Partial Left Ventriculectomy: Overall and Late Results in 44 Class IV Patients with 4-Year Follow-Up

• Published in: Journal of cardiac surgery Vol. 15; no. 3; pp. 179 - 185
• Main Authors: Lucchese, Fernando Antonio, Filho, Jose Dario Frota, Blacher, Celso, Pereira, Wagner, Lucio, Eraldo, Beck, Luiz, Leonetti, Lucas A., Leães, Paulo E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2000
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/j.1540-8191.2000.tb00453.x-i1

Background: This study reports long‐term results of partial left ventriculectomy (PLV). Methods: 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. Results: 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. Conclusions: 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.