Opening the "Dor," Not Always an Inferior Approach

The Dor procedure was historically used to restore the geometry of the heart in a patient with a left ventricular (LV) aneurysm via reduction and reshaping of the LV with an aneurysmectomy. Unfortunately, morbidity and mortality remain high with this procedure, with many patients little to no recovery of their ejection fraction while developing severe diastolic failure, often requiring further support; however, the natural history of these patients remains largely unknown. Heart transplant has long been considered the most durable of treatment for patients with end-stage heart failure (HF), but because of the scarcity of donor hearts, the implantation of left ventricular assist devices (LVAD) for mechanical circulatory support has also proven to be an essential tool in the treatment of the advanced heart failure patient. While various techniques for LVAD implantation have been well outlined, there is very limited literature on placement of a VAD in patients with a history of LV aneurysmectomy or Dor procedures, particularly with regard to the challenging aspects of apical cannulation in those with prior apical ventriculotomy and patch placement. In this series, we describe three patients with a history of LV aneurysmectomy procedures who underwent Heartware ventricular assist device (HVAD) implantations for end-stage HF.