Key result
Apex-sparing partial left ventriculectomy linked to an ~11% absolute LVEF improvement and reduced diastolic dimension.
Why the study?
Does apex-sparing partial left ventriculectomy improve left ventricular function and geometry in patients with end-stage dilated cardiomyopathy?
Observational (n=13)
Does apex-sparing partial left ventriculectomy improve left ventricular function and geometry in patients with end-stage dilated cardiomyopathy?
Apex-sparing partial left ventriculectomy is a feasible surgical option that improves LV function and geometry in patients with end-stage dilated cardiomyopathy.
May support feasibility in end-stage dilated cardiomyopathy; leaves open need for controlled trials before wider use.
BACKGROUND AND AIM: Currently, partial left ventriculectomy (PLV) has not been widely accepted as a treatment option for dilated cardiomyopathy (DCM) because its results thus far have been inconsistent. In an animal study, apex-sparing PLV (AS-PLV) was shown to produce greater improvement in left ventricle (LV) function than conventional PLV in which the apex was removed. The aim of this study is to investigate the effectiveness of AS-PLV in a clinical setting. PATIENTS AND METHODS: From September 1999 to December 2007, 13 patients with DCM underwent AS-PLV. Left ventriculotomy was made in the thinnest portion of the lateral wall without injuring the apex, the papillary muscles, and the circumflex coronary artery, which supplies the neighboring myocardium. RESULTS: All patients were discharged from the hospital, except for one patient who developed refractory ventricular fibrillation on postoperative day 35. After AS-PLV, the LV diastolic dimension decreased from 71 +/- 10 mm to 55 +/- 9 mm; LV ejection fraction (EF) from 28%+/- 8% to 39%+/- 11%; and New York Heart Association (NYHA) class from 3 +/- 1.7 to 1.5 +/- 0.6; the differences were significant (p < 0.01). LV function and geometry remained unchanged 2 years after AS-PLV with LVDD of 60 +/- 7 mm, LVEF of 34%+/- 8%, and NYHA class of 1.7 +/- 0.6, respectively (N.S vs. at discharge). CONCLUSIONS: Regardless of the etiology of LV dilatation, AS-PLV restored the ellipsoidal shape of the LV and improved LV function. AS-PLV is a feasible option for treating diseased LVs with lateral wall lesions.
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Nishina et al. (2009) conducted an observational in End-Stage Dilated Cardiomyopathy (n=13). Apex-sparing partial left ventriculectomy (AS-PLV) was evaluated on Left ventricular diastolic dimension, ejection fraction, and NYHA class (p=< 0.01). Apex-sparing partial left ventriculectomy significantly improved left ventricular ejection fraction from 28% to 39% and decreased diastolic dimension from 71 mm to 55 mm (p < 0.01).
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