Endoventricular patch plasty in patients with idiopathic, dilative cardiomyopathy as an alternative to heart transplantation?

Background: Although the concept of reducing wall tension as a treatment fo r advanced heart failure is convincing, clinical data from the Batista oper ation are conflicting. Despite a number of publications, it is not clear wh ether left ventricular reduction surgery is truly of benefit for patients w ith idiopathic, dilated cardiomyopathy (DCM). Surgery may reduce wall tensi on but the reason for dilation and contractile dysfunction remains. Thus, t he potential benefit of the operation may be overshadowed by the natural co urse of the underlying disease. Cases: We report a series of five cases whe re left ventricular reduction was performed and physiological geometry was restored in patients with DCM by a modification of Dor's endoventricular pa tch plasty. All patients demonstrated an improvement in cardiac function im mediately after the operation. This improvement was sustained in one of the patients at 18 months follow-up. Another patient developed severe heart fa ilure due to therapy resistant ventricular arrhythmia (Lown IVb), and under went successful transplantation 4 months after ventricular reduction surger y. Left ventricular dilation reoccurred in two patients 9 and 12 months aft er reduction surgery, and they were listed for transplant. One patient died after 9 weeks due to sepsis and respiratory dysfunction. Conclusions: Alth ough the endoventricular patch plasty as used in this study is well tolerat ed by most patients with dilated cardiomyopathy and results in immediate im provement of contractile function, the long-term benefits of this technique for DCM are uncertain. Thus, the technique is currently not an alternative for heart transplantation. However, the procedure may be an option in pati ents with contraindications for transplantation.