Partial left ventriculectomy for idiopathic dilated cardiomyopathy: Early results and six-month follow-up

Background. Recent reports show that partial left ventriculectomy improves hemodynamic and functional status in patients with dilated cardiomyopathy. This study sought to determine the effects of partial left ventriculectomy on clinical outcome and left ventricular function during 6-month follow-up. Methods. Twenty-two patients underwent partial left ventriculectomy. Mitral valve repair was performed whenever possible, otherwise the valve was replaced. Hemodynamic and functional data were obtained at baseline, as well as 2 weeks and 6 months postoperatively. Results. Overall, 7 of 22 patients died; there were three early and four late deaths. One-year survival was 68% +/- 10%. Ejection fraction increased from 23.9% +/- 6.8% before the operation to 40.7% +/- 12.5% at 2 weeks and to 36.8% +/- 7.7% at 6 months (p < 0.001, for both). The cardiac index before the operation, at 2 weeks, and at 6 months was 2.3 +/- 0.8, 2.9 +/- 0.6, and 3.4 +/- 1.0 L/m(2) per minute, respectively (p = 0.035, and p = 0.009, compared with baseline). The increase in ejection fraction 2 weeks postoperatively was less in patients with left circumflex artery dominance (10.9% +/- 3.2% compared with 19.9% +/- 10.7%, respectively, p = 0.017). At 6-month follow up, all surviving patients except one improved New York Heart Association functional class when compared with preoperative status (from 3.8 +/- 0.4 to 1.4 +/- 0.6, p = 0.0002). Conclusions. Early hemodynamic improvement after partial left ventriculectomy was maintained during mid-term follow-up. (C) 1998 by The Society of Thoracic Surgeons.