Left Ventricular Aneurysm Repair
Left Ventricular (LV) Aneurysm Repair
Left Ventricular (LV) Aneurysm Repair, often called an "Aneurysmectomy" or the "Dor Procedure," is a major surgical operation to correct a "bulge" in the heart's main pumping chamber. This bulge is typically a patch of thin, scarred, non-functioning muscle that forms after a massive heart attack. The focus of this surgery is "Ventricular Restoration"—reshaping the heart from a balloon-like state back into its natural, efficient oval shape to restore pumping power.
When You Should Consider LV Aneurysm Repair
Congestive Heart Failure: When the scarred area "balloons" outward, wasting the heart's energy and causing severe breathlessness and fatigue.
Recurrent Blood Clots: When blood pools and stagnates inside the bulge, creating clots that carry a high risk of stroke.
Refractory Arrhythmias: Life-threatening fast heartbeats (Ventricular Tachycardia) triggered by the border between healthy muscle and scar tissue.
Large Aneurysm Size: Even if symptoms are mild, a very large or expanding aneurysm may require repair to prevent progressive heart stretching.
Concomitant Surgery: Often performed if you already need a heart bypass (CABG) or mitral valve repair to fully restore heart efficiency.
Surgical Techniques
Linear Repair: For smaller aneurysms, the surgeon removes the scarred tissue and sews the healthy muscle edges back together.
The Dor Procedure (Endoventricular Circular Patch Plasty): The modern "gold standard" where a synthetic or tissue patch is placed inside the ventricle to rebuild its internal structure.
Hybrid LV Restoration: A 2026 approach combining surgical repair with catheter-based techniques for patients who are too high-risk for traditional surgery.
Extracellular Matrix (ECM) Patches: A newer option using biological "scaffolding" that may help the heart tissue integrate better than traditional synthetic materials.
Ventricular Reconstruction: Using internal sutures to "exclude" the dead tissue from the pumping chamber without actually cutting it out.
[Image showing a synthetic patch being sutured inside the left ventricle during a Dor Procedure]
How LV Aneurysm Repair Is Performed
Access: A midline incision is made through the breastbone (sternotomy) to reach the heart.
Bypass: The patient is connected to a heart-lung machine; the heart is stopped to allow the surgeon to safely open the ventricle.
Clot Removal: Any old blood clots (thrombi) trapped within the aneurysm are carefully removed to prevent future strokes.
Reshaping: The surgeon identifies the "border zone" of healthy muscle and secures the patch or sutures to create a new, smaller, and stronger pumping chamber.
Verification: An intraoperative ultrasound (TEE) is performed to ensure the heart's "Stroke Volume" (the amount of blood pumped per beat) has significantly improved.
Pre-Procedure Preparation
Fasting for at least 8–12 hours before the surgery, which is performed under general anesthesia.
Extensive blood work, including kidney function tests and cross-matching for potential blood transfusions.
Dental clearance to eliminate any hidden infections that could compromise the surgical site or the patch.
Adjusting medications, specifically heart failure drugs like ACE inhibitors and blood thinners, as directed by the surgeon.
Review of a "Viability Study" to confirm that the remaining heart muscle is strong enough to support the repair.
Tests Before LV Aneurysm Repair
Cardiac MRI: The best tool for mapping the exact size of the aneurysm and distinguishing between scar tissue and healthy muscle.
Echocardiogram (TEE): To measure the Ejection Fraction and check if the mitral valve is leaking due to the aneurysm.
Coronary Angiogram: To identify blockages in the arteries that will likely be bypassed during the same operation.
Cardiac CT Scan: To assess the proximity of the aneurysm to the chest wall, especially important for "redo" surgeries.
EP Study (Electrophysiology): Occasionally done if the patient has had life-threatening arrhythmias to locate the "trigger" points.
Life After LV Aneurysm Repair
ICU Stay: Usually 2 to 3 days for intensive monitoring of blood pressure, heart rhythm, and fluid levels.
Hospital Stay: Total stay typically ranges from 7 to 12 days, depending on the speed of recovery.
Mechanical Support: Some patients may briefly require a temporary pump (like an IABP) to help the reshaped heart work in the first 48 hours.
Sternal Precautions: No lifting anything heavier than 3 kg for 8 to 12 weeks to ensure the breastbone heals.
Long-term Meds: Lifelong use of beta-blockers and blood thinners is often necessary to protect the repair and prevent new clots.
Benefits of LV Aneurysm Repair
Improved Pumping Efficiency: Reshaping the heart significantly increases the Ejection Fraction and overall cardiac output.
Dramatic Symptom Relief: Most patients report a major decrease in shortness of breath and a return of energy within 4–8 weeks.
Reduced Stroke Risk: By removing the "pocket" where blood stagnates, the primary source of heart-related strokes is eliminated.
Rhythm Stability: Repairing the "border zone" often resolves or simplifies the management of dangerous heart arrhythmias.
2026 Success Rates: In specialized Indian centers, the success rate for the Dor Procedure is approximately 90–95% for elective cases.
