BACKGROUND: Partial left ventriculectomy has been recently introduced as a surgical therapy for end-stage heart failure. We performed a prospective study of partial left ventriculectomy in patients with end-stage idiopathic dilated cardiomyopathy (IDCM). METHODS: Patients considered as candidates for partial left ventriculectomy had IDCM, left ventricular end-diastolic diameter greater than 7 cm (LVEDD), refractory New York Heart Association class IV symptoms (NYHA), and severely impaired exercise oxygen consumption. All patients underwent a complete heart transplantation evaluation. RESULTS: Partial left ventriculectomy was performed in 16 patients with a mean follow-up of 11.1 months. Fourteen patients were male with a mean age of 49.6+/-10.5 years. After surgery there were significant changes in NYHA class, left ventricular ejection fraction, LVEDD, and degree of mitral regurgitation at up to 12 months follow-up. The operative mortality rate was 6.25% and 12-month Kaplan-Meier was 86%. Twelve-month freedom from need for listing for orthotopic heart transplantation was 65%. CONCLUSION: Partial left ventriculectomy can be performed in patients with idiopathic cardiomyopathy with acceptable operative and 12 month survival rates. Significant improvements are seen in ejection fraction, LVEDD, and NYHA class at 12 month follow up. Late failures do occur and some patients have required relisting for transplant after partial left ventriculectomy.
BACKGROUND: Partial left ventriculectomy has been recently introduced as a surgical therapy for end-stage heart failure. We performed a prospective study of partial left ventriculectomy in patients with end-stage idiopathic dilated cardiomyopathy (IDCM). METHODS:Patients considered as candidates for partial left ventriculectomy had IDCM, left ventricular end-diastolic diameter greater than 7 cm (LVEDD), refractory New York Heart Association class IV symptoms (NYHA), and severely impaired exercise oxygen consumption. All patients underwent a complete heart transplantation evaluation. RESULTS: Partial left ventriculectomy was performed in 16 patients with a mean follow-up of 11.1 months. Fourteen patients were male with a mean age of 49.6+/-10.5 years. After surgery there were significant changes in NYHA class, left ventricular ejection fraction, LVEDD, and degree of mitral regurgitation at up to 12 months follow-up. The operative mortality rate was 6.25% and 12-month Kaplan-Meier was 86%. Twelve-month freedom from need for listing for orthotopic heart transplantation was 65%. CONCLUSION: Partial left ventriculectomy can be performed in patients with idiopathic cardiomyopathy with acceptable operative and 12 month survival rates. Significant improvements are seen in ejection fraction, LVEDD, and NYHA class at 12 month follow up. Late failures do occur and some patients have required relisting for transplant after partial left ventriculectomy.