Dor procedure

Dor procedure, also known as the endocardial ventriculotomy, is a surgical technique used in the treatment of heart failure resulting from myocardial infarction (heart attack). This procedure is named after Vincent Dor, the cardiac surgeon who pioneered it. The Dor procedure is specifically aimed at improving the function of the left ventricle, which is often compromised following a heart attack. The technique involves the reshaping and restoration of the left ventricular cavity through the exclusion of non-functional, scarred heart tissue.

Indications

The Dor procedure is indicated for patients with heart failure secondary to a myocardial infarction, leading to the formation of a left ventricular aneurysm. Patients who are candidates for this surgery typically exhibit symptoms of congestive heart failure, such as shortness of breath, reduced exercise capacity, and fluid retention, despite optimal medical management. The procedure is considered when the damaged area of the heart is localized and involves a significant portion of the left ventricle.

Procedure

The surgery is performed under general anesthesia. The surgeon accesses the heart through a median sternotomy, where the chest is opened down the middle. The heart is temporarily stopped, and the patient is placed on a cardiopulmonary bypass machine, which takes over the heart's pumping function during the operation.

The surgeon then makes an incision into the scarred area of the left ventricle. The non-functional scar tissue is carefully removed, and the ventricular cavity is reshaped. This is achieved by suturing the edges of the remaining healthy tissue together, effectively excluding the scarred area and reducing the size of the ventricle. This process is known as endoventricular circular patch plasty (EVCPP) or the Dor plasty.

In some cases, a synthetic patch may be used to reinforce the ventricular wall and maintain the new shape of the left ventricle. The goal is to restore the ventricle to a more normal size and shape, thereby improving its pumping efficiency.

Benefits and Risks

The Dor procedure can significantly improve symptoms of heart failure, enhance the quality of life, and increase survival rates in selected patients. By restoring the left ventricle's shape and function, the procedure can help to alleviate symptoms such as fatigue and shortness of breath.

However, as with any major surgery, there are risks involved. These may include bleeding, infection, stroke, or the need for repeat surgery. The risk of complications is higher in patients with severe heart failure or other comorbidities.

Recovery

Recovery from the Dor procedure involves a stay in the intensive care unit (ICU) followed by a period of hospitalization. The total length of stay can vary depending on the patient's overall health and the presence of any complications. After discharge, patients will typically undergo cardiac rehabilitation to gradually improve their heart's function and their physical fitness.

Conclusion

The Dor procedure represents a significant advancement in the surgical treatment of heart failure due to left ventricular aneurysm following a myocardial infarction. By addressing the structural abnormalities of the heart, this technique offers hope for improved outcomes in patients who might otherwise face a progressive decline in their condition. As with any surgical intervention, careful patient selection and management of perioperative risks are essential to achieving the best possible results.