Original Articles
Partial Left Ventriculectomy to Treat End-Stage Heart Disease

Presented at the Thirty-Third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, 1997.
https://doi.org/10.1016/S0003-4975(97)00779-0Get rights and content

Abstract

Background. It is reasoned that reducing left ventricular diameter (Laplace’s law) in patients with dilated cardiomyopathy, will improve ventricular function.

Methods. Partial left ventriculectomy was performed in 120 patients with end-stage dilated cardiomyopathies of varying causes. Most patients were in New York Heart Association functional class IV. The procedure consisted of removal of a wedge of left ventricular muscle from the apex to the base of the heart. Depending on the distance between the two papillary muscles, the mitral valve apparatus was either preserved, repaired, or replaced with a tissue prosthesis.

Results. The 30-day mortality was 22% and the 2-year survival was 55%. Although 10% of surviving patients showed no improvement in New York Heart Association functional class, most of the surviving patients were in either class I (57%) or II (33.3%), and the others were in class III and IV.

Conclusions. Partial left ventriculectomy can be used to treat end-stage dilated cardiomyopathy. Further studies and a longer follow-up period are needed to fully assess the effects of this procedure.

Section snippets

Patients

The following were the characteristics of the patients from Brazil. Due to local circumstances, Brazilian patients only gave oral consent. They were mostly from a low socioeconomic class and had traveled long distances from the interior of the South American country to receive medical care. Cardiac transplantation and other forms of cardiac assist support, such as intraaortic balloon pumping and left ventricular (LV) assist devices, were not available at the Hospital Angelina Caron. It was

Results

The patients from both institutions ranged in age from 11 to 74 years (mean, 53.0 ± 12.0 years). There were 97 male and 23 female patients. All patients were in New York Heart Association (NYHA) functional class IV, and 30% required hemodynamic support at the time of the operation. All patients had an ejection fraction less than 0.20. Dilated (viral or idiopathic) cardiomyopathy with or without valvular involvement was the primary indication for operation in Buffalo, whereas ischemic,

Comment

We began performing partial left ventriculectomy in Brazil to treat patients with dilated cardiomyopathy of varying causes because we reasoned [1]that cardiac performance could be improved by reducing LV diameter (cardioreduction). Observations of hearts in different mammalian species, including humans, suggested that heart mass is proportional to body weight. Heart mass and radius are also related. An increase in radius leads to an increase in mass to maintain this normal relationship. When

References (4)

  • Batista RJV, Santos JVL, Cunha MA, et al. Ventriculectomia parcial: um novo conceito no tratamento cirurgico de...
  • RJV Batista et al.

    Partial left ventriculectomy to improve left ventricular function in end-stage heart diseases

    J Card Surg

    (1996)
There are more references available in the full text version of this article.

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