Key result
Partial left ventriculectomy bridges ~75% of severe pediatric end-stage DCM cases to transplant or definitive treatment.
Why the study?
Does partial left ventriculectomy improve outcomes in children with end-stage dilated cardiomyopathy compared to medical management?
Cohort (n=9)
Yes
Does partial left ventriculectomy improve outcomes in children with end-stage dilated cardiomyopathy compared to medical management?
p-value: p=<0.05
Partial left ventriculectomy may be a viable treatment option or bridge to transplantation for selected children with end-stage dilated cardiomyopathy who are unresponsive to medical therapy.
May support PLV consideration in severe refractory pediatric DCM; leaves open comparative efficacy versus medical management.
The purpose of this study was to define the role and indications of partial left ventriculectomy (PLV) in children with end-stage dilated cardiomyopathy (DCM). Clinical data were collected by retrospective chart review of children with DCM who were treated from 1997 to 2000. Four patients underwent PLV (PLV group) and 5 patients were managed without PLV (non-PLV group). In the PLV group, 2 patients are well 18 and 35 months postoperatively. One infant survived 6 months and then successfully underwent heart transplantation, and the other child died of hemoptysis 2 weeks postoperatively. Factors affecting outcome were preoperative status, in particular whether surgery was performed urgently or electively. In the non-PLV group, 4 patients were well controlled by medical treatment and 1 infant underwent mitral valve replacement for severe mitral regurgitation. The cardiothoracic ratio ranged from 72% to 76% in the PLV group and from 45% to 60% in the non-PLV group. The percentage of the expected left ventricular diastolic dimension ranged from 184% to 218% in the PLV group and from 109% to 163% in the non-PLV group. Ejection fractions in the PLV group were from 10% to 22% and from 36% to 56% in the non-PLV group. The serum brain natriuretic peptide concentration was above 1,200 pg/ml in the PLV group and below 168 pg/ml in the non-PLV group. In conclusion, PLV is indicated for selected children with end-stage DCM, and is most appropriate when medical therapy is not effective and heart transplantation is unavailable.
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Yoshii et al. (2002) conducted a cohort in End-stage dilated cardiomyopathy (n=9). Partial left ventriculectomy vs. Medical management was evaluated on Clinical outcome and preoperative parameters (CTR, LVDd, LVEF, BNP) (p=<0.05). Partial left ventriculectomy served as a definitive treatment or bridge to transplantation in 3 out of 4 children with end-stage dilated cardiomyopathy who had significantly worse preoperative parameters (p<0.05) than medically managed patients.
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