Partial left ventriculectomy as a biologic bridge to heart transplantation

Heart failure refractory to medical treatment is consuming an increasingly large proportion of health care resources. Partial left ventriculectomy has recently been used to treat patients with end-stage dilated cardiomyopathy. A 45-year-old man in end-stage heart failure had progressive exertional dyspnea for 3 years. Cardiac catheterization showed dilated cardiomyopathy with severe pulmonary hypertension and severely impaired left ventricular function. After partial left ventriculectomy, cardiac output increased from 2.11 L/min to 5.0 L/min. The left ventricular ejection fraction measured by radionuclide angiography increased from 13% preoperatively to 28% 1 month after the operation. The patient was discharged and monitored at the outpatient clinic. He had an exercise capacity of NYHA functional class II. However, he received heart transplantation 10 months after the partial left ventriculectomy because of recurrent heart failure. Partial left ventriculectomy improves heart function and may be used as a bridge to heart transplantation as an alternative to ventricular assist devices.