title: Partial left ventriculectomy for patients with ischemic cardiomyopathy.
abstract: BACKGROUND
  Partial left ventriculectomy (PLV) has been performed in patients with dilated cardiomyopathy (DCM), but improved myocardial energetics may make PLV useful also for ischemic cardiomyopathy (ICM) unamenable to conventional treatment.
  
  
  METHODS
  Of 262 patients undergoing PLV, 94 patients with ICM as the underlying pathology were analyzed and compared with 168 patients with DCM.
  
  
  RESULTS
  ICM patients were older (57.3 years vs 50.9 years, p = 0.0001) and heavier (69.7 kg vs 65.9 kg, p = 0.039) than those with DCM, but ventricular end-diastolic and end-systolic dimensions were similar with comparably depressed fractional shortening (16% vs 15%, p = 0.294) and equally severe functional limitation [New York Heart Association (NYHA) Class 3.7 vs 3.6, p = 0.734]. A majority of patients in both groups underwent lateral PLV (76% vs 74%, p = 0.883) with myocardium excised between papillary muscles and simultaneous mitral valvuloplasty (41% vs 74%, p < 0.0001). Because ICM patients required coronary artery bypass grafting (CABG) more frequently (79% vs 0.6%, p < 0.0001), operation was more extensive in terms of bypass time (74 minutes vs 47 minutes, p < 0.0001), percentage requiring cardiac arrest (43% vs 19%, p < 0.0001), and arrest duration (34 minutes vs 28 minutes, p = 0.280), but all had similar resection and postoperative ventricular dimensions. Nonetheless, ICM patients required shorter intensive care unit (ICU) time (4.4 days vs 5.9 days, p = 0.048) and similar postoperative hospital stays, resulting in similar hospital survival rates (69% vs 71%, p = 0.778) and functional capacity in long-term follow-up.
  
  
  CONCLUSIONS
  Results suggest that PLV can be performed in patients with ICM with comparable risks and benefits as in DCM. Relative efficacy of CABG and mitral repair as compared to volume reduction remains to be studied.
authors.affiliation: Department of Cardiovascular Surgery and Transplantation, Tokai University, Bohseidai, Isehara, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujimura
authors.forename: A T
authors.initials: AT
authors.lastname: Kawaguchi
authors.forename: H
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.forename: J
authors.initials: J
authors.lastname: Bergsland
authors.forename: S
authors.initials: S
authors.lastname: Koide
authors.forename: R J
authors.initials: RJ
authors.lastname: Batista
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome