Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy

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Abstract

Background.

Partial left ventriculectomy has been proposed for treatment of severe cardiomyopathies. This study reports midterm results of this procedure in 37 patients with dilated cardiomyopathy.

Methods.

All patients were in New York Heart Association class III (16) or IV (21). Partial ventriculectomy was associated with mitral annuloplasty in 27 patients and with mitral replacement in 2.

Results.

There were seven operative deaths (18.9%). During a mean follow-up of 18.2 ± 9.3 months, 9 more patients died. Actuarial survival was 56.7% ± 8.1% at 6 and 24 months. Analysis of factors influencing outcome showed that midterm survival was significantly affected only by myocardial cell diameter. Otherwise, functional class improved from 3.5 ± 0.5 to 1.8 ± 0.9 in the survivors (p < 0.001). Furthermore, left ventricular diastolic volume decreased from 523 ± 207 to 380 ± 148 mL (p < 0.001), and left ventricular ejection fraction increased from 17.1% ± 4.6% to 23% ± 8% (p < 0.001), whereas significant changes in cardiac index, stroke index, and pulmonary pressures were found at 1 month of follow-up. Although left ventricular diastolic volume tended to increase in the late postoperative period, left ventricular ejection fraction and hemodynamic variables did not change significantly.

Conclusions.

Partial ventriculectomy improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy for up to 24 months of follow-up. Nevertheless, this procedure's clinical application is limited by the high mortality observed in the first postoperative months. Otherwise, new perspectives may be advised by the identification that partial ventriculectomy results seem to be influenced by compromised myocardial cells.

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