Left ventricular regional wall motion, ejection fraction, and geometry after partial left ventriculectomy. Influence of associated mitral valve repair

Objective: Left partial ventriculectomy has been proposed for treatment of heart failure. We investigated the effects of isolated left partial ventric ulectomy and left partial ventriculectomy associated with mitral annuloplas ty on refractory heart failure due to idiopathic dilated cardiomyopathy. Me thods: Nineteen patients underwent partial left partial ventriculectomy ass ociated with mitral annuloplasty and six patients isolated left partial ven triculectomy. In two patients the left partial ventriculectomy associated w ith mitral annuloplasty was combined with tricuspid annuloplasty. We evalua ted before and after the surgery (24 +/- 14 days): th(: functional class, l eft ventricular ejection fraction (LVEF), right ventricular ejection fracti on (EF), regional wall motion, hemodynamics, mitral regurgitation, left ven tricular geometry and coronary angiography. Results: For the overall group LVEF improved from 14.5 +/- 8.0 to 30.3 +/- 12.2% (P < 0.0001) and right ve ntricular EF from 21.2 +/- 7.1 to 28.4 +/- 83% (P < 0.002). In patients who underwent left partial ventriculectomy associated with mitral annuloplasty LVEF increased from 14.5 +/- 8.6 to 29.5 +/- 12.2% (P < 0.002). Isolated l eft partial ventriculectomy increased LVEF from 13.5 +/- 7.5 to 31.5 +/- 11 .1% (P < 0.04). Distal segments of marginal branches of the circumflex arte ry were not visualized by coronary angiography. Left partial ventriculectom y associated with mitral annuloplasty reduced the wedge pressure from 25.0 +/- 12.1 to 18.0 +/- 7.0 mmHg (P < 0.03) and increased cardiac output from 3.8 +/- 0.8 to 4.6 +/- 1.1 l/min (P < 0.004), while isolated left partial v entriculectomy increased cardiac output from 3.7 +/- 1.0 to 4.8 +/- 1.3 l/m in (P < 0.03). Regional wall motion increment was more evident in anterolat eral region from 4.2 +/- 6.8 to 14 +/- 8.3% (P < 0.002) except in two patie nts. Left ventricular geometry changed in most patients, but a homogeneous pattern was not identified. Seven patients died during a mean follow-up of 546 +/- 276 days. Survivors had improvement in functional class. Augmentati on of LVEF >5% was associated with a favorable clinical outcome with improv ement in clinical status without death. Conclusions: Effects of left par ti al ventriculectomy an not necessarily dependent upon reduction of mitral re gurgitation or changes in left ventricular geometry. However, risk of death after the surgery must be reduced for a clinical application. (C) 2000 Els evier Science B.V. All rights reserved.