Impact of apex-sparing partial left ventriculectomy on left ventricular geometry, function, and long-term survival of patients with end-stage dilated cardiomyopathy

J Card Surg. Sep-Oct 2009;24(5):499-502. doi: 10.1111/j.1540-8191.2009.00874.x.

Abstract

Background and aim: Currently, partial left ventriculectomy (PLV) has not been widely accepted as a treatment option for dilated cardiomyopathy (DCM) because its results thus far have been inconsistent. In an animal study, apex-sparing PLV (AS-PLV) was shown to produce greater improvement in left ventricle (LV) function than conventional PLV in which the apex was removed. The aim of this study is to investigate the effectiveness of AS-PLV in a clinical setting.

Patients and methods: From September 1999 to December 2007, 13 patients with DCM underwent AS-PLV. Left ventriculotomy was made in the thinnest portion of the lateral wall without injuring the apex, the papillary muscles, and the circumflex coronary artery, which supplies the neighboring myocardium.

Results: All patients were discharged from the hospital, except for one patient who developed refractory ventricular fibrillation on postoperative day 35. After AS-PLV, the LV diastolic dimension decreased from 71 +/- 10 mm to 55 +/- 9 mm; LV ejection fraction (EF) from 28%+/- 8% to 39%+/- 11%; and New York Heart Association (NYHA) class from 3 +/- 1.7 to 1.5 +/- 0.6; the differences were significant (p < 0.01). LV function and geometry remained unchanged 2 years after AS-PLV with LVDD of 60 +/- 7 mm, LVEF of 34%+/- 8%, and NYHA class of 1.7 +/- 0.6, respectively (N.S vs. at discharge).

Conclusions: Regardless of the etiology of LV dilatation, AS-PLV restored the ellipsoidal shape of the LV and improved LV function. AS-PLV is a feasible option for treating diseased LVs with lateral wall lesions.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cardiac Surgical Procedures*
  • Cardiomyopathy, Dilated / diagnostic imaging
  • Cardiomyopathy, Dilated / mortality
  • Cardiomyopathy, Dilated / pathology
  • Cardiomyopathy, Dilated / surgery*
  • Diastole
  • Feasibility Studies
  • Female
  • Health Status Indicators
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Heart Ventricles / surgery*
  • Humans
  • Male
  • Middle Aged
  • Stroke Volume
  • Survival Analysis
  • Systole
  • Time Factors
  • Ultrasonography
  • United States
  • Ventricular Function, Left