Intermediate-Term Results After Partial Left Ventriculectomy for End-Stage Dilated Cardiomyopathy: Is There A Survival Benefit?

Background: The mortality of congestive heart failure remains high despite advances in medical therapy. Partial left ventriculectomy (PLV) has been advocated as a surgical alternative for select patients with dilated cardiomyopathy. Methods: A prospective clinical trial of PLV for patients with end‐...

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Bibliographic Details
Published in:	Journal of cardiac surgery Vol. 16; no. 2; pp. 153 - 158
Main Authors:	Etoch, Steven W., Cerito, Patricia, Henahan, Betty J., Gray, Laman A., Dowling, Robert D.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-03-2001
Subjects:	Adult Aged Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - methods Cardiomyopathy, Dilated - mortality Cardiomyopathy, Dilated - pathology Cardiomyopathy, Dilated - physiopathology Cardiomyopathy, Dilated - surgery Female Humans Male Middle Aged Prospective Studies Recurrence Severity of Illness Index Stroke Volume Survival Rate Time Factors Treatment Outcome
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Summary:	Background: The mortality of congestive heart failure remains high despite advances in medical therapy. Partial left ventriculectomy (PLV) has been advocated as a surgical alternative for select patients with dilated cardiomyopathy. Methods: A prospective clinical trial of PLV for patients with end‐stage idiopathic dilated cardiomyopathy was performed. Inclusion criteria were left ventricular end‐diastolic diameter (LVEDD) greater than 7 cm, refractory New York Heart Association (NYHA) Class IV symptoms, and severely depressed exercise oxygen consumption. Results: Twenty patients underwent PLV with mean follow‐up of 21.1 months. Sixteen were male; mean age was 50.1 years ± 12.0 years (range 25–67 years). Left ventricle (LV) ejection fraction improved after surgery from 14.1%± 4.7% to 24.1%± 3.1% (p < 0.05, t‐test) and this improvement persisted up to 3 years after operation. LVEDD and NYHA Class also were notably improved. There were two early deaths for an operative mortality of 10% (2 of 20 patients). Nine patients after initial improvement in clinical status and LV function developed worsening congestive heart failure (CHF). Six of the 9 ultimately died of complications secondary to CHF. One‐, 2‐, and 3‐year survival rates were 84%, 64%, and 40%, respectively, by Kaplan‐Meier analysis. The other three patients required listing for transplantation because of recurrent NYHA Class IV symptoms. Freedom from death or the need for listing for transplantation at 1, 2, and 3 years was 65%, 53%, and 33%, respectively. The remaining nine patients all had improvement in their NYHA classification. Conclusions: PLV can be performed with acceptable early and intermediate term mortality; survival compares favorably to reports of similar groups of patients treated with medical therapy alone.
Bibliography:	ark:/67375/WNG-M9C5DDHK-M ArticleID:JOCS153 istex:EB6611F37F6843E9C6FA76FF760851BC0131AB90 Presented in Part at the 3rd International Symposium on Cardiac Volume Reduction, April 9, 2000, Osaka, Japan. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0886-0440 1540-8191
DOI:	10.1111/j.1540-8191.2001.tb00501.x