Autopsy findings in early and late postoperative death after partial left ventriculectomy

Background. Partial left ventriculectomy (PLV) is an alternative to heart t ransplantation for patients with severe heart failure. However, this proced ure is accompanied by high morbidity and mortality. Therefore, we studied t he hearts of 12 patients who underwent this procedure to increase our under standing of the causes of bad outcome. Methods. We analyzed the autopsy hearts of 11 of 16 patients who died after PLV, and one heart from a patient who underwent heart transplantation. Results. Six patients died less than 30 days postoperatively, 4 of cardioge nic shock, 1 of arrhythmia, and 1 of coagulopathy. Five patients died from 36 to 120 days after the procedure, 4 of cardiogenic shock and 1 of arrhyth mia. The patient who underwent heart transplantation had a cardiogenic shoc k 230 days after:PLV. Ten hearts weighed more than 500 g and nine had myoca rdial infarction that extended to the papillary muscles. Four patients had infarction of both papillary muscles and 3 of them had episodes of arrhythm ia, suggesting some relation between these events. Conclusions. We found several important morphologic clues for bad outcome: infarction of both papillary muscles, which may be associated with the deve lopment of arrhythmia, and myocardial infarction and pericardial hemorrhage , which may contribute to the outcome of heart failure. (C) 2000 by The Society of Thoracic Surgeons.