Left Ventricular Volume Reduction: New Dawn or False Horizon? Basic Science and Clinical Doubts

Abstract

Left ventricular volume reduction surgery (LVVR) for end-stage dilated cardiomyopathy is a surgical option used selectively but with unclear long-term results. Increasing numbers of reports are appearing in the literature. These should be pooled into an international registry through collaborative efforts that allow for more effective analysis. Furthermore, high priority must be given to identify subgroups of patients who will potentially gain most benefit from LVVR. Basic science may add invaluable data and in this article w e describe h o w intraoperative myocardial biopsies from patients with idiopathic dilated cardiomyopathy were utilized t o isolate myocytes in an effort t o determine differential physiological characteristics at the cellular level. The result showed various degrees of contractile anomalies in response t o electrical stimulation associated with defective calcium handling as reflected by measurements of calcium transients. It is hoped that this approach may be extended t o preoperative catheter biopsy t o gain information that will facilitate patient selection t o avoid unnecessary surgical failures. (J Card Surg 1999; 14:3845)

Left Ventricular Volume Reduction Surgery in the Middle East

“…While certain echocardiographic criteria such as preoperative endsystolic wall stress may be helpful, more promising means of selection may have to be directed towards evaluation at the cellular level. [9][10][11] Operative technique, which has not yet been standardized, seems to play a key role in the success of this procedure. Theoretically, extensive resections are more likely to attain the objectives of the operation but they are associated with higher mortality.…”