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Intermediate-term results of partial left ventriculectomy.
R D Dowling1, S Koenig, M A Laureano
1The Department of Surgery, University of Louisville, Kentucky, USA. rddowl01@homer.louisville.edu
Journal of Cardiac Surgery
|May 2, 2000
Summary
Partial left ventriculectomy (PLV) offers improved heart function and reduced symptoms in severe dilated cardiomyopathy patients. While early survival is good, some patients may still require heart transplantation within a year.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Dilated cardiomyopathy (DCM) is a leading cause of heart failure.
- End-stage DCM often presents with refractory symptoms and poor prognosis.
- Surgical options for advanced heart failure are limited.
Purpose of the Study:
- To evaluate the efficacy and safety of partial left ventriculectomy (PLV) in patients with idiopathic dilated cardiomyopathy.
- To assess improvements in left ventricular function and clinical status post-PLV.
- To determine long-term survival and need for heart transplantation after PLV.
Main Methods:
- Prospective trial involving 16 patients with end-stage idiopathic DCM.
- Patients had refractory NYHA Class IV symptoms and enlarged left ventricles (LVEDD > 7 cm).
- Surgical procedure: Partial left ventriculectomy (PLV). Follow-up included LVEF, LVEDD, NYHA Class, survival, and transplantation listing.
Main Results:
- Left ventricular ejection fraction (LVEF) improved significantly from 13.9% to 21.0% post-surgery.
- Left ventricular end-diastolic diameter (LVEDD) and NYHA Class also showed significant improvement up to 12 months.
- Operative mortality was 6.25%, with 12-month survival at 86%.
- 25% of patients required re-listing for heart transplantation due to recurrent heart failure within 12 months.
Conclusions:
- Partial left ventriculectomy (PLV) is a viable surgical option for selected patients with end-stage dilated cardiomyopathy.
- PLV demonstrates acceptable early mortality and significant short-term improvements in cardiac function and symptoms.
- A notable proportion of patients may experience recurrent heart failure, necessitating consideration for heart transplantation.