The Dor procedure: what has changed after fifteen years of clinical practice?

See related article on page 863. H eart failure is a major health problem with increasing prevalence due partly to an aged population and more effective treatment of acute myocardial infarction. Postinfarction left ventricular remodeling is characterized by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction. In advanced form, it leads to the heart failure syndrome and is progressive. Intensive medical management reduces symptoms and improves survival. However, patients who are in functional class III or IV have a poor 3-year prognosis.1-3 Recently, surgical approaches have been designed to abort and reverse remodeling, diminish heart failure, and improve survival. With minor modifications, this surgical approach uses the Dor procedure. Surgical therapy achieves the following: 1. Relieves ischemia by coronary revascularization. 2. Diminishes ventricular volume. 3. Restores the ventricle to more normal geometry. 4. Further diminishes volume overload by mitral valve repair when appropriate.