Volume reduction surgery for end-stage heart failure: experience in Korea

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Research

Background:

• Idiopathic dilated cardiomyopathy (d-CMP) presents significant challenges, often necessitating heart transplantation.
• Partial left ventriculectomy (PLV) has emerged as a potential surgical alternative for advanced d-CMP.
• Left ventricular volume reduction surgery aims to improve cardiac function in end-stage heart failure.

Purpose of the Study:

• To evaluate the efficacy and outcomes of partial left ventriculectomy (PLV) as an alternative to heart transplantation for patients with idiopathic dilated cardiomyopathy (d-CMP).
• To assess the safety and effectiveness of the modified Dor procedure for left ventricular volume reduction.
• To analyze early and long-term results, including mortality, ventricular dimensions, and ejection fraction.

Main Methods:

• A retrospective analysis of 20 patients undergoing left ventricular volume reduction surgery (PLV or modified Dor procedure) between June 1996 and March 2000.
• PLV was performed in 17 patients (16 d-CMP, 1 ischemic CMP); modified Dor procedure in 3 patients (2 d-CMP, 1 ischemic CMP).
• Mitral valve repair/replacement and tricuspid valve procedures were performed as needed; patient data included demographics, preoperative status, operative details, and postoperative outcomes.

Main Results:

• Operative mortality was 35% (7/20) for PLV and 25% (1/4) for the modified Dor procedure, with right heart failure and ventricular tachyarrhythmia being primary causes for PLV deaths.
• Postoperative mean ventricular end-diastolic dimension decreased significantly (75.3mm to 50.9mm) and mean left ventricular ejection fraction (LVEF) improved (20.6% to 33.5%), though these showed slight increases/decreases at 22 months.
• Eleven patients were discharged, but four experienced heart failure progression with mitral regurgitation, necessitating transplantation in two cases.

Conclusions:

• Partial left ventriculectomy (PLV) appears to be an effective surgical alternative to heart transplantation for idiopathic dilated cardiomyopathy in the Korean population.
• The modified Dor procedure offers another option for left ventricular volume reduction.
• Progression of heart failure necessitates early intervention with ventricular assist devices or transplantation; further research is needed for patient selection and arrhythmia prevention.