PMID- 16297804
OWN - NLM
STAT- MEDLINE
DCOM- 20060615
LR  - 20051121
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 24
IP  - 11
DP  - 2005 Nov
TI  - Partial left ventriculectomy and mitral valve repair: favorable short-term 
      results in carefully selected patients with advanced heart failure due to dilated 
      cardiomyopathy.
PG  - 1957-64
AB  - BACKGROUND: Because of the scarcity of donor hearts, surgical alternatives to 
      heart transplantation, such as partial left ventriculectomy (PLV), were 
      introduced for treatment of advanced heart failure. Here, we report our 
      experience with this procedure performed in combination with mitral valve repair. 
      METHODS: Twelve patients with dilated cardiomyopathy (DCM), New York Heart 
      Association (NYHA) class exceeding III on maximal medical therapy, cardiac index 
      of 2.5 liter/min/m2 or less, VO2max of 14 ml/kg/min or less, left ventricular 
      end-diastolic diameter (LVEDD) of 7.0 cm or more, and grade II or greater mitral 
      incompetence, were selected for PLV and mitral valve reconstruction (MVR). 
      Echocardiography, hemodynamics, spiroergometry, and clinical assessment were 
      performed before and 1 year after the operation. RESULTS: One-year survival was 
      83.3%. All 10 surviving patients were free from failure of the procedure 1 year 
      post-operatively. From pre-operatively to 1 year post-operatively, NYHA 
      functional class improved from 3.3 +/- 0.3 to 1.9 +/- 0.2 (p < 0.001), cardiac 
      index increased from 2.0 +/- 0.2 liter/min/m2 to 2.9 +/- 0.2 liter/min/m2 (p < 
      0.001), stroke volume index from 25.9 +/- 4.8 ml/m2 to 40.3 +/- 7.3 ml/m2 (p = 
      0.008), and VO2max from 10.9 +/- 2.4 ml/kg/min to 16.0 +/- 3.6 ml/kg/min (p = 
      0.016), whereas LVEDD decreased from 8.4 +/- 0.6 cm to 6.6 +/- 0.3 cm (p < 
      0.001), left ventricular end-systolic diameter from 6.8 +/- 0.8 cm to 5.3 +/- 0.5 
      cm (p < 0.001), and mitral incompetence from 2.4 +/- 0.6 to 0.9 +/- 0.6 (p < 
      0.001). Pulmonary pressures and fractional shortening did not change 
      significantly (p > 0.05). Four patients received an implantable 
      cardioverter/defibrillator as a result of their pathologic electrophysiologic 
      examination. CONCLUSIONS: In carefully selected patients, PLV combined with MVR 
      achieves short-term results comparable to that after heart transplantation. 
      However, long-term results and multicenter evaluation will be needed to define 
      its place in the treatment of advanced heart failure.
FAU - Wilhelm, Markus J
AU  - Wilhelm MJ
AD  - Department of Thoracic and Cardiovascular Surgery, Westfalian 
      Wilhelms-University, Muenster, Germany. markus.wilhelm@swissonline.ch
FAU - Hammel, Dieter
AU  - Hammel D
FAU - Schmid, Christof
AU  - Schmid C
FAU - Kroner, Nina
AU  - Kroner N
FAU - Stypmann, Jorg
AU  - Stypmann J
FAU - Rothenburger, Markus
AU  - Rothenburger M
FAU - Wenzelburger, Frauke
AU  - Wenzelburger F
FAU - Schafers, Michael
AU  - Schafers M
FAU - Schmidt, Christoph
AU  - Schmidt C
FAU - Baba, Hideo A
AU  - Baba HA
FAU - Breithardt, Gunter
AU  - Breithardt G
FAU - Scheld, Hans H
AU  - Scheld HH
LA  - eng
PT  - Journal Article
DEP - 20050727
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
SB  - IM
MH  - Cardiac Surgical Procedures
MH  - Cardiomyopathy, Dilated/epidemiology/*surgery
MH  - Comorbidity
MH  - Female
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/epidemiology/*surgery
MH  - Oxygen Consumption
MH  - Patient Selection
MH  - Suture Techniques
MH  - Treatment Outcome
MH  - Ventricular Remodeling
EDAT- 2005/11/22 09:00
MHDA- 2006/06/16 09:00
CRDT- 2005/11/22 09:00
PHST- 2004/04/12 00:00 [received]
PHST- 2004/07/25 00:00 [revised]
PHST- 2005/03/08 00:00 [accepted]
PHST- 2005/11/22 09:00 [pubmed]
PHST- 2006/06/16 09:00 [medline]
PHST- 2005/11/22 09:00 [entrez]
AID - S1053-2498(05)00193-2 [pii]
AID - 10.1016/j.healun.2005.03.009 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2005 Nov;24(11):1957-64. doi: 
      10.1016/j.healun.2005.03.009. Epub 2005 Jul 27.