension and improve hemodynamics, and, when necessary, endocardiectomy and cryoablation to remove substrate for arrhythmia. Mitral valve repair is performed as needed.

This study cannot bring clarification to which one of these components is most effective for each problem, but it does, however, show that gratifying results in terms of survival and arrhythmia control can be achieved by applying the concepts introduced by Dor and associates.

In conclusion, this study shows that the Dor procedure including endocardiectomy and cryoablation yields a very high (90%) freedom from spontaneous VT and eliminates the need for an ICD in most patients. The long-term result in terms of survival was satisfactory.


   Acknowledgments
Top
 Abstract
 Introduction
 Patients and Methods
 Results
 Comment
 Acknowledgments
References
 
This work was supported by grants from the Swedish Heart Lung Foundation and Capio Research Foundation.


   References
Top
 Abstract
 Introduction
 Patients and Methods
 Results
 Comment
 Acknowledgments
 References
 

  1. Bourke JP, Richards DA, Ross DL, Wallace EM, McGuire MA, Uther JB. Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-upresults, optimal stimulation protocol and cost-effective screening. J Am Coll Cardiol 1991;18:780-788.[Abstract]
  2. Marchlinski FE, Waxman HL, Buxton AE, Josephson ME. Sustained ventricular tachyarrhythmias during the early postinfarction periodelectrophysiologic findings and prognosis for survival. J Am Coll Cardiol 1983;2:240-250.[Abstract]
  3. Wilber DJ, Olshansky B, Moran JF, Scanlon PJ. Electrophysiological testing and nonsustained ventricular tachycardia. Use and limitations in patients with coronary artery disease and impaired ventricular function Circulation 1990;82:350-358.[Abstract/Free Full Text]
  4. Hassapoyannes CA, Stuck LM, Hornung CA, Berbin MC, Flowers NC. Effect of left ventricular aneurysm on risk of sudden and nonsudden cardiac death Am J Cardiol 1991;67:454-459.[Medline]
  5. Buxton AE, Lee KL, DiCarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death N Engl J Med 2000;342:1937-1945.[Abstract/Free Full Text]
  6. Marrouche NF, Verma A, Wazni O, et al. Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy J Am Coll Cardiol 2004;43:1715-1720.[Abstract/Free Full Text]
  7. Bourke JP, Campbell RW, McComb JM, Furniss SS, Doig JC, Hilton CJ. Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator eraearly and long term outcomes in 100 consecutive patients. Heart 1999;82:156-162.[Abstract/Free Full Text]
  8. Stephenson LW, Hargrove 3rd WC, Ratcliffe MB, Edmunds Jr LH. Surgery for left ventricular aneurysm. Early survival with and without endocardial resection Circulation 1989;79(Pt 2):I108-I111.
  9. Kaul TK, Fields BL, Riggins LS, Wyatt DA, Jones CR. Ventricular arrhythmia following successful myocardial revascularizationincidence, predictors and prevention. Eur J Cardiothorac Surg 1998;13:629-636.
  10. O'Rourke RA. Role of myocardial revascularization in sudden cardiac death Circulation 1992;85(Suppl 1):I112-I117.
  11. Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysma new surgical approach. Thorac Cardiovasc Surg 1989;37:11-19.[Medline]
  12. Dor V, Sabatier M, Montiglio F, Rossi P, Toso A, Di Donato M. Results of nonguided subtotal endocardiectomy associated with left ventricular reconstruction in patients with ischemic ventricular arrhythmias J Thorac Cardiovasc Surg 1994;107:1301-1308.[Abstract/Free Full Text]
  13. Rastegar H, Link MS, Foote CB, Wang PJ, Manolis AS, Estes 3rd NA. Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy Circulation 1996;94:1041-1048.[Abstract/Free Full Text]
  14. Matthias Bechtel JF, Tolg R, Graf B, et al. High incidence of sudden death late after anterior LV-aneurysm repair Eur J Cardiothorac Surg 2004;25:807-811.[Abstract/Free Full Text]
  15. Sartipy U, Albåge A, Lindblom D. The Dor procedure for left ventricular reconstruction. Ten-year clinical experience Eur J Cardiothorac Surg 2005;27:1005-1010.[Abstract/Free Full Text]
  16. Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge techniquea simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg 1998;13:240-246.[Abstract/Free Full Text]
  17. Cox JL. Cardiac surgery for arrhythmias J Cardiovasc Electrophysiol 2004;15:250-262.[Medline]
  18. Josephson ME. Clinical Cardiac Electrophysiology, Techniques and Interpretations2nd ed. Philadelphia, PA: Lea & Febiger; 1993. pp. 436-437.
  19. Mickleborough LL, Merchant N, Ivanov J, Rao V, Carson S. Left ventricular reconstructionearly and late results. J Thorac Cardiovasc Surg 2004;128:27-37.[Abstract/Free Full Text]
  20. Wellens F, Geelen P, Demirsoy E, et al. Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation Eur J Cardiothorac Surg 2002;22:771-776.[Abstract/Free Full Text]
  21. von Oppell UO, Milne D, Okreglicki A, Scott Millar RN. Surgery for ventricular tachycardia of left ventricular originrisk factors for success and long-term outcome. Eur J Cardiothorac Surg 2002;22:762-770.[Abstract/Free Full Text]
  22. Pirk J, Bytesnik J, Kautzner J, et al. Surgical ablation of post-infarction ventricular tachycardia guided by mapping in sinus rhythmlong term results. Eur J Cardiothorac Surg 2004;26:323-329.[Abstract/Free Full Text]
  23. Demaria RG, Mukaddirov M, Rouviere P, et al. Long-term outcomes after cryoablation for ventricular tachycardia during surgical treatment of anterior ventricular aneurysms Pacing Clin Electrophysiol 2005;28(Suppl 1):S168-S171.
  24. Sosa E, Jatene A, Kaeriyama JV, et al. Recurrent ventricular tachycardia associated with postinfarction aneurysm. Results of left ventricular reconstruction J Thorac Cardiovasc Surg 1992;103:855-860.[Abstract]
  25. Koilpillai C, Quinones MA, Greenberg B, et al. Relation of ventricular size and function to heart failure status and ventricular dysrhythmia in patients with severe left ventricular dysfunction Am J Cardiol 1996;77:606-611.[Medline]
  26. Di Donato M, Toso A, Dor V, et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy Circulation 2004;109:2536-2543.[Abstract/Free Full Text]
  27. Zagrodzky JD, Ramaswamy K, Page RL, et al. Biventricular pacing decreases the inducibility of ventricular tachycardia in patients with ischemic cardiomyopathy Am J Cardiol 2001;87:1208-1210.[Medline]
  28. Higgins SL, Yong P, Sheck D, et al. Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators J Am Coll Cardiol 2000;36:824-827.[Abstract/Free Full Text]
  29. Kies P, Bax JJ, Molhoek SG, et al. Effect of left ventricular remodeling after cardiac resynchronization therapy on frequency of ventricular arrhythmias Am J Cardiol 2004;94:130-132.[Medline]
  30. Breithardt OA, Stellbrink C, Herbots L, et al. Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block J Am Coll Cardiol 2003;42:486-494.[Abstract/Free Full Text]
  31. Mickleborough LL, Usui A, Downar E, Harris L, Parson I, Gray G. Transatrial balloon technique for activation mapping during operations for recurrent ventricular tachycardia J Thorac Cardiovasc Surg 1990;99:227-233.[Abstract]
  32. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure N Engl J Med 2005;352:225-237.[Abstract/Free Full Text]
  33. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction N Engl J Med 2002;346:877-883.[Abstract/Free Full Text]
  34. Steinberg JS, Fischer AVI, Wang P, et al. The clinical implications of cumulative right ventricular pacing in the Multicenter Automatic Defibrillator Trial II J Cardiovasc Electrophysiol 2005;16:359-365.[Medline]



This article has been cited by other articles:


Home page
 MMCTSHome page
D. Lindblom, A. Albage, and U. Sartipy
Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration
MMCTS, December 17, 2007; 2007(1217): 2816.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
U. Sartipy, A. Albage, P. T. Larsson, P. Insulander, and D. Lindblom
Changes in B-type natriuretic peptides after surgical ventricular restoration
Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 922 - 928.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
U. Sartipy, A. Albage, E. Mattsson, and D. Lindblom
Edge-to-Edge Mitral Repair Without Annuloplasty in Combination With Surgical Ventricular Restoration
Ann. Thorac. Surg., April 1, 2007; 83(4): 1303 - 1309.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
U. Sartipy, A. Albage, and D. Lindblom
Improved Health-Related Quality of Life and Functional Status After Surgical Ventricular Restoration
Ann. Thorac. Surg., April 1, 2007; 83(4): 1381 - 1387.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Di Donato, M. Sabatier, L. Menicanti, and V. Dor
Incidence of ventricular arrhythmias after left ventricular reconstructive surgery
J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 289 - 291.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
G. Buckberg
Editorial comment: Left ventricular reconstruction for dilated ischemic cardiomyopathy: biology, registry, randomization, and credibility
Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 759 - 761.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
U. Sartipy, A. Albage, and D. Lindblom
Risk factors for mortality and hospital re-admission after surgical ventricular restoration
Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 762 - 769.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
U. Sartipy, A. Albage, and D. Lindblom
Implantable cardioverter-defibrillator after left ventricular reconstruction?
J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1210 - 1211.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Ulrik Sartipy
Anders Albåge
Dan Lindblom
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sartipy, U.
Right arrow Articles by Lindblom, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sartipy, U.
Right arrow Articles by Lindblom, D.
Related Collections
Right arrow Electrophysiology - arrhythmias

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS