Partial Left Ventriculectomy: Overall and Late Results in 44 Class IV Patients with 4-Year Follow-Up

Abstract

Background.-This study reports long-term results of partial left ventriculectomy (PLV). Methods: Forty-four patients with dilated cardiomyopathy were operated on in a 4year study. Echocardiograms, catheterization, and stress tests with oxygen consumption (VO,) were performed. Results: The survivors' preoperative ejection fractions of 22.1 YO % 4.9% improved t o 30.9% f 9.4%, left ventricular (LV) end-diastolic diameter decreased from 79.4 2 9.3 mm t o 61.9 f 8.2 mm, and maximum VO, consumption improved from 8.8 k 3.9 mL/kg per minute t o 15.8 f 6.1 mL/kg per minute at 22.6 months. These data also showed improvements in nonsurviving patients, according t o the last evaluation before death. Seven of 12 survivors (58.3%) were in New York Heart Association (NYHA) I and II in December 1998. Twelve patients had elevated pulmonary vascular resistance (PVR) contraindicating heart transplant. In five patients the PVR returned t o normal and one high-PVR patient was transplanted a t the 16th postoperative month. Survival was 56.8%, 47.70/, 38.4%. and 35.9%, respectively, a t 3,6, 12, and 18 months, with a tendency t o stabilize at 32.7% thereafter. Arrhythmias and heart failure were the main causes of death. Conclusions: In spite of improvement of ventricular function and quality of life of the survivors, high mortality is a limiting factor. PLV can be indicated as a bridge t o heart transplantation in high-PVR patients or if ventricular assist devices or donor hearts are not available. (J Card Surg 2000;75:179-185) Partial left ventriculectomy (PLV) or Batista operation (BO)l,* has been used at our institution since 1994 as an alternative surgical procedure to treat end-stage heart failure in nontransplantable patients. The attractive rationales of the procedure coupled with the lack of heart transplantation donors were the two most important reasons to consider use of PLV. Many institutions have been designing protocols to evaluate patient selection and the results of PLV in a wide range of circumstances. However, despite widespread interest and clinical use of PLV, there is lack of information on long-term outcome. This report presents unique outcome information in a consecutive series of patients prospectively selected for this operation bv well-defined criteria. MATERIAL AND METHODS Patient selectionForty-four consenting consecutive patients uncember 1998. Selection criteria included the fol-Address for correspondence: Fernando Lucchese, M.D., Rua Antonio Parreiras 322/402, Porto Alegre, RS. Brazil derwent pLv between December 9g4 and De-90.450-050. Fax: (55) 51-2271604. 184 LUCCHESE, ET AL. PARTIAL LEFT VENTRiCULECTOMY J CARD SURG 2000;15:179-185

Plication of the free wall of the left ventricle in dogs with doxorubicin-induced cardiomyopathy

“…An initial study 9 of plication of the left ventricle used clinically normal dogs; thus, the ejection fraction did not change in those dogs after plication. In humans with DCM who have undergone partial ventriculectomy, there is a reduction in LVd and LVs and an increase in ejection fraction of approximately 65% (from 29.0% before surgery to 48.7% 12 months after surgery), 17 50.1% (from 23.9% to 40.7%), 18 33.9% (from 17.7% to 23.7%), 19 39.8% (from 22.1% to 30.9%), 20 and 70.8% (from 24.0% to 41.0%). 21 In human patients who have undergone partial ventriculectomy, inotropic support is usually necessary.…”