| 4. | Mid-Term Results of Partial Left Ventriculectomy in Patients With Dilated
Cardiomyopathy Luiz Felipe P. Moreira*, Noedir A. G. Stolf*, Edimar A. Bocchi*, Fernando Bacal*, Giovanni Bellotti*, and Adib D. Jatene*, Sao Paulo, Brazil |
Surgical reduction of left ventricular volume has been proposed for treatment of severe cardiomyopathies. This study reports mid-term results of partial left ventriculectomy (Batista procedure) performed with preservation of the mitral valve in 31 patients with dilated cardiomyopathy.
Methods: All patients were in NYHA functional class III (13) or IV (18). Ventricular resection was performed in the lateral wall of the left ventricle and was associated with mitral annuloplasty in 25 patients. Patients were studied at two weeks and for six month intervals at follow-up.
Results: There were five hospital deaths (16%). The remaining patients were followed for 14±8 months. Seven more patients died at mid-term follow-up due to progressive heart failure (3) or arrhythmia-related events (4). Actuarial survival was 60.9±8.8% from six to 24 months of follow-up. Functional class improved from 3.6±0.5 to 1.4±0.6 in the survivors (p<0.001). The table shows the modifications of radioisotopic and hemodynamic parameters:
| Pre(25) | 2wks(26) | 6mo(17) | 12mo(11) | 24mo(8) | |
| LV ejection fraction (%) | 17±4 | 26±8* | 25±8* | 23±6* | 23±6 |
| LV diastolic volume (ml) | 468±170 | 324±134* | 343±129* | 348±96* | 429±133 |
| Cardiac index (L/min/m2) | 2.1±0.6 | 2.7±0.5* | 2.7±0.4* | 2.6±5* | 2.5±0.5* |
| Pulm. wedge pressure (mmHg) | 22±9 | 15±6* | 18±10* | 19±9 | 20±8 |
| Numbers indicate patients studied at each period; *p<0.05 in relation to preoperative data | |||||
Conclusions: Partial ventriculectomy improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy. This improvement can be maintained for 24 months, despite the tendency for redilatation of the left ventricle. Nevertheless, the high incidences of progressive heart failure and arrhythmia-related deaths after this procedure represent an important limitation for its clinical application.