Combined surgical left ventricular reconstruction and left ventricular assist device implantation for destination therapy in end-stage heart failure.

End-stage heart failure is a growing problem associated with high mortality, using conventional medical care.1 Although heart transplantation remains the gold standard therapy for end-stage heart failure, it is a limited resource that is not applicable to a large portion of heart failure patients, particularly the elderly. An alternative strategy for patients who do not meet standard heart transplantation criteria is destination therapy with left ventricular assist device (LVAD) implantation.2 The implantation of nonpulsatile, continuousflow LVADs has become a relatively routine procedure in large surgical centers that is associated with a relatively low complication rate.3 However, cannulation for LVAD implantation is occasionally challenging. In particular, patients who have undergone a LV restoration and patch volume reduction plasty (ie, “Dor procedure”)4 pose a particular challenge. We describe a favorable 1-year outcome for a severely symptomatic patient with chronic ischemic heart failure and a large LV aneurysm treated by a Dor procedure and simultaneous LVAD implantation.