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

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