Results of partial left ventriculectomy for dilated cardiomyopathy - Hemodynamic, clinical and echocardiographic observations

OBJECTIVES The study was done to prospectively measure the echocardiographi c, hemodynamic and clinical outcomes after partial left ventriculectomy (PL V). BACKGROUND Although PLV can improve symptoms of advanced heart failure, imm ediate postoperative echocardiographic findings remain abnormal. METHODS Fifty-nine patients with cardiomyopathy and advanced heart failure underwent PLV and concomitant mitral valve surgery between May 1996 and Dec ember 1997. Thirty-nine percent were on inotropic therapy. Al were New York Heart Association (NYHA) functional class III or IV. Mechanical circulator y support (LVAD) and transplant were provided for rescue therapy when hemod ynamic compromise occurred. Patients were followed for a mean of 405 +/- 16 8 days, and clinical, echocardiographic and hemodynamic measures were obtai ned preoperatively, immediately postoperatively, and at 3 and 12 months pro spectively. RESULTS Comparing preoperative and 12-month postoperative values in event-f ree survivors, we found: NYHA functional class improved from 3.6 to 2.1, p < 0.0001; peak oxygen consumption increased from 10.8 to 16.0 ml/kg/min, p < 0.0001; LV ejection fraction increased from 13 +/- 6.0% to 24 +/- 6.9%, p < 0.0001; LV end diastolic diameter decreased from 8.2 +/- 1.03 to 6.2 +/- 0.64 cm, p ( 0.0001, and volume was reduced from 167 +/- 60 to 105 +/- 38 ml/m(2), p = 0.02. Central hemodynamics did not normalize after surgery. CONCLUSIONS Partial left ventriculectomy can provide structural remodeling of the heart that may result in temporary improvement in clinical compensat ion. However, perioperative failures and the return of heart failure limit the propriety of this procedure. (C) 2000 by the American College of Cardio logy.