DOR Procedure

DOR Procedure for Left Ventricular Reconstruction

DOR procedure, also known as Linear Endoventricular Patch Plasty (EVCPP) is a medical procedure performed as an isolated procedure or as a part of heart surgery to correct geometry or treat an aneurysm of the heart.

It is common for an area of infarction following a myocardial infarction or heart attack to form a non-functional scar. A sustained increase in cholesterol levels over time can result in heart dilatation. It is also possible for a heart to change shape from an elliptical one to a globular one, resulting in a reduction in its function; this can result in heart failure. In such cases, a DOR procedure restores the normal elliptical shape of the heart, which in turn restores its ability to pump blood. As part of a routine Coronary Artery Bypass Graft surgery (CABG) or as an isolated procedure, this procedure is performed. 

What happens during the DOR operation?

The DOR procedure is performed under general anaesthesia. During the DOR operation, the left ventricle is cut to expose the damaged area. Scarred aneurysms are stitched up with looped stitches to shrink them. In addition to the DOR procedure, the surgeon may perform a coronary artery bypass graft (CABG) surgery or a valve repair procedure if it is necessary.

After the DOR procedure, the left ventricle is restored to its normal size and shape. During the DOR procedure, the left ventricular end-systolic volume index (LVESVI) is reduced and the ejection fraction is increased. Symptoms such as chest pain and shortness of breath are reduced, and the heart's ability to pump blood is improved.

The following tests must be performed before the procedure or surgery:

An MRI (if you do not have an implantable defibrillator or pacemaker) or PET scan is recommended to determine if you have enough healthy heart tissue to benefit from the surgery. You will need an echocardiogram to determine your heart’s pumping ability and the condition of your valves. In addition to the DOR operation, you will need a cardiac catheterization within one year of it. A chest X-ray, an electrocardiogram, and routine blood tests will also be conducted.

How does the DOR procedure work?

• Usually, DOR is performed following heart surgery such as a coronary artery bypass graft.

• For the purpose of finding the scarred aneurysm, a small incision is made on the left ventricle.

• Around the edge of the aneurysm, circular stitches are made to separate it from the surrounding tissues.

• The stitches are then tied together to make a complete separation.

• Occasionally, one or more portions of an aneurysm scar are removed before the stitches are tied together.

• The use of Dacron patches is indicated when the scarring is too great and the standard stitches are inadequate.

• After the DOR procedure, stitches are placed in the left ventricle.

How to prepare for your DOR?

• Surgery patients may be prescribed certain medications by their surgeons.

• Two weeks before the surgery, the patient may stop taking certain medications.

• An antiseptic skin cleanser may be prescribed by surgeons before the procedure.

• For at least 6 to 8 hours before surgery, the patient shouldn't eat or drink anything.

• Taking medicine with a small amount of water is okay.

What is left ventricular reconstructive surgery?

Left ventricular reconstruction surgery (Modified DOR) is sometimes used to treat heart failure. During a heart attack, a scar may form in the left ventricle (left lower chamber of the heart). When each heartbeat occurs, the scarred area expands. These bulging, thin areas are called aneurysms. As a result of your aneurysm and other heart problems, your heart has to work harder to pump blood throughout your body. Over time, your heart becomes less efficient and becomes larger than normal as a result of the additional work.

An operation to the reconstructive left ventricle (or repair of an aneurysm) involves removing scarred, dead heart tissue and/or the aneurysm, allowing the left ventricle to assume a more normal shape. Heart failure symptoms and/or angina (chest pain) may be improved via this procedure, as well as maybe your heart's pumping ability.

How is left ventricular reconstructive surgery performed?

An incision is made within the left ventricle during this procedure, where the surgeon locates the area of dead or scarred tissue. To separate the dead tissue from healthy tissue, the surgeon stitches two or more rows around the border of the dead tissue. The stitches are then pulled together (like a purse-string) in order to separate the dead tissue from the remaining heart tissue permanently. The stitches are sometimes pulled together after the scar tissue has been removed.

Occasionally, a patch is placed when there is a lot of dead tissue to remove and standard stitches aren’t enough to exclude the area. As a final step, the surgeon stitches a second row of stitches around the outside of the ventricle.

What can I expect after my surgery?

Depending on how quickly you recover, you can expect to spend 5 to 7 days in the hospital. You can gradually increase your level of activity during your hospital stay with the help of a cardiac rehabilitation specialist. During that time, your recovery will be accelerated.

To treat a serious abnormal heart rhythm, some patients may require an implantable cardioverter-defibrillator (ICD). You will discuss the details of the device and implantation procedure with your cardiologist if this is needed. Before you go home, you may undergo a test called an EP study (electrophysiology study) to determine your heart rhythm.

The hospital will provide you with specific information about wound care, medications, warning signs to look for and who to contact if you experience any problems after you leave the hospital.

Why choose CARE Hospitals for DOR operation?

The CARE Hospitals surgical team has pioneered DOR operation in Hyderabad and its other facilities, which has become one of the most widely accepted in the world. It is believed that this modified procedure is superior to DOR’s original procedure. 

CARE Hospitals Key Advantages:

• Operating rooms dedicated to cardiac surgery

• Operating rooms for cardiac surgery

• Paediatric & Adult Cardiac Experience

• Intensive care and diagnostic facilities of the highest quality

• Multidisciplinary Approach, Leading To Better Medical Outcomes