Early and Late Results of Partial Left Ventriculectomy: Single Center Experience and Review of the Literature

• Published in: Journal of cardiac surgery Vol. 18; no. 3; pp. 190 - 196
• Main Authors: Ascione, Raimondo, Lim, Kelvin HH, Chamberlain, Martin, Al-Ruzzeh, Sharif, Angelini, Gianni D.
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA. , and 9600 Garsington Road , Oxford OX4 2DQ , UK Blackwell Science Inc 01.05.2003
• Subjects: Actuarial Analysis; Aged; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - surgery; Cause of Death; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications - mortality; Prospective Studies; Registries; Risk Assessment; Sampling Studies; Severity of Illness Index; Survival Analysis; Time Factors; Treatment Outcome; United Kingdom; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - surgery
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1046/j.1540-8191.2003.02017.x

Aim: To evaluate early and late outcome of partial left ventriculectomy (PLV) in a single center and to conduct a review of the literature. Methods: From February 1996 to August 2001, 24 patients with dilated cardiomyopathy (DCM) (12 idiopathic, 12 ischemic) underwent PLV. Perioperative and follow‐up data were prospectively entered into a database and analyzed. An observational analysis of the literature was carried out of all the published series of PLV reporting on ≥15 patients. Results: In our series there were 22 males with amean age of 65 years (range 49 to73]). Of the 22, there were 3 (12.5%) in‐hospital deaths. Mean duration of follow‐up was 26 months (range 3 to 71) with 9 late deaths (38%), 6 in the idiopathic group. The five‐year actuarial survival was 74% in the ischemic group and 33% in the idiopathic group. The observational analysis of literature included a total of 506 patients (425 males, age 50.2 ± 5.2 years)]. The etiology was idiopathic in 255 (50.4%), and ischemic in 89 (17.6%) patients. Baseline characteristics of the whole population include: ejection fraction 18.9 ± 3.9%, NYHA functional class 3.7 ± 0.2, and LVEDD of 7.7 ± 0.4 cm. Severe mitral regurgitation was present in 368 (72.7%) patients. There were 88 (17.4%) in‐hospital deaths. Cause of death included 55 due to (62.5%) low cardiac output, 10 (11.3%) due to severe bleeding, 7 (7.95%) caused by malignant arrhythmias, 8 (9%) due to sepsis, and 5 (5.7%) as a result of stroke. Ten of the selected series (overall 386 patients) reported late outcome. There were 89 (22.9%) late deaths, 12 (13.5%) were not cardiac‐related, 50 (56.2%) were due to recurrence of congestive heart failure (CHF), 20 (22.5%) caused by sudden arrhythmias, 5 (5.6%) due to infections, and 2 (2.2%) from strokes. Overall, there were 248 (64.2%) survivors, of whom 179 (72.17%) were reported to be in NYHA functional class I or II. All 10 papers reported one‐year survival ranging from 50% to 85%. Seven reported a two‐year survival of 45% to 72%, and 4 reported a three‐year survival of 33% to 64%. Conclusions: Our results and the review of the literature seem to suggest a relatively high early mortality with satisfactory late results of PLV in patients with dilated cardiomyopathy.(J Card Surg 2003;18:190‐196)