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Research Article | DOI: https://doi.org/10.5281/zenodo.15791584

Single-Surgeon Outcomes of Left Ventricular Aneurysm Repair in Wartime Syria: A 10-Year Retrospective Study at Damascus University Cardiac Surgery Hospital

Ahmad Mohammad Ramadan 1, Safana Abdullah Algutaini 2*, Nada Muhammad Eid Alsabbagh 3, Mohammed Kamel Hasan 4, Mohannad Adnan Saleh 5

1  Consultant Cardiac Surgeon,University Cardiac Surgery Hospital, Damascus, Syria.

2 Epidemiologist, East Carolina University, North Carolina, USA.

3 Consultant Cardiologist,University Cardiac Surgery Hospital, Damascus, Syria.

4 Specialist Cardiac Surgeon,University Cardiac Surgery Hospital, Damascus, Syria.

5 Specialist Cardiac Surgeon,University Cardiac Surgery Hospital, Damascus, Syria.

*Corresponding Author: Safana Abdullah Algutaini , Epidemiologist, East Carolina University, North Carolina, USA

Citation: Ahmad Mohammad Ramadan, Safana Abdullah Algutaini, Nada Muhammad Eid Alsabbagh, Mohammed Kamel Hasan, Mohannad Adnan Saleh (2025). Single-Surgeon Outcomes of Left Ventricular Aneurysm Repair in Wartime Syria: A 10-Year Retrospective Study at Damascus University Cardiac Surgery Hospital, J Biomedical Research and Clinical Advancements. 2(3) 22, DOI: 10.5281/zenodo.15791584.

Copyright: Safana Abdullah Algutaini, et al © (2025). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 07 June 2025 | Accepted: 10 June 2025 | Published: 19 June 2025

Keywords: surgeon; left ventricular; cardiac surgery; surgical ventricular reconstruction (svr)

Abstract

Background:

Surgical ventricular reconstruction (SVR) is a key procedure for patients with ischemic left ventricular aneurysms, particularly in low-resource and conflict-affected regions. This 10-year retrospective study evaluates the clinical, hemodynamic, and structural outcomes of SVR performed by a single surgeon (Dr. Ahmad Ramadan) at Damascus University Cardiac Surgery Hospital in Syria.

Methods:

We reviewed 90 patients who underwent SVR between October 2012 and January 2022. Two surgical techniques were used: linear closure (n = 51) and Dor procedure (n = 39). All surgeries were performed using cardiopulmonary bypass with mild hypothermia and intermittent antegrade cold blood cardioplegia, administered in the aortic root and in venous grafts every 15–20 minutes. Grafts included the left internal mammary artery and a saphenous vein. A temporary intraventricular sizing balloon was used to guide reconstruction, and Dacron or bovine pericardial patches were utilized in Dor repairs to preserve optimal ventricular geometry and prevent low cardiac output syndrome. Additional procedures included mitral valve repair (n = 16), mitral valve replacement (n = 6), and tricuspid valve interventions (n = 9).

Echocardiographic data were collected preoperatively and postoperatively, including left ventricular diameters (LVEDD, LVESD), volumes (LVEDV, LVESV), indexed volumes (LVEDVI, LVESVI), ejection fraction (EF), and pulmonary arterial pressure (PAP). About 70% of patients underwent left ventriculography, and 100% underwent nuclear imaging for myocardial viability assessment.

Results:

Postoperative outcomes showed a significant improvement in mean ejection fraction (from 42.5% to 47.4%), NYHA functional class (from 3.12 to 1.74), and pulmonary arterial pressure (from 44.6 mmHg to 31.1 mmHg). Indexed left ventricular volumes were markedly reduced: LVEDVI and LVESVI declined by an average of 14.2 and 10.5 mL/m², respectively. Among patients initially in NYHA class IV (n = 21), 90.5% improved to class II or lower at follow-up. The need for inotropic support was categorized as mild (34.4%), moderate (48.9%), and severe (16.7%).

Postoperative complications included pneumonia (6.6%), atrial fibrillation (3.3%), bleeding (4.4%), wound infection (4.4%), arrhythmia, conduction blocks, acute renal failure, and cardiopulmonary bypass (CPB)-related effects. The 30-day mortality rate was 10%, primarily due to heart failure (33.3%), cardiogenic shock (22.2%), CPB-related complications (22.2%), septic shock (11.1%), and pulmonary complications (11.1%). Mortality was slightly higher in Dor group (12.8%) compared to linear repair (7.8%).

Conclusion:

Surgical ventricular reconstruction—when performed by an experienced surgeon even under wartime constraints—can yield substantial improvements in left ventricular geometry, function, and clinical status. While both Dor and linear techniques were effective, linear repair showed slightly lower mortality, whereas Dor repair provided greater reverse remodeling. These findings support the feasibility and safety of complex cardiac surgery in resource-limited settings when guided by structured surgical protocols and individualized patient care.

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Testimonial for the Journal of Biomedical Research and Clinical Advancements It was a truly rewarding experience publishing our study, "Single-Surgeon Outcomes of Left Ventricular Aneurysm Repair in Wartime Syria: A 10-Year Retrospective Study at Damascus University Cardiac Surgery Hospital," with the Journal of Biomedical Research and Clinical Advancements. The editorial and peer-review process was both rigorous and efficient, demonstrating a high standard of academic integrity and scientific scrutiny. The journal’s commitment to open access and global health equity is evident in its support of research emerging from conflict-affected and resource-limited settings—making our work not only visible but impactful. The professionalism of the editorial team, the speed of communication, and the clarity of submission guidelines all contributed to a smooth publication process. We were particularly impressed by the quality of the publication layout and the prompt indexing of our article, which enhances its accessibility to clinicians, researchers, and policymakers worldwide. We are proud to have contributed to this journal and highly recommend it to fellow researchers seeking a reputable platform to disseminate clinically significant and globally relevant findings.