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Results of partial left ventriculectomy in patients with end-stage idiopathic dilated cardiomyopathy
R D Dowling1, S Koenig, M A Laureano
1Department of Surgery, University of Louisville, KY, USA. rddowl01@homer,louisville.edu
Insights
Partial left ventriculectomy shows acceptable survival rates for end-stage idiopathic dilated cardiomyopathy patients. The procedure significantly improves heart function and reduces symptoms, though some patients may still require heart transplantation.
Area of Science:
- Cardiovascular Surgery
- Heart Failure Management
- Cardiomyopathy Research
Background:
- Partial left ventriculectomy is an emerging surgical option for end-stage heart failure.
- Idiopathic dilated cardiomyopathy (IDCM) is a primary indication for this novel procedure.
Purpose of the Study:
- To prospectively evaluate the efficacy and safety of partial left ventriculectomy in patients with end-stage IDCM.
- To assess changes in cardiac function and patient outcomes post-surgery.
Main Methods:
- Prospective study of 16 patients with IDCM, NYHA class IV symptoms, and LVEDD > 7 cm.
- Patients underwent partial left ventriculectomy and comprehensive cardiac evaluation.
- Follow-up included assessment of NYHA class, ejection fraction, LVEDD, and mitral regurgitation.
Main Results:
- Operative mortality was 6.25% with 12-month survival at 86%.
- Significant improvements observed in NYHA class, ejection fraction, LVEDD, and mitral regurgitation at 12 months.
- 65% of patients were free from heart transplant listing at 12 months.
Conclusions:
- Partial left ventriculectomy offers acceptable operative and 12-month survival rates for IDCM patients.
- The procedure leads to significant functional improvements in ejection fraction, LVEDD, and NYHA class.
- Late complications can occur, with some patients needing subsequent heart transplantation.
Background:
Partial left ventriculectomy has been recently introduced as a surgical therapy for end-stage heart failure. We performed a prospective study of partial left ventriculectomy in patients with end-stage idiopathic dilated cardiomyopathy (IDCM).
Methods:
Patients considered as candidates for partial left ventriculectomy had IDCM, left ventricular end-diastolic diameter greater than 7 cm (LVEDD), refractory New York Heart Association class IV symptoms (NYHA), and severely impaired exercise oxygen consumption. All patients underwent a complete heart transplantation evaluation.
Results:
Partial left ventriculectomy was performed in 16 patients with a mean follow-up of 11.1 months. Fourteen patients were male with a mean age of 49.6+/-10.5 years. After surgery there were significant changes in NYHA class, left ventricular ejection fraction, LVEDD, and degree of mitral regurgitation at up to 12 months follow-up. The operative mortality rate was 6.25% and 12-month Kaplan-Meier was 86%. Twelve-month freedom from need for listing for orthotopic heart transplantation was 65%.
Conclusion:
Partial left ventriculectomy can be performed in patients with idiopathic cardiomyopathy with acceptable operative and 12 month survival rates. Significant improvements are seen in ejection fraction, LVEDD, and NYHA class at 12 month follow up. Late failures do occur and some patients have required relisting for transplant after partial left ventriculectomy.
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