Background: Batista Partial Left Ventriculectomy has been used as a surgical alternative in the treatment of end-stage heart failure. However as a novel procedure it ensues many questions and answers. Objectives: To evaluate surgical indication, survival, quality of life and the incidence of lifethreatening or fatal arrhythmias after partial left ventriculectomy and report its availability as a biological bridge to transplantation. Material and Methods: Forty-one patients were operated on from December 1994 to December 1997, ages ranging from 32 to 70 years, in whom a diagnosis of dilated cardiomyopathy was established. NYHA functional class IV (92.6%) and III (7.3%), contraindication to heart transplantation and poor quality of life were part of the inclusion criteria. Echocardiograms and electrophysiologic studies (EPS) were performed. They were clinically grouped according to their NYHA functional class and categorized concerning our own quality of life protocol. Results: A group of 15 patients showed sustained decrease in heart dimensions and functional parameters at 30 and 90 postoperative days, as follows: where FE = fractional shortening, EF = ejection fraction, LVED = left ventricular end-dimensions both diastolic and systolic. Survival was 66%, 53%, 40% and 36.6% at 3, 6, 12 and 24 months of follow-up, respectively. At the conclusion of this 3 year period the immediate and late mortalities are 21.5 % and 42.1 %, with an overall mortality of 63.6%. EPSs probably can predict less mortality rate due to ventricular arrhythmias when those are not induced postoperatively. Quality of life was better postoperatively (72.7 % in NYHA classes I and II and 81.8% in QOL I and II) and two patients were transplanted after primary PLVs. Conclusions: Cardiac dynamics, Quality of Life and NYHA functional classes improved in all survivors. EPSs can provide useful information concerning the probability of fatal ventricular arrhythmias and the need for implantable cardioverter-defibrillators. Survival is encouraging if we keep in mind the seriousness of this cohort of patients. Patient selection is still controversial.
Heart ventricle; Cardiomyopathy; Cardiomyopathy; Treatment outcome
