Mid-term results of partial left ventriculectomy in end-stage heart disease

• Published in: European journal of cardio-thoracic surgery 2000-11, Vol.18 (5), p.550-556
• Main Authors: Vural, Kerem M., Taşdemİr, Oğuz
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Aged; Aged, 80 and over; Batista; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Cardiomyopathy; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - surgery; Congestive; Exercise Test; Female; Follow-Up Studies; Heart; Heart failure; Heart Failure - etiology; Heart Ventricles - surgery; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Mitral; Myocarditis. Cardiomyopathies; Palliative Care - methods; Predictive Value of Tests; Proportional Hazards Models; Risk Factors; Severity of Illness Index; Survival Analysis; Treatment Outcome; Ventriculectomy
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(00)00564-9

Objective: Immediate and mid-term effectiveness of partial left ventriculectomy (PLV) is assessed in 27 idiopathic dilated cardiomyopathy patients. Methods: All patients were in New York Heart Association (NYHA) class III (17) or IV (ten). The average left ventricular ejection fraction (LVEF) was 19±4% by MUGA, and 23±4% by digital echocardiography. The mean end-systolic volume (LVESV) was 259±66 ml and the mean end-diastolic volume (LVEDV) was 342±83 ml. Mitral valve replacement was a routine part of the procedure. Results: Operative mortality was 18.5%, a LVEDP≫25 mmHg, left atrial diameter≫55 mm, pulmonary artery systolic pressure≫40 mmHg, congestive hepatomegaly and NYHA class IV being the mortality predictors. Three-year Kaplan–Meier survival was 64±10%, including operative mortality; freedom from congestive heart failure was 65±11%. Functional status improved from 3.2±0.4 to 1.5±0.6 (P=0.0003). The mean LVEF was dramatically increased after PLV (to 40±4%, P=0.0001); LVESV was decreased to 90±30 ml (P≪0.0001) and LVEDV to 160±49ml (P≪0.0001). This improvement was sustained during the first 30 months. Conclusions: PLV is a reasonable approach for end-stage patients, providing sustained dramatic changes in ventricular geometry and functional capacity, especially in the absence of compromised right and diastolic left heart functions. Routine replacement of the mitral valve allows a more liberal ventriculectomy and eliminates mitral regurgitation, and this may help minimize ventricular distention.