HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James F. McCarthy Patrick M. McCarthy Randall C. Starling Nicholas G. Smedira Vigneshwar Kasirajan James B. Young Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCarthy, J. F. Articles by Young, J. B. Search for Related Content PubMed PubMed Citation Articles by McCarthy, J. F. Articles by Young, J. B.

Eur J Cardiothorac Surg 1998;13:337-343
© 1998 Elsevier Science NL

Partial left ventriculectomy and mitral valve repair for end-stage congestive heart failure¹

^a The section of Cardiac Transplantation and Mechanical Circulatory Assist Program, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-25, Cleveland, OH 44195, USA
^b The section of Heart Failure, Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
^c The Transplant Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA

Received 6 October 1997; received in revised form 29 December 1997; accepted 14 January 1998.

Corresponding author. Tel.: +1 216 4440648; fax: +1 216 4440777; e-mail: mccartp@cesmtp.ccf.org

Objective: Partial left ventriculectomy (PLV), pioneered by Batista, has been proposed as an alternative treatment strategy in patients with refractory congestive heart failure. In order to analyze the midterm outcome of PLV and mitral valve (MV) repair and stratify patients according to risk, we prospectively studied 57 consecutive patients who underwent this procedure at the Cleveland Clinic Foundation (CCF). Methods: Patients had a mean age of 53 years and were predominantly males (74%). In 95% the etiology of heart failure was idiopathic dilated cardiomyopathy. All patients had a left ventricular end diastolic diameter of >7cm and were in New York Heart Association (NYHA) functional classes III and IV. A total of 54 patients (95%) were awaiting heart transplantation. Preoperatively, requirements included inotropes in 23 (40%), intraaortic balloon pump counterpulsation in 3 (5.3%), and left ventricular assist device placement (LVAD) in 1 (1.8%). Concomitant procedures included MV repair (55 patients), MV replacement (2), tricuspid valve repair (34 patients), coronary artery bypass graft (CABG) (5), and aortic valve repair or replacement (1 patient each). Results: Measurements preoperatively and at 3 months demonstrated improvement in left ventricular ejection fraction (14.4±7.7–23.2±10.7%, P<0.001), left ventricular end diastolic volume (254±85–179±73 ml, P<0.001) and left ventricular end diastolic diameter (8.4±1.1–6.3±0.9 cm, P<0.001). Peak oxygen consumption (MVO2) increased from 10.6±3.9 to 15.3±4.5 ml/kg per min (P<0.001). Cardiac index did not change (2.2 l/min per m²), although 40% had been on inotropes preoperatively and none were on inotropes at 3 months. NYHA functional class improved from 3.6±0.5 preoperatively to 2.2±0.9 at 3 months (P<0.001). LVAD support was required as rescue therapy in 11 patients (17%). Actuarial freedom from procedure failure, defined as death or relisting for transplant, was 58% at 1 year. Hospital mortality was 3.5% (n=2). On follow-up, there were 7 late deaths (including 3 sudden deaths) giving an actuarial survival of 82% at 1 year. Multivariate risk factor analysis revealed that age less than 40 years was associated with failure (P=0.02). Conclusions: Although PLV with MV repair is now a surgical option in the treatment of end-stage congestive heart failure, caution is advised as early failures are unpredictable and mechanical support may be required as rescue therapy. Better risk stratification and patient selection may improve outcome. Further study is required to determine the procedure's exact role in the treatment of congestive heart failure.

Key Words: Partial left ventriculectomy • Batista • Dilated cardiomyopathy

This article has been cited by other articles:

				M. Murtra The adventure of cardiac surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 167 - 180. [Full Text] [PDF]

				X. M. Mueller, H. T. Tevaearai, O. Tucker, Y. Boone, and L. K. von Segesser Reshaping the remodelled left ventricle: a new concept Eur. J. Cardiothorac. Surg., October 1, 2001; 20(4): 786 - 791. [Abstract] [Full Text] [PDF]

				J. H. Artrip, M. C. Oz, and D. Burkhoff Left ventricular volume reduction surgery for heart failure: A physiologic perspective J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 775 - 782. [Abstract] [Full Text] [PDF]

				K. Minami Surgical Treatments for Endstage Heart Failure Due to Dilated Cardiomyopathy Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 159 - 166. [Full Text] [PDF]

				D. Burkhoff New heart failure therapy: The shape of things to come? J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 421 - 423. [Full Text] [PDF]

				V. Borghetti, M. Campana, C. Scotti, G. Parrinello, and R. Lorusso Preliminary observations on haemodynamics during physiological stress conditions following 'double-orifice' mitral valve repair Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 262 - 269. [Abstract] [Full Text] [PDF]

				G. Bhat and R. D. Dowling Evaluation of predictors of clinical outcome after partial left ventriculectomy Ann. Thorac. Surg., July 1, 2001; 72(1): 91 - 95. [Abstract] [Full Text] [PDF]

				S. Christiansen, K. Redmann, and D. Hammel Impact of myocardial infarction on the outcome after partial left ventriculectomy Ann. Thorac. Surg., June 1, 2001; 71(6): 2088 - 2088. [Full Text] [PDF]

				A. Franco-Cereceda, P. M. McCarthy, E. H. Blackstone, K. J. Hoercher, J. A. White, J. B. Young, and R. C. Starling Partial left ventriculectomy for dilated cardiomyopathy: Is this an alternative to transplantation? J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 879 - 893. [Abstract] [Full Text] [PDF]

				L. F. P. Moreira, N. A.G. Stolf, M. d. L. Higuchi, F. Bacal, E. A. Bocchi, and S. A. Oliveira Current perspectives of partial left ventriculectomy in the treatment of dilated cardiomyopathy Eur. J. Cardiothorac. Surg., January 1, 2001; 19(1): 54 - 60. [Abstract] [Full Text] [PDF]

				G. DREYFUS and S. MIHEALAINU The Batista procedure Heart, January 1, 2001; 85(1): 1 - 2. [Full Text]

				G. A. Thomas, R. L. Hammond, K. Greer, H. Lu, J. C. Jarvis, A. P. Shortland, D. M. Pullan, S. Salmons, and L. W. Stephenson Functional assessment of skeletal muscle ventricles after pumping for up to four years in circulation Ann. Thorac. Surg., October 1, 2000; 70(4): 1281 - 1289. [Abstract] [Full Text] [PDF]

				P. Elliott CARDIOMYOPATHY: Diagnosis and management of dilated cardiomyopathy Heart, July 1, 2000; 84(1): 106 - 106. [Full Text] [PDF]

				P. M. Cury, M. d. L. Higuchi, P. S. Gutierrez, L. F. P. Moreira, E. A. Bocchi, N. A.G. Stolf, and A. D. Jatene Autopsy findings in early and late postoperative death after partial left ventriculectomy Ann. Thorac. Surg., March 1, 2000; 69(3): 769 - 773. [Abstract] [Full Text] [PDF]

				E. S. Bishay, P. M. McCarthy, D. M. Cosgrove, K. J. Hoercher, N. G. Smedira, D. Mukherjee, J. White, and E. H. Blackstone Mitral valve surgery in patients with severe left ventricular dysfunction Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 213 - 221. [Abstract] [Full Text] [PDF]

				T. Isomura, H. Suma, T. Horii, T. Sato, and N. Kikuchi Partial left ventriculectomy, ventriculoplasty or valvular surgery for idiopathic dilated cardiomyopathy - the role of intra-operative echocardiography Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 239 - 245. [Abstract] [Full Text] [PDF]

				M. B. Izzat, S. S. Kabbani, H. Suma, K. Pandey, K. Morishita, and A. P.C. Yim Early experience with partial left ventriculectomy in the Asia-Pacific region Ann. Thorac. Surg., June 1, 1999; 67(6): 1703 - 1707. [Abstract] [Full Text] [PDF]

				L. F. P. Moreira and N. A.G. Stolf Reply Ann. Thorac. Surg., May 1, 1999; 67(5): 1542 - 1542. [Full Text] [PDF]

				F. Maisano, A. Redaelli, G. Pennati, R. Fumero, L. Torracca, and O. Alfieri The hemodynamic effects of double-orifice valve repair for mitral regurgitation: a 3D computational model Eur. J. Cardiothorac. Surg., April 1, 1999; 15(4): 419 - 425. [Abstract] [Full Text] [PDF]

				P. Totaro, E. Tulumello, P. Fellini, M. Rambaldini, G. La Canna, G. Coletti, M. Zogno, and R. Lorusso Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up Eur. J. Cardiothorac. Surg., February 1, 1999; 15(2): 119 - 126. [Abstract] [Full Text] [PDF]