Partial left ventriculectomy: sunrise or sunset?

Partial left ventriculectomy (PLV) was proposed as an alternative to cardia c transplantation for patients with advanced heart failure. Patients with d ilated cardiomyopathy that were considered eligible candidates for cardiac transplantation were offered the option of surgical ventriculectomy or to c ontinue waiting for a donor organ. Sixty-two patients underwent PLV between May 1996 and December 1998, mean age 54 years, 47 males, mean ejection fra ction 13.5%, mean peak oxygen consumption 10.8 ml/kg/min, 39% NYHA class II I and 61% NYHA IV. Perioperative mortality 3.2%, 10/62 (16%) required impla nt of a left ventricular assist device (LVAD) due to shock, most in the ear ly post-operative period. Survival at 1 and 2 years was 78% and 68%. Event free survival (freedom from death, LVAD, or return of NYHA class IV failure ) was 50% and 37% at 1 and 2 years. Event free survivors experienced improv ement in NYHA class (3.7 to 2.2) and increased oxygen consumption (11.7 to 16.0 ml/kg/min). Based on these data PLV has a significant early failure ra te and a 2 year event free survival rate of only 37%. PLV does not yield ou tcomes equivalent to cardiac transplantation based on current selection cri teria and requires further investigation to determine its role in the treat ment of advanced heart failure. (C) 1999 European Society of Cardiology. Al l rights reserved.