Long-Term Outcomes of Dor Versus Cooley Procedure in Patients With Post-Infarction Left Ventricular Aneurysm Repair: A Propensity Score-Matched Study.

Aim: The optimal surgical strategy for patients with post-infarction left ventricular aneurysms remains unclear. The superiority of the Dor technique over the Cooley repair has not been demonstrated in terms of long-term outcomes. This study aimed to compare the clinical outcomes between the Dor and Cooley repair techniques.

Methods: Patients who underwent left ventricular repair between 2003 and 2021 were retrospectively recruited. All the patients underwent left ventricular aneurysm repair and coronary artery bypass grafting. For comparative assessment of outcomes between the Cooley and Dor groups, 1:2 propensity score matching was applied. The primary study endpoint was long-term mortality, whereas the secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs), defined as a combination of cardiac death, myocardial infarction, stroke, readmission due to nonfatal myocardial infarction, and repeat revascularisation.

Results: The median follow-up period was 106 months (interquartile range: 41-148). Eight hospital deaths (2.1%) occurred in the Cooley group and 11 (5.1%) in the Dor group within 30 days postoperatively. For the entire follow-up period, the Dor group had lower mortality (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.45-0.99; p=0.043) and greater freedom from myocardial infarction (HR 0.41; 95% CI 0.18-0.93; p=0.033). The overall incidence of MACCEs was significantly lower in the Dor group (HR 0.65; 95% Cl 0.48-0.88; p=0.005). The Dor group showed a notably lower readmission rate (HR 0.63; 95% Cl 0.42-0.94; p=0.022).

Conclusions: For long-term survival and MACCEs, the Dor procedure demonstrated better outcomes than the Cooley reconstruction.