Partial left ventriculectomy. The First Japanese Registry Report 1999

Partial left ventriculectomy has been performed without standardized inclusion/exclusion criteria. A registry has been established to accumulate experience with this procedure to identify indications, risks and benefits.

In response to a mailed inquiry, 90 cases were voluntarily registered from 28 Japanese institutions.

Males (n = 67, 74.4%) predominated, and 29 (32.2%) patients were over 60 years old. The underlying cardiac pathologies included dilated cardiomyopathy (n = 75, 83.3%), valvular disease (n = 8, 8.9%), the dilated phase of hypertrophic cardiomyopathy (n = 4, 4.5%), and others (n = 3, 3.3%). Gender, age, etiology, papillary muscle excision and absent transplant indication did not significantly affect survival. Poorer preoperative condition, reduced contraction and decompensation necessitating emergency operation were each associated with a significantly higher risk. Hospitals performing less than 5 cases had poorer results than more experienced institutions (p = .0019), which showed a tendency towards improved survival in the second half of their experience (p = .096). Hospital mortality (n = 29, 32.6%) and late death (n = 10, 11.2%) were mainly from ventricular failure with few sudden deaths over a period of 63.6 patient years follow-up. Late mortality was equally distributed in the first year and leveled off with significantly improved cardiac functional class in survivors.

Partial left ventriculectomy was associated with better survival in less symptomatic patients with better contractile reserve undergoing an elective operation preserving the papillary muscles. Avoidance of identified risk factors may allow better patient selection and improved survival in the current environment where rescue transplantation is not readily available. Long-term follow-up is warranted with more registry data.