Combined Reparative Approaches for Dilated Failing Ventricles.

(J Card Surg 2005;20:S1-S2).

Left ventricular volume reduction surgery: The 4th International Registry Report 2004.

BACKGROUND AND METHODS: An international registry of left ventricular volume reduction (LVVR) procedures, including partial left ventriculectomy, has been expanded, updated, and refined to include 568 cases voluntarily reported from 52 hospitals in 12 countries. RESULTS: Gender, age, ventricular dimension, ethnology, myocardial mass, presence or absence of mitral regurgitation, as well as transplant indication, had little effect on event-free survival, which was defined as either absence of death or ventricular failure requiring mechanical assist or transplantation. Poor preoperative patient condition such as New York Heart Association classification IV, depressed contractility and decompensation requiring an emergency procedure were associated with reduced event-free survival. Other risk factors included an early surgery date, lack of experience, dilated cardiomyopathy as the underlying pathology and extended myocardial resection. Performance of LVVR reached a peak by 1998, but was largely abandoned by 2001, except in Asia, where experienced institutes continue to perform it in patients in better condition with preserved myocardial contractility. CONCLUSION: Avoidance of risk factors appears to have contributed to the recent survival improvement and may help stratify patients for LVVR. While performance has been decreasing, the concept has been extended to other LVVR and less invasive procedures, which are now under clinical trials.

Ventricular volume reduction procedures.

Although partial left ventriculectomy (PLV) has been abandoned in many institutions, a few hospitals continue to perform it with a relatively favorable outcome. Other volume reduction procedures have become popular with renewed interest in ventricular reshaping to improve function. Although recent refined selection criteria have improved survival with PLV, earlier unpredictable results prompted less invasive procedures based on the same physiologic concept of reducing radius or wall tension by wrapping, piercing, or clasping. These new techniques are not only less invasive but also reversible and adjustable and appear safer for less symptomatic patients at risk of progressive heart failure. Nonetheless, mechanisms of action and degrees of volume reduction and/or restriction need to be delineated before widespread clinical application.

Partial left ventriculectomy--The Third International Registry Report 2002.

BACKGROUND: An international registry of partial left ventriculectomy (PLV) has been expanded, updated, and refined to include 440 cases voluntarily reported from 51 hospitals in 11 countries. RESULTS: Gender, age, ventricular dimension, etiology, ethnology, myocardial mass, operative variation or presence or absence of mitral regurgitation as well as transplant indication had no effects on event-free survival, which was defined as either absence of death or ventricular failure requiring ventricular assist device or listing for transplantation. Preoperative patient condition such as NYHA functional class IV, depressed contractility, and decompensation requiring an emergency procedure were associated with reduced event-free survival. Other risk factors included early date of surgery, lack of experience, and extended myocardial resection. Performance of PLV reached a peak by 1998 and was largely abandoned by 2000 except in Asia, where experienced institutes continue to perform PLV in patients in better condition with preserved myocardial contractility. CONCLUSION: Avoidance of delineated risk factors appears to improve recent survival and may help stratify high- or low-risk patients for PLV. An integrated approach with mechanical and biological circulatory assist may improve prognosis for patients with dilated failing hearts. While frequency of PLV has decreased, the concept of ventricular volume reduction has been extended to other volume reduction procedures and less invasive procedures now under clinical trial.