Partial left ventriculectomy in elderly patients not suitable for heart transplantation

Although donor scarcity and intolerance to immunosuppression tend to exclude elderly patients from transplantation, partial left ventriculectomy (PLV) has been performed without bias against advanced age.

Among 392 patients undergoing PLV, 61 elderly patients aged 65 or older (> or =65) were compared with the rest of the patients in terms of underlying disease, postoperative course, and survival time.

The aged patients (> or =65) compared to younger patients (<65), had ischemic disease (37.7% vs. 19.3%, p < 0.05) more frequently than cardiomyopathy (34.4% vs. 43.2%) or valvular disease (23.9% vs. 16.4%) and underwent lateral PLV (74% vs. 79%) more frequently than extended PLV (26% vs. 21%). Although the elderly patients required coronary bypass grafting more frequently (39.3% vs.17.2%, p < 0.05), surgical complexity was similar in terms of bypass time (63 minutes vs. 63 minutes) and percentage requiring cardiac arrest (31% vs. 44%). Despite advanced age, they required comparable ICU care (6.6 days vs. 5.4 days) and postoperative hospital stay (12 days vs. 11 days), resulting in a low but similar hospital survival (57% vs. 62%) and functional capacity after discharge (NYHA class 1.5 vs. 1.4).

The results suggest that PLV can be performed in elderly patients (> or =65 years) with comparable risks and benefits with the younger patients, promoting its application in patients disqualified for heart transplantation because of age criteria.