Factors affecting ventricular function and survival after partial left ventriculectomy.
BACKGROUND
Partial left ventriculectomy (PLV) helps some patients but is deleterious in others. Selection of patients who will benefit from PLV, and exclusion of those who will not is necessary for safe and effective application of the procedure.


METHODS
Sixty-nine consecutive patients who underwent PLV were monitored with pressure-volume relationship analyses, Doppler echocardiography, and histopathologic studies of excised myocardium. These parameters were correlated with postoperative stroke volume (SV, ml), cardiac output (CO, L/min), ventricular function (improved, no change, or deteriorated), and postoperative course (duration of survival and/or hospital discharge).


RESULTS
Positive responders (n = 36) with increased SV at reduced end diastolic pressure had significantly larger preoperative end-systolic dimension, smaller SV, and less stroke work with milder fibrosis than non- or negative responders (n = 33). In multivariate analyses, poor preoperative hemodynamics were associated with increased SV and CO, but these improvements did not lead to improved survival. Postoperative survival was negatively affected by larger preoperative left ventricular end-diastolic volume and larger excised-muscle-weight. Milder fibrosis and thicker excised wall were consistently related to improved ventricular function and survival.


CONCLUSIONS
Although effects of PLV are related to preoperative status, factors affecting postoperative ventricular function and survival were often discordant. While poor preoperative ventricular function was associated with functional improvement without survival benefit, milder fibrosis, thicker excised wall and less myocardial resection were positive contributors to improved ventricular function, discharge, and survival. Preoperative evaluation with more cases and variables are needed to identify patients more likely to benefit from PLV.
Kawaguchi
Akira T
AT
Tokai University, Isehara, Japan. akira@is.icc.u-tokai.ac.jp
Takahashi
Nobuo
N
Ishibashi-Ueda
Hatsue
H
Shimura
Shinichirou
S
Karamanoukian
Hratch L
HL
Batista
Randas J V
RJ
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004719:Endomyocardial Fibrosis / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D009929:Organ Size; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*