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Partial left ventriculectomy: overall and late results in 44 class IV patients with 4-year follow-up
F A Lucchese1, J D Frota Filho, C Blacher
1São Francisco Hospital at Complexo Hospitalar da Santa Casa, Porto Alegre, RS, Brazil.
Insights
Partial left ventriculectomy (PLV) improved cardiac function in dilated cardiomyopathy patients but had high mortality. PLV may serve as a bridge to heart transplantation for select patients.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Heart Failure Management
Background:
- Dilated cardiomyopathy (DCM) presents significant challenges in heart failure management.
- Partial left ventriculectomy (PLV) is a surgical option explored for advanced DCM.
Purpose of the Study:
- To report long-term outcomes of partial left ventriculectomy (PLV) in patients with dilated cardiomyopathy.
- To evaluate the impact of PLV on ventricular function, quality of life, and survival rates.
Main Methods:
- A cohort of 44 patients with dilated cardiomyopathy underwent PLV over a 4-year period.
- Comprehensive assessments included echocardiograms, cardiac catheterization, and maximal oxygen consumption (VO2) stress tests.
Main Results:
- Survivors showed improved ejection fraction (22.1% to 30.9%), reduced LV end-diastolic diameter (79.4 mm to 61.9 mm), and enhanced VO2 (8.8 to 15.8 mL/kg/min).
- Significant improvements were also noted in non-survivors prior to death.
- Survival rates at 3, 6, 12, and 18 months were 56.8%, 47.7%, 38.4%, and 35.9%, respectively, stabilizing around 32.7% long-term.
- Arrhythmias and heart failure were primary causes of mortality.
Conclusions:
- While PLV improves ventricular function and quality of life for survivors, high mortality remains a significant concern.
- PLV can be a viable option for patients awaiting heart transplantation, particularly those with high pulmonary vascular resistance (PVR) or when other options are unavailable.
Background:
This study reports long-term results of partial left ventriculectomy (PLV).
Methods:
Forty-four patients with dilated cardiomyopathy were operated on in a 4-year study. Echocardiograms, catheterization, and stress tests with oxygen consumption (VO2) were performed.
Results:
The survivors' preoperative ejection fractions of 22.1% +/- 4.9% improved to 30.9% +/- 9.4%, left ventricular (LV) end-diastolic diameter decreased from 79.4 +/- 9.3 mm to 61.9 +/- 8.2 mm, and maximum VO2 consumption improved from 8.8 +/- 3.9 mL/kg per minute to 15.8 +/- 6.1 mL/kg per minute at 22.6 months. These data also showed improvements in nonsurviving patients, according to the last evaluation before death. Seven of 12 survivors (58.3%) were in New York Heart Association (NYHA) I and II in December 1998. Twelve patients had elevated pulmonary vascular resistance (PVR) contraindicating heart transplant. In five patients the PVR returned to normal and one high-PVR patient was transplanted at the 16th postoperative month. Survival was 56.8%, 47.7%, 38.4%, and 35.9%, respectively, at 3, 6, 12, and 18 months, with a tendency to stabilize at 32.7% thereafter. Arrhythmias and heart failure were the main causes of death.
Conclusions:
In spite of improvement of ventricular function and quality of life of the survivors, high mortality is a limiting factor. PLV can be indicated as a bridge to heart transplantation in high-PVR patients or if ventricular assist devices or donor hearts are not available.