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J Thorac Cardiovasc Surg 1997;114:755-765
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

EARLY RESULTS WITH PARTIAL LEFT VENTRICULECTOMY

Patrick M. McCarthy , MDa, Randall C. Starling , MDb, James Wong , MBBS, PhDb, Gregory M. Scalia , MBBSb, Tiffany Buda , RNa, Rita L. Vargo, MSN , RNa, Marlene Goormastic , MPHc, James D. Thomas , MDb, Nicholas G. Smedira , MDa, James B. Young , MDb

Received for publication May 16, 1997 revisions requested July 7, 1997; revisions received August 1, 1997 accepted for publication August 4, 1997. Address for reprints: Patrick M. McCarthy, MD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Desk F-25, Cleveland, OH 44195.

Abstract

Objective: We sought to determine the role of partial left ventriculectomy in patients with dilated cardiomyopathy. Methods: Since May 1996 we have performed partial left ventriculectomy in 53 patients, primarily (94%) in heart transplant candidates. The mean age of the patients was 53 years (range 17 to 72 years); 60% were in class IV and 40% in class III. Preoperatively, 51 patients were thought to have idiopathic dilated cardiomyopathy, one familial cardiomyopathy, and one valvular cardiomyopathy. As our experience accrued we increased the extent of left ventriculectomy and more complex mitral valve repairs. For two patients mitral valve replacement was performed. For 51 patients the anterior and posterior mitral valve leaflets were approximated (Alfieri repair); 47 patients also had ring posterior annuloplasty. In 27 patients (51%) one or both papillary muscles were divided, additional left ventricular wall was resected, and the papillary muscle heads were reimplanted. Results: Echocardiography showed a significant decrease in left ventricular dimensions after resection (8.3 cm to 5.8 cm), reduction in mitral regurgitation (2.8+ to 0), and increase in forward ejection fraction (15.7% to 32.7%). Cardiac index did not increase significantly (2.2 to 2.4 L/min per square meter). Eight patients (15%) required a perioperative left ventricular assist device; one died and was the only perioperative mortality (1.9%). At 11 months, actuarial survival was 87% and freedom from relisting for transplantation was 72% Conclusions: Improved selection criteria are necessary to avoid early failures, and much more follow-up and analyses of data are mandatory. However, the operation may become a biologic bridge, or even alternative, to transplantation.




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