In 1985, Dor introduced EVCPP as a viable method for restoring a dilated left ventricle (LV) to its normal, elliptical geometry.
The myocardium consists of a single, vascular, continuous tissue that wraps around itself, spiraling up from the apex of the heart, to form a helix with elliptically shaped ventricles.
As the ventricle dilates, the muscle fiber orientation, which is critical to a good ejection fraction, becomes transverse, or more horizontal.
Geometric derangement induced by nonviable myocardium (see myocardial infarction) is exponentially impacted and proportional to the weight of the performance determinant measured.
Occasionally this reveals that the patient may be better suited for biventricular pacing or a defibrillator, but if the cardiologist determines that the Dor procedure is necessary, then the patient must display other symptoms to indicate that they would be a good candidate, including: angina, heart failure, arrhythmias or a combination of the three, large areas of akinesis or dyskensis, ejection fraction of less than forty percent Contraindications include: dysfunctional right ventricle, pulmonary hypertension, dysfunction at the base of the heart, systolic pulmonary artery pressure greater than 60mmHg (in the absence of severe mitral regurgitation) Surgeons usually perform the Dor procedure following a coronary artery bypass graft (CABG).
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.
It is recommended that the patient be placed on a mild anti-coagulant post operation to reduce the risk of blood clots.
[3] Because the Dor procedure restores the left ventricle to its correct, elliptical orientation, it results in a mean ejection fraction increase of 12.5%.