Partial left ventriculectomy in patients with dilated failing ventricle

Background: While partial left ventriculectomy (PLV) improves left ventricu lar energetic efficiency, concomitant reduction in mitral regurgitation may improve ventricular function. Methods: Two hundred ninety-five patients un dergoing lateral ventricular wall excision between the papillary muscles (l ateral PLV) and 101 patients with an additional excision of papillary muscl es and mitral valve replacement (extended PLV) were compared with 65 patien ts undergoing excision of anterior wall or ventricular aneurysm (anterior P LV). Results: All patients had reduced functional capacity, New York Heart Association (NYHA) Class III to IV (3.62 +/- 0.49). Etiologies were cardiom yopathy (37.3%), coronary artery disease (32.3%), valvular disease (19.7%), Chagas' disease (7.8%), and others (2.8%). Patients undergoing lateral and extended PLV had cardiomyopathy as the primary cause of heart failure, whi le a majority of anterior PLV patients had ischemic disease. Associated pro cedures included mitral valvuloplasty or replacement (lateral PLV 67%, exte nded PLV 100%, anterior PLV 40%) and tricuspid annuloplasty (67%, 76%, 28%, respectively.) In each group after surgery, end-systolic dimension decreas ed more than end-diastolic dimension despite reduced mitral regurgitation. Although extended PLV resulted in greater volume reduction and less mitral regurgitation, these patients had delayed recovery and poor survival. Patie nts with valvular disease had the most advanced myocardial hypertrophy with the best survival, while those with Chagas' disease had more severe myocar ditis, interstitial fibrosis, and the poorest survival. Conclusion: Lateral PLV improved hemodynamics and functional capacity as much as aneurysmectom y by reducing ventricular volume and mitral regurgitation. Inclusion and ex clusion criteria have to be sought to make PLV safer and more effective.