Key result
Dor procedure linked to ~5.3-fold higher mortality than modified reconstruction in ischemic LV aneurysm.
Why the study?
Surgical reconstruction is the most effective treatment for post-MI left ventricular aneurysm, and several techniques are used to restore LV geometry and volume. This study sought to compare the clinical outcomes of modified left ventricular reconstruction versus the Dor procedure in patients with ischemic left ventricular aneurysm.
Does modified left ventricular reconstruction reduce all-cause mortality compared to the Dor procedure in patients with ischemic left ventricular aneurysm?
Cohort (n=324)
No
Does modified left ventricular reconstruction reduce all-cause mortality compared to the Dor procedure in patients with ischemic left ventricular aneurysm?
In patients undergoing surgical reconstruction for ischemic left ventricular aneurysm, modified left ventricular reconstruction was associated with lower long-term risks of all-cause mortality and MACCE compared to the traditional Dor procedure.
Supports preferring modified reconstruction over Dor in ischemic LV aneurysm; leaves open confirmation in prospective trials.
Background Left ventricular aneurysm (LVA) is one of the serious complications of myocardial infarction (MI) which adversely affects both the function and morphology of the left ventricular (LV). Surgical reconstruction remains the most effective approach for the treatment of LVA. Several surgical techniques are employed to restore the geometry and volume of the LV. This study aims to compare the clinical outcomes of modified left ventricular reconstruction (LVR) and the Dor procedure in ischemic left ventricular aneurysm (LVA) patients. Methods A retrospective study was conducted to evaluate 324 ischemic LVA patients who underwent left ventriculoplasty at our institution. Among these patients, 266 were treated with the modified LVR (modified LVR group) while the rest received the Dor procedure (patch group). The baseline discrepancies between the groups were addressed using propensity score matching (PSM) method. The primary endpoint was all-cause mortality. Results The median follow-up duration was 78.0 [72.0, 90.0] months. During the follow-up, all-cause mortality was observed in 45 (13.9%) patients. The unmatched analysis revealed that compared with the modified LVR group, the patch group reported a higher risk of all-cause mortality and MACCE. 54 pairs of patients were matched after PSM, and the risk of all-cause mortality (HR:5.35 95%CI:1.57 – 18.18, P = 0.007) and MACCE (HR:3.17 95%CI:1.35 – 7.47, P = 0.008) remained higher in the patch group in the PSM analysis. Conclusions Our results indicated that, compared with the Dor procedure, the modified LVR might be associated with a lower risk in LVA patients undergoing surgical reconstruction.
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Nan et al. (2026) conducted a cohort in Ischemic left ventricular aneurysm (n=324). Dor procedure (patch group) vs. Modified left ventricular reconstruction (LVR) was evaluated on All-cause mortality (HR 5.35, 95% CI 1.57-18.18, p=0.007). The Dor procedure was associated with higher all-cause mortality than modified left ventricular reconstruction in ischemic LV aneurysm (HR 5.35; 95% CI 1.57-18.18; P=0.007).
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