Intermediate-term results of partial left ventriculectomy

Partial left ventriculectomy (PLV) has been introduced as an option for pat ients with end-stage dilated cardiomyopathy. We report the result of a pros pective trial of PLV in patients with idiopathic dilated cardiomyopathy, le ft ventricular end-diastolic diameter (LVEDD) > 7 cm, refractory New York H eart Association (NYHA) Class IV symptoms, and depressed exercise oxygen co nsumption studies. Sixteen patients underwent a PLV with a mean follow-up o f 13 months. Fourteen patients were male. Mean age was 49.6 +/- 10.5 years (range 30 to 67 years). Left ventricular ejection fraction (LVEF) improved after surgery from 13.9 +/- 5.6 to 21.0 +/- 8.4, and this improvement persi sted for up to 12 months after operation. LVEDD and NYHA Class also were si gnificantly improved after surgery and for up to 12 months of follow-up. Op erative mortality was 6.25%. Twelve-month survival was 86% by Kaplan-Meier analysis. Four (25%) of 16 patients that had initial improvement after PLV developed recurrent heart failure and were listed for transplantation. Free dom from need for listing for heart transplantation was 65% at 12 months. F reedom from death or the need for relisting at 12 months was 56%. PLV can b e performed with acceptable early and 12-month mortality. Significant impro vements in LVEF, LVEDD, and NYHA Class are seen at up to 12 months of follo w-up. Some patients will develop recurrent heart failure and require relist ing for heart transplantation.