The complex surgery with left ventricular reconstruction, also known as the Dor procedure, is routinely performed only at a limited number of health centres in the United States.
"Ventricular reconstruction is for patients with the most damaged hearts, for those with coronary artery disease who already have suffered a major heart attack,” said Richard Lee, M.D., assistant professor of surgery at Saint Louis University School of Medicine.
During this reconstructive surgery, Lee makes a small incision into the ventricle to find the dead or scarred tissue. He stitches around the border of the dead tissue, separates it from healthy heart tissue and then pulls the stitches together like the drawstrings of a purse. The dead tissue is then permanently separated from the rest of the heart. The procedure returns the ventricle to a more elliptical shape, enabling it to beat more effectively.
"For patients who eventually need a heart transplant, ventricular reconstruction may buy them some time or keep them from having to go on a ventricular assist device,” said Lee, who treats patients from throughout the Midwest. "And for patients too old or sick to qualify for transplantation, reconstruction may be a way for us to improve their symptoms and perhaps extend their lives.”
A few surgeons have been performing the Dor technique since the mid 1980s, but Lee said advances in imaging technology and surgical techniques have only recently made the procedure precise and predictable.
Analyses of patients who have undergone ventricular reconstruction show that the majority survive longer and experience fewer hospitalisations than typical patients with the same degree of heart failure on medical management alone. "I think that as a result of this procedure's success, it will continue to evolve and benefit many patients who had no hope before,” Lee said.
MEDICA.de; Source: Saint Louis University Health Sciences Center