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Published on: July 18, 2014
Results after partial left ventriculectomy versus heart transplantation for idiopathic cardiomyopathy
S W Etoch1, S C Koenig, M A Laureano
1Department of Surgery, Division of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA.
Insights
Partial left ventriculectomy offers comparable survival to heart transplantation for idiopathic dilated cardiomyopathy. However, many patients require subsequent transplantation, suggesting it may be a bridge therapy rather than a definitive solution.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Idiopathic dilated cardiomyopathy presents a significant challenge in heart failure management.
- Partial left ventriculectomy has emerged as a potential surgical alternative to heart transplantation.
- Evaluating the comparative outcomes of these interventions is crucial for patient care.
Purpose of the Study:
- To compare operative mortality, 12-month survival, and freedom from death or need for relisting between partial left ventriculectomy and heart transplantation.
- To assess the efficacy of partial left ventriculectomy as a definitive therapy versus a bridge to transplantation.
- To analyze outcomes for patients with idiopathic dilated cardiomyopathy undergoing these procedures.
Main Methods:
- A single-center, retrospective analysis of patients with idiopathic dilated cardiomyopathy.
- Comparison of patients who underwent partial left ventriculectomy versus those listed for heart transplantation.
- Assessment of survival rates and need for relisting for transplantation post-intervention.
Main Results:
- Operative survival was 94% for both partial left ventriculectomy and heart transplantation (P =.92).
- 12-month Kaplan-Meier survival was 86% after partial left ventriculectomy and 93% after heart transplantation (P =.90).
- Freedom from death or need for relisting was significantly lower after partial left ventriculectomy (56%) compared to heart transplantation (86%, P =.063).
Conclusions:
- Partial left ventriculectomy and heart transplantation demonstrate comparable operative and 12-month survival rates.
- A significant proportion of patients undergoing partial left ventriculectomy require subsequent relisting for heart transplantation.
- Partial left ventriculectomy may be best utilized as a bridge to heart transplantation for idiopathic dilated cardiomyopathy patients.
Objective:
Partial left ventriculectomy has been introduced as an alternative surgical therapy to heart transplantation. We performed a single-center, retrospective analysis of all patients with idiopathic dilated cardiomyopathy who underwent partial left ventriculectomy or heart transplantation or who were listed for transplantation to determine operative mortality rate, 12-month survival, freedom from death on the heart transplantation waiting list, and freedom from death or need for relisting for heart transplantation.
Methods:
Patients who had partial left ventriculectomy (October 1996 to April 1998) were retrospectively compared with patients who were listed for heart transplantation (January 1995 to April 1998). Survival was assessed after the surgical procedure (partial left ventriculectomy vs heart transplantation) and from time of listing for heart transplantation to assess the additional impact of waiting list deaths. Freedom from death or relisting for heart transplantation was also compared.
Results:
There was no difference in age or United Network for Organ Sharing status between the 2 groups. Twenty-nine patients with idiopathic dilated cardiomyopathy were listed for heart transplantation; 17 patients underwent transplantation, 6 patients died while on the waiting list, and 6 patients remain listed. One patient died after heart transplantation, and 1 patient required relisting. Sixteen patients had partial left ventriculectomy; 10 patients are in improved condition, 2 patients died (1 death early from sepsis and 1 death from progressive heart failure), and 4 patients required relisting for heart transplantation. Operative survival was 94% after partial left ventriculectomy and 94% after heart transplantation (P =.92). Postoperative 12-month Kaplan-Meier survival was 86% after partial left ventriculectomy and 93% after heart transplantation (P =.90). Twelve-month Kaplan-Meier survival after listing for heart transplantation was 75% due to death while on the waiting list (P =.76). Freedom from death or need for relisting for heart transplantation was 56% after partial left ventriculectomy and 86% after transplantation (P =.063).
Conclusion:
Operative and 12-month survival after partial left ventriculectomy and heart transplantation were comparable. However, despite their initial improvement, many patients who underwent partial left ventriculectomy required relisting for transplantation. Although partial left ventriculectomy is associated with acceptable operative and 12-month survival, it may prove to serve better as a bridge to transplantation in patients with idiopathic dilated cardiomyopathy rather than definitive therapy, given the number of patients who required relisting for transplantation.
