Results after partial left ventriculectomy versus heart transplantation for idiopathic cardiomyopathy

Objective: Partial left ventriculectomy has been introduced as an alternati ve surgical therapy to heart transplantation. We performed a single-center, retrospective analysis of all patients with idiopathic dilated cardiomyopa thy who underwent partial left ventriculectomy or heart transplantation or who were listed for transplantation to determine operative mortality rate, 12-month survival, freedom from death on the heart transplantation waiting list, and freedom from death or need for relisting for heart transplantatio n.,Methods: Patients who had partial left ventriculectomy (October 1996 to April 1998) were retrospectively compared with patients who were listed for heart transplantation (January 1995 to April 1998), Survival was assessed after the surgical procedure (partial left ventriculectomy vs heart transpl antation) and from time of listing for heart transplantation to assess the additional impact of waiting list deaths. Freedom from death or relisting f or heart transplantation was also compared. Results: There was no differenc e in age or United Network for Organ Sharing status between the 2 groups. T wenty-nine patients with idiopathic dilated cardiomyopathy mere listed for heart transplantation; 17 patients underwent transplantation. 6 patients di ed while on the waiting list, and 6 patients remain listed. One patient die d after heart transplantation, and 1 patient required relisting. Sixteen pa tients had partial left ventriculectomy; 10 patients are in improved condit ion, 2 patients died (I death early from sepsis and 1 death from progressiv e heart failure), and 4 patients required relisting for heart transplantati on. Operative survival was 94% after partial left ventriculectomy and 94% a fter heart transplantation (P =.92). Postoperative 12-month Kaplan-Meier su rvival was 86% after partial left ventriculectomy and 93% after heart trans plantation (P =.90). Twelve-month Kaplan-Meier survival after listing for h eart transplantation was 75% due to death while on the waiting list (P =.76 ). Freedom from death or need for relisting for heart transplantation was 5 6% after partial left ventriculectomy and 86% after transplantation (P =.06 3), Conclusion: Operative and 12-month survival after partial left ventricu lectomy and heart transplantation mere comparable.)Ion ever, despite their initial improvement, many patients who underwent partial left ventriculecto my required relisting for transplantation. Although partial left ventricule ctomy is associated with acceptable operative and 12-month survival, it may prove to serve better as a bridge to transplantation in patients with idio pathic dilated cardiomyopathy rather than definitive therapy, given the num ber of patients who required relisting for transplantation.