Related Experiment Videos
Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy
N A Stolf1, L F Moreira, E A Bocchi
1Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil.
Insights
Partial left ventriculectomy shows midterm benefits for dilated cardiomyopathy patients, improving heart function. However, high early mortality limits its use, though results may depend on myocardial cell health.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Heart Failure Management
Background:
- Partial left ventriculectomy is a proposed treatment for severe cardiomyopathies.
- This study evaluates midterm outcomes of this procedure in 37 patients with dilated cardiomyopathy.
Purpose of the Study:
- To report the midterm results of partial left ventriculectomy in patients with dilated cardiomyopathy.
- To assess the impact of the procedure on cardiac function and survival rates.
Main Methods:
- 37 patients with dilated cardiomyopathy (NYHA class III/IV) underwent partial ventriculectomy.
- The procedure was combined with mitral annuloplasty in 27 patients and mitral replacement in 2.
Main Results:
- Seven operative deaths (18.9%) occurred. Over 18.2 months mean follow-up, 9 additional deaths were recorded, with 56.7% actuarial survival at 24 months.
- Survivors showed improved functional class (3.5 to 1.8), decreased LV diastolic volume (523 to 380 mL), and increased LVEF (17.1% to 23%).
- Myocardial cell diameter was the only factor significantly affecting midterm survival. Late postoperative LV diastolic volume tended to increase, but LVEF and hemodynamics remained stable.
Conclusions:
- Partial ventriculectomy improves left ventricular function and heart failure symptoms in dilated cardiomyopathy patients up to 24 months.
- High early postoperative mortality significantly limits the clinical application of this procedure.
- The effectiveness of partial ventriculectomy may be influenced by the condition of myocardial cells.
Background:
Partial left ventriculectomy has been proposed for treatment of severe cardiomyopathies. This study reports midterm results of this procedure in 37 patients with dilated cardiomyopathy.
Methods:
All patients were in New York Heart Association class III (16) or IV (21). Partial ventriculectomy was associated with mitral annuloplasty in 27 patients and with mitral replacement in 2.
Results:
There were seven operative deaths (18.9%). During a mean follow-up of 18.2+/-9.3 months, 9 more patients died. Actuarial survival was 56.7%+/-8.1% at 6 and 24 months. Analysis of factors influencing outcome showed that midterm survival was significantly affected only by myocardial cell diameter. Otherwise, functional class improved from 3.5+/-0.5 to 1.8+/-0.9 in the survivors (p < 0.001). Furthermore, left ventricular diastolic volume decreased from 523+/-207 to 380+/-148 mL (p < 0.001), and left ventricular ejection fraction increased from 17.1%+/-4.6% to 23%+/-8% (p < 0.001), whereas significant changes in cardiac index, stroke index, and pulmonary pressures were found at 1 month of follow-up. Although left ventricular diastolic volume tended to increase in the late postoperative period, left ventricular ejection fraction and hemodynamic variables did not change significantly.
Conclusions:
Partial ventriculectomy improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy for up to 24 months of follow-up. Nevertheless, this procedure's clinical application is limited by the high mortality observed in the first postoperative months. Otherwise, new perspectives may be advised by the identification that partial ventriculectomy results seem to be influenced by compromised myocardial cells.