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[Left ventriculoplasty for non-ischemic cardiomyopathy with severe heart failure in 70 patients]
1Department of Cardiovascular Surgery, Hayama Heart Center, Shimoyamaguchi 1898, Hayama, Miura-gun, Kanagawa 240-0116.
Insights
Left ventriculoplasty improved cardiac function in patients with non-ischemic cardiomyopathy. Elective surgery demonstrated acceptable safety and clinical improvement with careful postoperative care.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Heart Failure Management
Context:
- Non-ischemic cardiomyopathy leads to severe cardiac failure.
- Surgical interventions like left ventriculoplasty aim to improve ventricular function.
- The Batista operation and septal anterior ventricular exclusion are specific techniques evaluated.
Purpose:
- To evaluate the safety and efficacy of left ventriculoplasty for cardiac failure in non-ischemic cardiomyopathy.
- To assess the impact of surgical technique, including selective volume reduction, on outcomes.
- To analyze short-term and long-term results, including mortality and functional improvement.
Summary:
- Left ventriculoplasty was performed on 70 patients with non-ischemic cardiomyopathy, with 51 undergoing elective and 19 emergency procedures.
- Hospital mortality was 21.4% overall, significantly lower in elective cases and reduced with intraoperative echo-guided volume reduction.
- Postoperative improvements included increased ejection fraction, decreased ventricular dimensions and volumes, and reduced pulmonary capillary wedge pressure.
Impact:
- Left ventriculoplasty is a viable option for selected patients with non-ischemic cardiomyopathy, particularly when performed electively.
- Selective ventriculoplasty guided by intraoperative echo improved outcomes compared to the initial technique.
- Significant functional class improvement and sustained benefits were observed in survivors, highlighting the procedure's potential for heart failure management.
Objectives:
Treatment of cardiac failure due to non-ischemic cardiomyopathy by left ventriculoplasty using partial left ventriculectomy (Batista operation) or septal anterior ventricular exclusion was evaluated.
Methods:
Left ventriculoplasty was performed in 70 patients (59 men and 11 women with a mean age of 51 years) from December 1996 to June 2000. Preoperative New York Heart Association (NYHA) functional class was IV in 43 patients including 29 receiving inotropic support, and class III in 27 patients. Nineteen patients required emergency surgery because of on-going shock and 51 patients were operated electively. Combined cardiac procedures were mitral valve reconstruction in 62 patients (45 replacements, 17 repairs), tricuspid annuloplasty in 37, and aortic valve replacement in 4. The initial 24 patients underwent typical Batista operation regardless of myocardial viability. The other 46 patients underwent selective ventriculoplasty to excise or exclude the weakest part according to the findings of the intraoperative echo-guided volume reduction test.
Results:
The intraaortic balloon pump was used in 12 patients and the left ventricular assist device in 2 patients. Three (5.9%) of the 51 patients who underwent elective operation and 12 (63.2%) of the 19 patients with emergency operation died in the hospital, giving an overall hospital mortality of 21.4% (15/70). Hospital mortality was reduced from 33.3% (8/24) in the initial 24 patients to 15.2% (7/46) in the recent 46 patients with the volume reduction test. Mean ejection fraction increased from 22.2 +/- 6.7% to 29.6 +/- 6.0%. Diastolic dimension decreased from 81.1 +/- 9.5 to 69.8 +/- 19.2 mm. End-diastolic and systolic volume indices decreased from 199.0 +/- 47.9 to 124.1 +/- 34.9 ml/m2 and from 154.0 +/- 41.2 to 89.3 +/- 31.7 ml/m2, respectively, at one postoperative month in the 55 hospital survivors. The mean pulmonary capillary wedge pressure decreased from 25.6 +/- 7.8 to 13.6 +/- 4.5 mmHg. Serum brain natriuretic peptide decreased from 999 +/- 647 preoperatively to 547 +/- 362 pg/ml one month after the operation. Thirteen patients (18.6%) died in the late period mainly due to heart failure. Among the 42 survivors, 37 patients returned to NYHA functional class I-II, and cardiac events were rare after one postoperative year. Actuarial survivals at 3 years in elective and emergency operations were 71.9% and 33.3%, respectively.
Conclusions:
Left ventriculoplasty is acceptably safe for elective operation and clinical improvement can be obtained by proper surgical procedures and careful postoperative medical treatment.