Intermediate-term results of partial left ventriculectomy.

Abstract

Partial left ventriculectomy (PLV) has been introduced as an option for patients with end-stage dilated cardiomyopathy. We report the result of a prospective trial of PLV in patients with idiopathic dilated cardiomyopathy, left ventricular end-diastolic diameter (LVEDD) > 7 cm, refractory New York Heart Association (NYHA) Class IV symptoms, and depressed exercise oxygen consumption studies. Sixteen patients underwent a PLV with a mean follow-up of 13 months. Fourteen patients were male. Mean age was 49.6+/-10.5 years (range 30 to 67 years). Left ventricular ejection fraction (LVEF) improved after surgery from 13.9+/-5.6 to 21.0+/-8.4, and this improvement persisted for up to 12 months after operation. LVEDD and NYHA Class also were significantly improved after surgery and for up to 12 months of follow-up. Operative mortality was 6.25%. Twelve-month survival was 86% by Kaplan-Meier analysis. Four (25%) of 16 patients that had initial improvement after PLV developed recurrent heart failure and were listed for transplantation. Freedom from need for listing for heart transplantation was 65% at 12 months. Freedom from death or the need for relisting at 12 months was 56%. PLV can be performed with acceptable early and 12-month mortality. Significant improvements in LVEF, LVEDD, and NYHA Class are seen at up to 12 months of follow-up. Some patients will develop recurrent heart failure and require relisting for heart transplantation.