Dor Procedure - The Procedure

The Procedure

Surgeons usually perform the Dor procedure following a coronary artery bypass graft (CABG). EVCPP consumes only approximately the last twenty minutes of the three to four hour procedure.

To begin a basic remodeling, the surgeon makes an incision at the center of the depressed area on the LV wall and removes blood clots and endocardial scar tissue. To restore the heart to its elliptical shape, an endoventricular suture is put in place and a longitudinal tuck is made to return the cardiac apex from the posterior to the front. The suture also serves as guidance for the patch location. The surgeon then inserts a balloon into the ventricular cavity to ensure correct size and sutures a Dacron patch, deflating the balloon and removing it before complete closure. The non-viable fibrous tissue is pulled over the patch, and surgical glue is occasionally used to complete the closure. When the lesion is placed on the anteroseptoapical wall of the heart, it will include the septum and apex more extensively than the lateral wall. As a result, the suture is placed deeply within the septum, and the new neck of the suture, which holds the Dacron patch, extends from the septum. Dor explicates this procedure in detail.

When the lesion is placed on the posterolateral wall of the heart, a triangular patch is used and stabilized by the posterior mitral annulus. This placement of the lesion allows for mitral valve replacement to be easily conducted by the transventricular approach. (The surgeon does not have to incise the atrium, rather can replace the valve through the already incised ventricle.)

It is recommended that the patient be placed on a mild anti-coagulant post operation to reduce the risk of blood clots. Some surgeons suggest the use of stronger anti-coagulants.