Results Of Partial Left Ventriculectomy Research Articles

Myocardial Fiber Diameter as a Good Indicator of Outcome in Batista's Operation

Despite the initial promissory results of partial left ventriculectomy, or Batista's operation, the postoperative mortality associated with the procedure has been too high. We described a histopathologic study performed to identify histological parameters that could help to determine outcomes of patients undergoing this procedure. Myocardial fiber diameter, myocardial fibrosis, thickness of the compact wall, and number of cells presenting from the endocardium to epicardium were analyzed in 32 patients with idiopathic dilated cardiomyopathy who underwent Batista's operation. Data were grouped by patients who died < or = 6 months and patients who survived for > 6 months after the surgical procedure. Additional analyses were performed to compare results according the causes of death and to test the application of these results to biopsy. Myocardial fiber diameter was the only index that could distinguish the two groups. Myocardial fiber diameter < 22 microm distinguished the group of patients who survived the 6-month postoperative period from patients who died during that time with sensitivity of 85.7 and specificity of 72.2. The subendocardial region of the compact wall and the trabecular portion of the wall exhibited comparable results. Our results indicate that the myocardial fiber diameter of samples from the trabecular or subendocardial compact wall regions may help predict the outcome of left ventriculectomy. Samples from the trabecular or subendocardial compact wall regions were used for analysis. Further prospective studies involving left ventricular endomyocardial biopsies are necessary to confirm if the use of myocardial fiber diameter in the selection of patients for surgery improves the index of success of Batista's operation. Other factors that are involved remain unclear.

Angiographic and Hemodynamic Follow-Up of Patients After Partial Left Ventriculectomy

Angiographic, Doppler-echocardiographic and hemodynamic studies early (+6 days) and late (+180 days) after partial left ventriculectomy (PLV) on 24 patients revealed that PLV decreased end-systolic volume (or dimension) more than the end-diastolic volume (or dimension), improving stroke volumes (or contractile excursion), and doubling ejection fraction (or fractional shortening). Results of PLV appeared to depend on a balance between improved systolic contractility and reduced diastolic performance. All these survivors had improved diastolic relaxation, suggesting myocardial viability is a prerequisite for PLV to be successful.

Results of partial left ventriculectomy of dilated cardiomyopathy

Results of partial left ventriculectomy of dilated cardiomyopathy

Results of partial left ventriculectomy for dilated cardiomyopathy: Hemodynamic, clinical and echocardiographic observations

OBJECTIVESThe study was done to prospectively measure the echocardiographic, hemodynamic and clinical outcomes after partial left ventriculectomy (PLV).BACKGROUNDAlthough PLV can improve symptoms of advanced heart failure, immediate postoperative echocardiographic findings remain abnormal.METHODSFifty-nine patients with cardiomyopathy and advanced heart failure underwent PLV and concomitant mitral valve surgery between May 1996 and December 1997. Thirty-nine percent were on inotropic therapy. All were New York Heart Association (NYHA) functional class III or IV. Mechanical circulatory support (LVAD) and transplant were provided for rescue therapy when hemodynamic compromise occurred. Patients were followed for a mean of 405 ± 168 days, and clinical, echocardiographic and hemodynamic measures were obtained preoperatively, immediately postoperatively, and at 3 and 12 months prospectively.RESULTSComparing preoperative and 12-month postoperative values in event-free survivors, we found: NYHA functional class improved from 3.6 to 2.1, p < 0.0001; peak oxygen consumption increased from 10.8 to 16.0 ml/kg/min, p < 0.0001; LV ejection fraction increased from 13 ± 6.0% to 24 ± 6.9%, p < 0.0001; LV end diastolic diameter decreased from 8.2 ± 1.03 to 6.2 ± 0.64 cm, p < 0.0001, and volume was reduced from 167 ± 60 to 105 ± 38 ml/m2, p = 0.02. Central hemodynamics did not normalize after surgery.CONCLUSIONSPartial left ventriculectomy can provide structural remodeling of the heart that may result in temporary improvement in clinical compensation. However, perioperative failures and the return of heart failure limit the propriety of this procedure.

Mid-term results of partial left ventriculectomy in end-stage heart disease.

Immediate and mid-term effectiveness of partial left ventriculectomy (PLV) is assessed in 27 idiopathic dilated cardiomyopathy patients. All patients were in New York Heart Association (NYHA) class III (17) or IV (ten). The average left ventricular ejection fraction (LVEF) was 19+/-4% by MUGA, and 23+/-4% by digital echocardiography. The mean end-systolic volume (LVESV) was 259+/-66 ml and the mean end-diastolic volume (LVEDV) was 342+/-83 ml. Mitral valve replacement was a routine part of the procedure. Operative mortality was 18.5%, a LVEDP>25 mmHg, left atrial diameter>55 mm, pulmonary artery systolic pressure>40 mmHg, congestive hepatomegaly and NYHA class IV being the mortality predictors. Three-year Kaplan-Meier survival was 64+/-10%, including operative mortality; freedom from congestive heart failure was 65+/-11%. Functional status improved from 3.2+/-0.4 to 1.5+/-0.6 (P=0.0003). The mean LVEF was dramatically increased after PLV (to 40+/-4%, P=0.0001); LVESV was decreased to 90+/-30 ml (P<0.0001) and LVEDV to 160+/-49ml (P<0.0001). This improvement was sustained during the first 30 months. PLV is a reasonable approach for end-stage patients, providing sustained dramatic changes in ventricular geometry and functional capacity, especially in the absence of compromised right and diastolic left heart functions. Routine replacement of the mitral valve allows a more liberal ventriculectomy and eliminates mitral regurgitation, and this may help minimize ventricular distention.

Partial left ventriculectomy: overall and late results in 44 class IV patients with 4-year follow-up.

This study reports long-term results of partial left ventriculectomy (PLV). Forty-four patients with dilated cardiomyopathy were operated on in a 4-year study. Echocardiograms, catheterization, and stress tests with oxygen consumption (VO2) were performed. The survivors' preoperative ejection fractions of 22.1% +/- 4.9% improved to 30.9% +/- 9.4%, left ventricular (LV) end-diastolic diameter decreased from 79.4 +/- 9.3 mm to 61.9 +/- 8.2 mm, and maximum VO2 consumption improved from 8.8 +/- 3.9 mL/kg per minute to 15.8 +/- 6.1 mL/kg per minute at 22.6 months. These data also showed improvements in nonsurviving patients, according to the last evaluation before death. Seven of 12 survivors (58.3%) were in New York Heart Association (NYHA) I and II in December 1998. Twelve patients had elevated pulmonary vascular resistance (PVR) contraindicating heart transplant. In five patients the PVR returned to normal and one high-PVR patient was transplanted at the 16th postoperative month. Survival was 56.8%, 47.7%, 38.4%, and 35.9%, respectively, at 3, 6, 12, and 18 months, with a tendency to stabilize at 32.7% thereafter. Arrhythmias and heart failure were the main causes of death. In spite of improvement of ventricular function and quality of life of the survivors, high mortality is a limiting factor. PLV can be indicated as a bridge to heart transplantation in high-PVR patients or if ventricular assist devices or donor hearts are not available.

Intermediate-term results of partial left ventriculectomy.

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.

Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy

Objective: This study reports initial results of partial left ventriculectomy performed with preservation of the mitral valve in the treatment of 27 patients with idiopathic dilated cardiomyopathy. Methods: Patients were in New York Heart Association class III or IV. Partial ventriculectomy was performed as an isolated procedure in four patients and associated with mitral annuloplasty in 23 patients. There were four hospital deaths (14.8%) and the remaining patients were followed for 11.2 ± 6 months. Results: Decrease of left ventricular diastolic diameter (81.8 ± 8.7 to 68.5 ± 7.6 mm, p < 0.001) and improvement of left ventricular wall shortening (12% ± 3.1% to 18.1% ± 3.9%, p < 0.001) were demonstrated by echocardiography after the operation. Left ventricular radioisotopic angiography showed reduction of diastolic volume (495 ± 124 ml to 352 ± 108 ml, p < 0.001) and increase of ejection fraction (17.7% ± 4.6% to 23.7% ± 8.8%, p < 0.001). Right-sided heart catheterization demonstrated improvement of stroke index (24.3 ± 7.7 ml/m 2 to 28.3 ± 7.6 ml/m 2, p < 0.01) and decrease of pulmonary wedge pressure (23.2 ± 8.8 mm Hg to 17 ± 7 mm Hg, p < 0.01). Similar results were documented at 6 and 12 months of follow-up. Functional class improved from 3.6 ± 0.5 to 1.4 ± 0.6 ( p < 0.001). However, seven patients died at midterm follow-up because of heart failure progression or arrhythmia-related events, and survival rate was 59.2% ± 9.4% from 6 to 24 months of follow-up. Conclusions: Partial left ventriculectomy performed with preservation of the mitral valve improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy. Nevertheless, the high incidences of heart failure progression and arrhythmia-related deaths observed after this procedure preclude its wide clinical application. (J Thorac Cardiovasc Surg 1998;115:800-7)

Intermediate Results of Partial Left Ventriculectomy for Dilated Cardiomyopathy

Intermediate Results of Partial Left Ventriculectomy for Dilated Cardiomyopathy

Myocardial Fiber Diameter as a Good Indicator of Outcome in Batista's Operation

Abstract Background: Despite the initial promissory results of partial left ventriculectomy, or Batista's operation, the postoperative mortality associated with the procedure has been too high. We described a histopathologic study performed to identify histological parameters that could help to determine outcomes of patients undergoing this procedure. Methods and Results: Myocardial fiber diameter, myocardial fibrosis, thickness of the compact wall, and number of cells presenting from the endocardium to epicardium were analyzed in 32 patients with idiopathic dilated cardiomyopathy who underwent Batista's operation. Data were grouped by patients who died ≤ 6 months and patients who survived for &gt; 6 months after the surgical procedure. Additional analyses were performed to compare results according the causes of death and to test the application of these results to biopsy. Results: Myocardial fiber diameter was the only index that could distinguish the two groups. Myocardial fiber diameter &lt; 22 μm distinguished the group of patients who survived the 6‐month postoperative period from patients who died during that time with sensitivity of 85.7 and specificity of 72.2. The subendocardial region of the compact wall and the trabecular portion of the wall exhibited comparable results. Conclusion: Our results indicate that the myocardial fiber diameter of samples from the trabecular or subendocardial compact wall regions may help predict the outcome of left ventriculectomy. Samples from the trabecular or subendocardial compact wall regions were used for analysis. Further prospective studies involving left ventricular endomyocardial biopsies are necessary to confirm if the use of myocardial fiber diameter in the selection of patients for surgery improves the index of success of Batista's operation. Other factors that are involved remain unclear.

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) &gt; 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.