Immediate effects of partial left ventriculectomy on left ventricular function.

Abstract

Attempts to prolong life or to improve the quality of life by partial left ventriculectomy in patients suffering from dilated cardiomyopathy have yielded strikingly variable results in leading surgical centers. The outcome of patients after partial left ventriculectomy depends on intraoperative myocardial protection together with appropriate long-term pharmacotherapy. We further assume that partial removal of the fibrotic ventricular wall may lead to a particularly inhomogeneous pattern of wall stress, giving rise to the potential of a paradoxical increase in wall stress and the creation of arrhythmogenic foci. During surgery in 24 patients, local mesh tension was measured using needle-force probes in up to five sites within the left ventricular wall before and after resection of the interpapillary mural segment. The data were used to calculate regional peak developed force and to identify any differences in the timing of local mechanical activity between the measured regions. Mean decrease in regional wall stress was 42% (76 sites of measurement). However, we discovered a paradoxical increase of 42% in 18 sites of measurement. The time delay in the onset of force development between the measured regions prior to surgery was 0 msec in 10 patients, up to 30 msec in 7 patients, and beyond 80 msec in 7 patients. After resection, the time delay increased considerably in incidence and duration. Ventriculectomy is an effective means of reducing wall stress. The unexpectedly high incidence of inhomogeneities in wall stress after asymmetrical surgical ventricular remodeling, currently typical for the classical Batista procedure, together with the asynchronous regional ventricular function that we found to increase after partial left ventriculectomy, needs further elucidation by electrophysiological investigations.