INTERMEDIATE TERM RESULTS OF PARTIAL LEFT VENTRICULECTOMY AS AN ALTERNATIVE TO HEART TRANSPLANTATION

Abstract

106 Partial left ventriculectomy (PLV) has been advocated as an alternative to heart transplantation (OHT). However, little data is available regarding clinical outcomes and the long-term benefit of PLV. We report the results of a prospective trial of PLV in pts with idiopathic dilated cardiomyopathy. METHODS: A prospective clinical trial of PLV was begun on 10/96. Inclusion criteria were 1) idiopathic cardiomyopathy, 2) NYHA class IV, 3) LVEDD >7.0cm, 4) severely impaired exercise oxygen consumption (VO2 Max). All pts met standard criteria for listing for OHT. RESULTS: 18 pts underwent PLV (15 male, mean age 51.4 yrs). Mean follow-up is 15.2 months. Seven pts (7/18, 39%) were UNOS status I with 5 pts on IABP. Mean pre-op LVEF was 13.1±4.5% and pre-op LVEDD was 8.1± 1.0 cm. There were significant improvements in LVEF, NYHA Class, LVEDD, and degree of mitral regurgitation at up to 18 months follow-up (Table). There were 2 early deaths (sepsis 1, MSOF 1) and two late deaths(recurrent heart failure 1, CVA 1). Five pts (5/18, 28%) developed recurrent heart failure and required listing for OHT. Kaplan-Meier freedom from death at twelve months was 86% and at 18 months was 77%. Kaplan-Meier freedom from death or listing for OHT was 55% at 18 months. Statistical analysis was performed with repeated measures of analysis of variance (MANOVA).TableCONCLUSION: Partial left ventriculectomy resulted in significant improvements in LV function and NYHA Class in the majority of pts with end stage idiopathic dilated cardiomyopathy. However, some pts developed recurrent heart failure that required listing for transplantation. Current efforts are focused on determining which preoperative parameters will identify pts that will have long-term benefit from PLV.