Dor Procedure: Reshaping The Left Ventricle To Treat Heart Attacks & Heart Failure

The Dor procedure, also known as surgical ventricular restoration (SVR), is a surgical technique used to reshape and restore the left ventricle’s function in patients who have experienced heart attacks or suffer from heart failure. This procedure is particularly beneficial for those who have developed left ventricular aneurysms or significant scarring following a heart attack, which can lead to an enlarged, weakened heart that struggles to pump blood effectively.

Understanding the Problem

When a heart attack occurs, part of the heart muscle is deprived of oxygen, causing it to become damaged or die. This damage often results in the formation of scar tissue, which can weaken the left ventricle's wall and cause it to bulge outward, forming what’s known as a ventricular aneurysm. As a result, the left ventricle, which is the heart's main pumping chamber, becomes enlarged and less efficient at pumping blood. This enlargement can lead to heart failure, as the heart struggles to maintain adequate blood circulation throughout the body.

How the Dor Procedure Works

The primary goal of the Dor procedure is to reshape and reduce the size of the left ventricle, improving its pumping ability. During the surgery, the heart is accessed through an incision in the chest, and the patient is connected to a heart-lung machine to maintain blood circulation while the heart is temporarily stopped.

The surgeon identifies the scarred or damaged area of the left ventricle and removes it or sutures it inward to reduce its size. A synthetic patch is then sewn into place over the opening left by the removed scar tissue, allowing the surgeon to restore the ventricle to a more normal, elliptical shape. The patch helps to reinforce the ventricle’s wall, ensuring that it contracts more efficiently and effectively pumps blood. By reducing the size of the ventricle, the Dor procedure also reduces the amount of blood the heart has to pump with each beat, thereby improving overall cardiac function.

Benefits of the Dor Procedure

The Dor procedure offers several benefits for patients with heart failure or left ventricular aneurysms caused by heart attacks. By reshaping the left ventricle, the procedure significantly improves the heart's pumping efficiency, reducing symptoms such as shortness of breath, fatigue, and fluid retention. It also decreases the likelihood of future heart failure by preventing further enlargement of the ventricle and reducing the strain on the heart muscle.

Long-Term Outcomes

Research has shown that the Dor procedure can lead to substantial improvements in heart function and quality of life for patients with heart failure caused by left ventricular dysfunction. Many patients experience enhanced exercise tolerance, improved ejection fraction (a measure of how much blood the heart pumps out with each beat), and a reduction in hospitalisations related to heart failure.

The Dor procedure is a valuable surgical intervention that helps reshape the left ventricle, restoring its function and efficiency in patients who have suffered heart attacks or heart failure. By reducing the size and correcting the shape of the damaged heart chamber, this procedure offers improved heart performance and a better quality of life for individuals struggling with severe heart conditions.

The author is Consultant Cardio-thoracic Surgeon Wokhardt Hospitals, Mumbai Central

Dr Gulshan Rohra

Guest Author Consultant Cardio-thoracic Surgeon Wokhardt Hospitals, Mumbai Central