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| PARTIAL
LEFT VENTRICULECTOMY: SUCCESS AND FAILURE AFTER FIVE YEARS |
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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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