[Endoventricular patch plasty in patients with idiopathic dilated cardiomyopathy: an alternative to heart transplantation?].
BACKGROUND
Although the concept of reducing wall tension as a treatment for advanced heart failure is convincing, clinical data from the Batista operation are conflicting. Despite a number of publications, it is not clear whether left ventricular reduction surgery is truly of benefit for patients with idiopathic, dilated cardiomyopathy (DCM). Surgery may reduce wall tension but the reason for dilation and contractile dysfunction remains. Thus, the potential benefit of the operation may be overshadowed by the natural course of the underlying disease.


METHODS
We report a series of five cases where left ventricular reduction was performed and physiological geometry was restored in patients with DCM by a modification of Dor's endoventricular patch plasty. All patients demonstrated an improvement in cardiac function immediately after the operation. This improvement was sustained in one of the patients at 18 months follow-up. Another patient developed severe heart failure due to therapy resistant ventricular arrhythmia (Lown IVb), and underwent successful transplantation 4 months after ventricular reduction surgery. Left ventricular dilation reoccurred in two patients 9 and 12 months after reduction surgery, and they were listed for transplant. One patient died after 9 weeks due to sepsis and respiratory dysfunction.


CONCLUSIONS
Although the endoventricular patch plasty as used in this study is well tolerated by most patients with dilated cardiomyopathy and results in immediate improvement of contractile function, the long-term benefits of this technique for DCM are uncertain. Thus, the technique is currently not an alternative for heart transplantation. However, the procedure may be an option in patients with contraindications for transplantation.
Abteilung für Herz- und Gefässchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg. doenst@chl1.ukl.uni-freiburg.de
T
T
Doenst
L
L
Ahn-Veelken
C
C
Schlensak
M
M
Berchtold-Herz
K
K
Sarai
M
M
Schaefer
A
A
van de Loo
F
F
Beyersdorf
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011126:Polypropylenes; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D013318:Stroke Volume; D013537:Sutures
D011093:Polyethylene Terephthalates; D011126:Polypropylenes