Partial left ventriculectomy: sunrise or sunset?

Partial left ventriculectomy (PLV) was proposed as an alternative to cardiac transplantation for patients with advanced heart failure. Patients with dilated cardiomyopathy that were considered eligible candidates for cardiac transplantation were offered the option of surgical ventriculectomy or to continue waiting for a donor organ. Sixty-two patients underwent PLV between May 1996 and December 1998, mean age 54 years, 47 males, mean ejection fraction 13.5%, mean peak oxygen consumption 10.8 ml/kg/min, 39% NYHA class III and 61% NYHA IV. Perioperative mortality 3.2%, 10/62 (16%) required implant of a left ventricular assist device (LVAD) due to shock, most in the early post-operative period. Survival at 1 and 2 years was 78% and 68%. Event free survival (freedom from death, LVAD, or return of NYHA class IV failure) was 50% and 37% at 1 and 2 years. Event free survivors experienced improvement in NYHA class (3.7 to 2.2) and increased oxygen consumption (11.7 to 16.0 ml/kg/min). Based on these data PLV has a significant early failure rate and a 2 year event free survival rate of only 37%. PLV does not yield outcomes equivalent to cardiac transplantation based on current selection criteria and requires further investigation to determine its role in the treatment of advanced heart failure.