Partial left ventriculectomy: Overall and late results in 44 class IV patients with 4-year follow-up

Background: This study reports long-term results of partial left ventricule ctomy (PLV). Methods: Forty-four patients with dilated cardiomyopathy were operated on in a 4-year study. Echocardiograms, catheterization, and stress tests with oxygen consumption (VO2) were performed. Results: The survivors ' preoperative ejection fractions of 22.1% +/- 4.9% improved to 30.9% +/- 9 .4%, left ventricular (LV) end-diastolic diameter decreased from 79.4 +/- 9 .3 mm to 61.9 +/- 8.2 mm, and maximum VO2 consumption improved from 8.8 +/- 3.9 mL/kg per minute to 15.8 +/- 6.1 mL/kg per minute at 22.6 months. Thes e data also showed improvements in nonsurviving patients, according to the last evaluation before death, Seven of 12 survivors (58.3%) were in New Yor k Heart Association (NYHA) I and II in December 1998. Twelve patients had e levated pulmonary vascular resistance (PVR) contraindicating heart transpla nt. In five patients the PVR returned to normal and one high-PVR patient wa s transplanted at the 16th postoperative month. Survival was 56.8%, 47.7%, 38.4%, and 35.9%, respectively, at 3, 6, 12, and 18 months, with a tendency to stabilize at 32.7% thereafter. Arrhythmias and heart failure were the m ain causes of death. Conclusions: In spite of improvement of ventricular fu nction and quality of life of the survivors, high mortality is a limiting f actor. PLV can be indicated as a bridge to heart transplantation in high-PV R patients or if ventricular assist devices or donor hearts are not availab le.