Partial left ventriculectomy and limited heart transplantation availability.
OBJECTIVE
Partial left ventriculectomy, a novel cardiac volume reduction operation, is applied in countries without a developed heart transplantation program. We sought to determine its impact in our population of patients.


METHODS
Partial left ventriculectomy was performed in 38 patients during the last 4 years. Basic inclusion criteria were nonischemic dilated cardiomyopathy and poor response to medical therapy for heart failure. Hemodynamic evaluation was carried out before and after operation. A modified surgical technique of mitral valve repair and ventricle suturing was applied.


RESULTS
Thirty-day, 6-month, and 2-year survival rates were 82% +/- 7%, 65% +/- 8%, and 61% +/- 9%, respectively. Duration of heart failure symptoms was the only predictor of survival (p = 0.042). A high proportion of noncardiac causes of death was noted. Functional capacity in surviving patients improved at every successive measurement up to 1 year postoperatively.


CONCLUSIONS
The introduction of partial left ventriculectomy in a country with limited heart transplantation availability had a great impact on the management of end-stage heart failure and may represent the only surgical option for some patients. The average cost per patient was substantially lower when compared to heart transplantation.
Gradinac
S
S
Dedinje Cardiovascular Institute, Belgrade, Yugoslavia. gradinac@eunet.yu
Popović
Z
Z
Mirić
M
M
Vasiljević
J
J
Nastasić
S
S
Perić
M
M
Bojić
M
M
Radovancević
B
B
Frazier
O H
OH
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D016138:Walking; D015022:Yugoslavia