Partial Left Ventriculectomy and Limited Heart Transplantation Availability

Background:

Partial left ventriculectomy, a novel cardiac volume
reduction operation, is applied in countries without a developed heart
transplantation program. We sought to determine its impact in our population
of patients.

Methods:

Partial left ventriculectomy was performed in 38
patients during the last 4 years. Basic inclusion criteria were nonischemic
dilated cardiomyopathy and poor response to medical therapy for heart
failure. Hemodynamic evaluation was carried out before and after operation.
A modified surgical technique of mitral valve repair and ventricle suturing
was applied.

Results:

Thirty-day, 6-month, and 2-year survival rates were
82% +/- 7%, 65% +/- 8%, and 61% +/- 9%, respectively. Duration of heart
failure symptoms was the only predictor of survival (p = 0.042). A high
proportion of noncardiac causes of death was noted. Functional capacity
in surviving patients improved at every successive measurement up to 1
year postoperatively.

Conclusions:

The introduction of partial left ventriculectomy
in a country with limited heart transplantation availability had a great
impact on the management of end-stage heart failure and may represent
the only surgical option for some patients. The average cost per patient
was substantially lower when compared to heart transplantation.