Left ventricular volume reduction: New dawn or false horizon? Basic science and clinical doubts

Left ventricular volume reduction surgery (LVVR) for end-stage dilated card iomyopathy is a surgical option used selectively but with unclear long-term results. Increasing numbers of reports are appearing in the literature. Th ese should be pooled into an international registry through collaborative e fforts that allow for more effective analysis. Furthermore, high priority m ust be given to identify subgroups of patients who will potentially gain mo st benefit from LVVR. Basic science may add invaluable data and in this art icle we describe how intraoperative myocardial biopsies from patients with idiopathic dilated cardiomyopathy were utilized to isolate myocytes in an e ffort to determine differential physiological characteristics at the cellul ar level. The result showed various degrees of contractile anomalies in res ponse to electrical stimulation associated with defective calcium handling as reflected by measurements of calcium transients. It is hoped that this a pproach may be extended to preoperative catheter biopsy to gain information that will facilitate patient selection to avoid unnecessary surgical failu res.