Partial left ventriculectomy: overall and late results in 44 class IV patients with 4-year follow-up.
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.
Lucchese
F A
FA
São Francisco Hospital at Complexo Hospitalar da Santa Casa, Porto Alegre, RS, Brazil.
Frota Filho
J D
JD
Blacher
C
C
Pereira
W
W
Lucio
E
E
Beck
L
L
Leonetti
L A
LA
Leães
P E
PE
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016019:Survival Analysis; D014463:Ultrasonography; D014655:Vascular Resistance