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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

PARTIAL LEFT VENTRICULECTOMY: SUCCESS AND FAILURE AFTER FIVE YEARS
S. Gradinac, Z. Popović, M. Mirić, M. Jakovljević, S.Borović and A.N. Nešković
Dedinje Cardiovascular Institute, Belgrade, Yugoslavia

Objectives: We sought to determine factors that predict capacity status and survival after partial left ventriculectomy (PLV), five years from introduction. Methods: Since 1996 PLV was performed in 42 patients. Mean age was 52±13 years (2-71 yr, six female), 89% were NYHA functional class IV, while 33% were on inotropic intravenous support preoperatively. Unless contraindicated, supine bicycle ergometry and invasive diagnostic was performed > 12 month after PLV. Patients were defined as nonresponders (NYHA Class>2 and exercise tolerance < 25W, n =7), or responders (NYHA Class<2 and exercise tolerance > 25W, n =10). Results: There was a significantly better survival in the group with shorter than 48 months heart failure symptoms duration (p=0.017). This matched our previous, the duration of less than 48 months , findings that the difference in the degree of changes in myocyte hypertrophy and fibrosis as well as in the measurements of median myocyte diameter and median nuclear size influence survival. After PLV, LV systolic major-to-minor axis ratio was higher in responders at early, mid, and late follow-up (P=0.003, P=0.008, and P=0.04, respectively). LV circumferential end-diastolic stress was lower in responders (P=0.006). In conclusion, higher success rate in functional recovery and survival could be expected in patients with shorter duration of symptoms, better myocyte histology profile, and those with improved postoperative short-to-long axis ratio. Failure of the procedure was largely linked to longer duration of heart failure symptoms, unfavourable histology, and insufficient postoperative shape change with high circumference wall stress.

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