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J Am Coll Cardiol, 2000; 36:2098-2103
© 2000 by the American College of Cardiology Foundation
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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{dagger}, Tiffany Buda, RN{dagger}, James Wong, MB, BS, PhD*, Marlene Goormastic, MPH{ddagger}, Nicholas G. Smedira, MD{dagger}, James D. Thomas, MD, FACC*, Eugene H. Blackstone, MD, FACC{dagger} 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
{dagger} George M. and Linda H. Kaufman Center for Heart Failure, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
{ddagger} 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




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