This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Starling, R. C. Articles by Young, J. B. Search for Related Content PubMed PubMed Citation Articles by Starling, R. C. Articles by Young, J. B.

CLINICAL STUDY: HEART FAILURE

Results of partial left ventriculectomy for dilated cardiomyopathy

Hemodynamic, clinical and echocardiographic observations

Randall C. Starling, MD, MPH, FACC^*, Patrick M. McCarthy, MD, Tiffany Buda, RN, James Wong, MB, BS, PhD^*, Marlene Goormastic, MPH, Nicholas G. Smedira, MD, James D. Thomas, MD, FACC^*, Eugene H. Blackstone, MD, FACC and James B. Young, MD, FACC^*

^* George M. and Linda H. Kaufman Center for Heart Failure, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
George M. and Linda H. Kaufman Center for Heart Failure, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
George M. and Linda H. Kaufman Center for Heart Failure, Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA

Manuscript received March 9, 2000; revised manuscript received August 23, 2000, accepted September 19, 2000.

Reprint requests and correspondence: Randall C. Starling, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195
starlir{at}ccf.org

OBJECTIVES

The study was done to prospectively measure the echocardiographic, hemodynamic and clinical outcomes after partial left ventriculectomy (PLV).

BACKGROUND

Although PLV can improve symptoms of advanced heart failure, immediate postoperative echocardiographic findings remain abnormal.

METHODS

Fifty-nine patients with cardiomyopathy and advanced heart failure underwent PLV and concomitant mitral valve surgery between May 1996 and December 1997. Thirty-nine percent were on inotropic therapy. All were New York Heart Association (NYHA) functional class III or IV. Mechanical circulatory support (LVAD) and transplant were provided for rescue therapy when hemodynamic compromise occurred. Patients were followed for a mean of 405 ± 168 days, and clinical, echocardiographic and hemodynamic measures were obtained preoperatively, immediately postoperatively, and at 3 and 12 months prospectively.

RESULTS

Comparing preoperative and 12-month postoperative values in event-free survivors, we found: NYHA functional class improved from 3.6 to 2.1, p < 0.0001; peak oxygen consumption increased from 10.8 to 16.0 ml/kg/min, p < 0.0001; LV ejection fraction increased from 13 ± 6.0% to 24 ± 6.9%, p < 0.0001; LV end diastolic diameter decreased from 8.2 ± 1.03 to 6.2 ± 0.64 cm, p < 0.0001, and volume was reduced from 167 ± 60 to 105 ± 38 ml/m², p = 0.02. Central hemodynamics did not normalize after surgery.

CONCLUSIONS

Partial left ventriculectomy can provide structural remodeling of the heart that may result in temporary improvement in clinical compensation. However, perioperative failures and the return of heart failure limit the propriety of this procedure.

Abbreviations and Acronyms   LVAD = left ventricular assist device   PLV = partial left ventriculectomy

This article has been cited by other articles:

				J. K. Ghali, S. Hu, Z. Zheng, H. Fan, C. L. Athanasuleas, G. D. Buckberg, J. V. Conte, A. S. Wechsler, J. E. Strobeck, F. Beyersdorf, et al. Surgical Ventricular Reconstruction N. Engl. J. Med., July 30, 2009; 361(5): 529 - 532. [Full Text] [PDF]

				D. Burkhoff and A. S. Wechsler Surgical ventricular remodeling: A balancing act on systolic and diastolic properties. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 459 - 463. [Full Text] [PDF]

				M. G. Crespo-Leiro and J. J. Cuenca-Castillo Surgical treatment of heart failure: heart transplantation and ventricular restoration surgery Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E39 - E42. [Abstract] [Full Text] [PDF]

				K. Iino, H. Ohashi, Y. Tsutsumi, T. Kawai, H. Fujii, and M. Ohnaka Biventricular Pacing 18 Months After Batista Operation Ann. Thorac. Surg., June 1, 2006; 81(6): 2302 - 2304. [Abstract] [Full Text] [PDF]

				R. Ascione, P. Wilde, and G. D. Angelini Left ventricular volume reduction MMCTS, June 28, 2005; 2005(0628): 760. [Abstract] [Full Text] [PDF]

				R. M. Setser, R. D. White, B. Sturm, P. M. McCarthy, R. C. Starling, J. B. Young, J. Kasper, T. Buda, N. Obuchowski, and M. L. Lieber Noninvasive assessment of cardiac mechanics and clinical outcome after partial left ventriculectomy Ann. Thorac. Surg., November 1, 2003; 76(5): 1576 - 1585. [Abstract] [Full Text] [PDF]

				R. M. Setser, J. M. Kasper, M. L. Lieber, R. C. Starling, P. M. McCarthy, and R. D. White Persistent abnormal left ventricular systolic torsion in dilated cardiomyopathy after partial left ventriculectomy J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 48 - 55. [Abstract] [Full Text] [PDF]

				S. S Kabbani, M. B. Izzat, H. Jamil, B. Akasheh, D. Hanania, and H. Raffa Left Ventricular Volume Reduction Surgery in the Middle East Asian Cardiovasc Thorac Ann, June 1, 2003; 11(2): 99 - 101. [Abstract] [Full Text] [PDF]

				M. Jessup and S. Brozena Heart Failure N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018. [Full Text] [PDF]

				W. F. Saavedra, R. S. Tunin, N. Paolocci, T. Mishima, G. Suzuki, C. W. Emala, P. A. Chaudhry, P. Anagnostopoulos, R. C. Gupta, H. N. Sabbah, et al. Reverse remodeling and enhancedadrenergic reserve from passive externalsupport in experimental dilated heart failure J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2069 - 2076. [Abstract] [Full Text] [PDF]

				J. R. Teerlink and M. B. Ratcliffe Ventricular remodeling surgery for heart failure: small animals and how to measure an improvement in ventricular function Ann. Thorac. Surg., May 1, 2002; 73(5): 1368 - 1370. [Full Text] [PDF]

				J. M. Guccione, S. M. Moonly, A. W. Wallace, and M. B. Ratcliffe Residual stress produced by ventricular volume reduction surgery has little effect on ventricular function and mechanics: A finite element model study J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 592 - 599. [Abstract] [Full Text] [PDF]

				Partial Left Ventriculectomy of Limited Benefit for Dilated Cardiomyopathy Journal Watch Cardiology, April 6, 2001; 2001(406): 12 - 12. [Full Text]

				Surgery for Heart Failure: Disappointing Data Journal Watch (General), December 22, 2000; 2000(1222): 2 - 2. [Full Text]

				M. Ratcliffe Batista's operation: what have we learned? J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2115 - 2118. [Full Text] [PDF]