Current perspectives of partial left ventriculectomy in the treatment of dilated cardiomyopathy

Objectives: Partial left ventriculectomy has been performed as an alter nat ive to heart transplantation in the treatment of severe cardiomyopathies. T his investigation documents the clinical and left ventricular (LV) function effects of this procedure, associated, when necessary, with mitral insuffi ciency correction, in 43 patients with idiopathic dilated cardiomyopathy. M ethods: Eighteen patients were in New York, Heart Association class III and 25 in class IV. Seven of them were operated in cardiogenic shock. The proc edure was associated with mitral annuloplasty in 32 patients and mitral rep lacement in three. Results: Nine patients (20.9%) died during the hospital period and the cause of death was associated with ventricular failure in se ven patients. The other patients were followed up from 2 to 57 months (mean , 28.3 months). At 6 months of follow-up, eight patients were in functional class I, 13 in class II, three in class III and one patient was in class I V (P < 0.001). On the other hand, nine patients died during the first 6 mon ths and another six in the later postoperative period. The cause of late de ath was progressive heart failure in eight patients, and seven patients die d because of arrhythmia related events. The actuarial survival was 58.1 <pl us/minus> 7.5% at 1 year and 43.9 +/- 8.1% at 4 years of follow-up. Regardi ng ventricular function modifications, the LV diastolic volume decreased by around 25% and the LV ejection fraction increased from 17.8 +/- 4.7 to 22. 3 +/- 7.9% (P < 0.001), whereas significant changes in the cardiac index, s troke index and pulmonary pressures were also found 1 month after the opera tion. In the later follow-up, despite the maintenance of hemodynamic improv ement, the LV diastolic volume tended to increase and returned to preoperat ive levels at 4 years, while a concomitant decrease in the LV ejection frac tion was also observed. Conclusion: Partial left ventriculectomy associated with mitral insufficiency correction improves LV function and ameliorates congestive heart failure in patients with idiopathic cardiomyopathy. Other wise, the LV function benefits seem to be restricted by the possibility of progressive LV redilatation. Furthermore, the clinical application of this procedure is limited by the high mortality observed in the first postoperat ive months and by the possibility of heart failure progression and arrhythm ia related events at late follow-up. (C) 2001 Elsevier Science B.V, All rig hts reserved.