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Long-term results after partial left ventriculectomy
Matthias Claus1, Mark Beling, Andrea Grohmann
1Klinik für Innere Medizin mit Schwerpunkt Kardiologie, Angiologie und Pulmologie, Universitätsklinikum Charité, Campus Mitte, Humboldt-Universität, Schumannstr. 20/21, D-10117, Berlin, Germany. matthias.claus@charite.de <matthias.claus@charite.de>
Insights
Partial left ventriculectomy (PLV) shows high mortality and no long-term cardiac performance improvement in heart failure patients. Key predictors of mortality include reduced ventricular wall thickness and poor response to dobutamine.
Area of Science:
- Cardiovascular Surgery
- Heart Failure Management
- Surgical Outcomes Research
Background:
- Partial left ventriculectomy (PLV) is a surgical option for advanced heart failure.
- Long-term effects and outcome predictors following PLV require thorough investigation.
Purpose of the Study:
- To determine the long-term clinical, echocardiographic, and hemodynamic effects of PLV.
- To identify predictors of outcome after PLV in patients with various cardiomyopathies.
Main Methods:
- PLV was performed on 39 patients (NYHA class III/IV) with dilated, ischemic, or valvular cardiomyopathy.
- Follow-up included clinical, echocardiographic, hemodynamic assessments, and stress testing up to 24 months.
- Concomitant procedures like CABG and valve surgery were performed as needed.
Main Results:
- Actuarial survival rates were 64% at 1 year, 55% at 2 years, and 44% at 3 years.
- Significant improvement in NYHA functional class was observed at 2-year follow-up.
- No significant long-term improvement in LV ejection fraction, LV end-diastolic diameter, cardiac index, or peak oxygen consumption was noted.
Conclusions:
- PLV is associated with significant postoperative mortality.
- The procedure does not provide sustained long-term improvement in cardiac performance.
- Decreased left ventricular wall thickness and inadequate stroke volume index response to dobutamine predict mortality.
Background:
Long-term clinical, echocardiographic and hemodynamic effects after partial left ventriculectomy (PLV) and predictors of outcome have been determined.
Methods:
Between January 1995 and July 1999, PLV was performed in 39 patients. In 15 patients the etiology of heart failure was idiopathic dilated cardiomyopathy (DCMP), 19 patients had ischemic cardiomyopathy (ICMP) and five patients had valvular cardiomyopathy. Concomitant procedures included coronary artery bypass grafting in 16 patients, mitral valve repair in 33 patients and aortic valve replacement in five patients. All patients belonged in New York Heart Association (NYHA) functional class III or IV. Mean follow-up was 663+/-514 days. Clinical, echocardiographic and hemodynamic assessments and metabolic stress testing were performed preoperatively, within 30 days postoperatively and 6, 12 and 24 months after the operation.
Results:
Actuarial survival was 64% after 1 year, 55% after 2 years and 44% 3 years after the operation. In patients with ICMP as well as in patients with DCMP actuarial 1 year survival was 60%. At 2-year follow-up NYHA functional class was improved significantly (P<0.05), but LV ejection fraction, LV end-diastolic diameter, cardiac index and peak oxygen consumption did not differ significantly from preoperative values. Analysis of factors influencing postoperative outcome indicated that decreased left ventricular wall thickness and a failure to increase the stroke volume index as a response to preoperative dobutamine administration were associated with postoperative mortality.
Conclusions:
PLV is associated with considerable postoperative mortality and lacking long-term improvement of cardiac performance.
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