Partial left ventriculectomy: overall and late results in 44 class IV patients with 4-year follow-up

Plication of the free wall of the left ventricle in dogs with doxorubicin-induced cardiomyopathy

OBJECTIVE

To evaluate plication of the free wall of the left ventricle, which reduces the left ventricular area and volume, as a method to improve the left ventricular systolic function without cardiopulmonary bypass.

ANIMALS

8 mixed-breed adult dogs.

PROCEDURE

Dilated cardiomyopathy (DCM) was induced in each dog by administration of doxorubicin (30 mg/m2, i.v., q 21 d for 168 days). Two dogs died during induction of cardiomyopathy. Plication surgery was performed in 4 dogs. Two dogs did not ondergo to surgery (control group). Values for cardiac output (CO), 2-dimensional and M-mode echocardiography, arterial blood pressure, electrocardiography, blood cell counts, and serum biochemical analyses were recorded after induction of DCM (baseline) and 1, 2, 7, 15, 21, 30, 60, 90, 120, 150, and 180 days after plication surgery. Ambulatory ECG (Holter) recordings were conducted for 24 hours on the day of surgery.

RESULTS

1 dog died after plication surgery. The remaining dogs undergoing ventricular plication had a significant improvement in CO, ejection fraction, and fractional shortening and reductions of left ventricular area and volume after surgery. Electrocardiographic and Holter recordings revealed premature ventricular complexes, which resolved without treatment during the first week after surgery. Clinical condition of the control dogs declined, and these 2 dogs died approximately 40 days after induction of cardiomyopathy.

CONCLUSIONS AND CLINICAL RELEVANCE

Plication of the free wall of the left ventricle improved left ventricular systolic function in dogs with doxorubicin-induced cardiomyopathy. Additional studies are needed to evaluate its application in dogs with naturally developing DCM.

Left ventricular volume reduction

The 'left volume ventricular reduction' operation was originally proposed by Dr Batista to reduce the diameter of the dilated left ventricle by excising a sizable amount of the ventricular free wall. Batista explains that the mechanism of cardiac improvement totally depends on La Place's law, therefore left ventricular wall tension is decreased by reducing the diameter leading to an increase in ejection fraction. Questions, however, still remain on diastolic function, preoperative judgement of left ventricular wall characteristics and late re-dilatation of the left ventricle. The operation was originally performed using normothermic cardiopulmonary bypass on the beating heart. Additional techniques with cardioplegic arrest, concomitant mitral valve repair, and closure of the left ventricle for improvement of hemostasis are shown.

Early and late results of partial left ventriculectomy: single center experience and review of the literature

AIM

To evaluate early and late outcome of partial left ventriculectomy (PLV) in a single center and to conduct a review of the literature.

METHODS

From February 1996 to August 2001, 24 patients with dilated cardiomyopathy (DCM) (12 idiopathic, 12 ischemic) underwent PLV. Perioperative and follow-up data were prospectively entered into a database and analyzed. An observational analysis of the literature was carried out of all the published series of PLV reporting on > or =15 patients.

RESULTS

In our series there were 22 males with amean age of 65 years (range 49 to73). Of the 22, there were 3 (12.5%) in-hospital deaths. Mean duration of follow-up was 26 months (range 3 to 71) with 9 late deaths (38%), 6 in the idiopathic group. The five-year actuarial survival was 74% in the ischemic group and 33% in the idiopathic group. The observational analysis of literature included a total of 506 patients (425 males, age 50.2 +/- 5.2 years)]. The etiology was idiopathic in 255 (50.4%), and ischemic in 89 (17.6%) patients. Baseline characteristics of the whole population include: ejection fraction 18.9 +/- 3.9%, NYHA functional class 3.7 +/- 0.2, and LVEDD of 7.7 +/- 0.4 cm. Severe mitral regurgitation was present in 368 (72.7%) patients. There were 88 (17.4%) in-hospital deaths. Cause of death included 55 due to (62.5%) low cardiac output, 10 (11.3%) due to severe bleeding, 7 (7.95%) caused by malignant arrhythmias, 8 (9%) due to sepsis, and 5 (5.7%) as a result of stroke. Ten of the selected series (overall 386 patients) reported late outcome. There were 89 (22.9%) late deaths, 12 (13.5%) were not cardiac-related, 50 (56.2%) were due to recurrence of congestive heart failure (CHF), 20 (22.5%) caused by sudden arrhythmias, 5 (5.6%) due to infections, and 2 (2.2%) from strokes. Overall, there were 248 (64.2%) survivors, of whom 179 (72.17%) were reported to be in NYHA functional class I or II. All 10 papers reported one-year survival ranging from 50% to 85%. Seven reported a two-year survival of 45% to 72%, and 4 reported a three-year survival of 33% to 64%.

CONCLUSIONS

Our results and the review of the literature seem to suggest a relatively high early mortality with satisfactory late results of PLV in patients with dilated cardiomyopathy.