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J Thorac Cardiovasc Surg 1998;115:800-807
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy

Supported by grant 1058/95/58 from Fundação E. J. Zerbini, São Paulo, Brazil.

Received for publication July 10, 1997. Revisions requested Oct. 10, 1997; revisions received Nov. 11, 1997. Accepted for publication Nov. 11, 1997. Address for reprints: Luiz Felipe P. Moreira, MD, Divisão de Cirurgia—Instituto do Coração, Av. Dr. Enéas Carvalho Aguiar, 44, São Paulo, SP, Brazil. CEP:05403-000

Abstract

Objective: This study reports initial results of partial left ventriculectomy performed with preservation of the mitral valve in the treatment of 27 patients with idiopathic dilated cardiomyopathy.
Methods: Patients were in New York Heart Association class III or IV. Partial ventriculectomy was performed as an isolated procedure in four patients and associated with mitral annuloplasty in 23 patients. There were four hospital deaths (14.8%) and the remaining patients were followed for 11.2 ± 6 months.
Results: Decrease of left ventricular diastolic diameter (81.8 ± 8.7 to 68.5 ± 7.6 mm, p < 0.001) and improvement of left ventricular wall shortening (12% ± 3.1% to 18.1% ± 3.9%, p < 0.001) were demonstrated by echocardiography after the operation. Left ventricular radioisotopic angiography showed reduction of diastolic volume (495 ± 124 ml to 352 ± 108 ml, p < 0.001) and increase of ejection fraction (17.7% ± 4.6% to 23.7% ± 8.8%, p < 0.001). Right-sided heart catheterization demonstrated improvement of stroke index (24.3 ± 7.7 ml/m² to 28.3 ± 7.6 ml/m², p < 0.01) and decrease of pulmonary wedge pressure (23.2 ± 8.8 mm Hg to 17 ± 7 mm Hg, p < 0.01). Similar results were documented at 6 and 12 months of follow-up. Functional class improved from 3.6 ± 0.5 to 1.4 ± 0.6 (p < 0.001). However, seven patients died at midterm follow-up because of heart failure progression or arrhythmia-related events, and survival rate was 59.2% ± 9.4% from 6 to 24 months of follow-up.
Conclusions: Partial left ventriculectomy performed with preservation of the mitral valve improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy. Nevertheless, the high incidences of heart failure progression and arrhythmia-related deaths observed after this procedure preclude its wide clinical application. (J Thorac Cardiovasc Surg 1998;115:800-7)

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