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Left ventricular volume reduction for end-stage heart disease
P Vanelli1, L Beretta, P M Fundarò
1Department of Cardiac Surgery, Azienda Ospedaliera Polo Universitario Luigi Sacco, Milan, Italy.
Insights
Partial left ventriculectomy (PLV) improves ventricular function in end-stage dilated cardiomyopathy. Despite high mortality, PLV offers a valid treatment option for advanced heart failure.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Dilated cardiomyopathy (DCM) is a severe heart condition.
- End-stage DCM significantly impairs ventricular function.
- Partial left ventriculectomy (PLV) is a novel surgical approach.
Purpose of the Study:
- To evaluate the efficacy and outcomes of PLV in patients with end-stage DCM.
- To assess changes in ventricular function and survival rates post-PLV.
Main Methods:
- PLV was performed on 14 patients with end-stage DCM (idiopathic or ischemic).
- Preoperative and postoperative echocardiography assessed ventricular dimensions and function.
- Mitral valve replacement was performed in 11 patients.
Main Results:
- Postoperative echocardiography showed reduced left end-diastolic diameter and improved cardiac index.
- 30-day mortality was 28.6%, with 20-month survival at 57.2%.
- One patient experienced postoperative mitral incompetence.
Conclusions:
- PLV can improve ventricular function in end-stage DCM.
- High mortality necessitates identification of prognostic factors for early failure.
- PLV remains a viable option for select patients with advanced DCM.
Abstract:
Partial left ventriculectomy (PLV) was recently introduced for end-stage dilated cardiomyopathy to improve ventricular function. Since November 1996 we have performed PLV in 14 patients; preoperatively 4 patients had idiopathic dilated cardiomyopathy and 10 had ischemic dilated cardiomyopathy. 57.1% of patients were in New York Heart Association functional Class IV. The mitral valve was replaced in 11 patients. Postoperative echocardiography showed a reduction of left end-diastolic diameter (55.4 +/- 5.4 mm) and an increase in forward ejection (cardiac index from 2.19 +/- 0.571 min/m2 to 2.67 +/- 0.931/min/m2). The 30-day mortality was 28.6% and 20-month survival was 57.2%. Only one patient was not in NYHA functional class due to postoperative progressive mitral incompetence. Prognostic factors should be identified to avoid early failure. However, even if the mortality rate for PLV high, this operation is a valid choice for the treatment of end-stage dilated cardiomyopathy.