A surgical approach to severe congestive heart failure--overlapping ventriculoplasty.

Background: Previously we developed a new procedure of overlapping cardiac volume reduction (OLCVR) surgery for patients with dilated cardiomyopathy refractory to medical treatment. Papillary muscle plication (PMP) when combined with OLCVR may achieve a better clinical outcome.

Purpose: To investigate the early and intermediate results of OLCVR with or without PMP.

Methods: Twenty-five patients (21 males, 4 females, aged 60 +/- 13 years) with either ischemic (n = 7) or nonischemic (n = 18) dilated cardiomyopathy underwent either isolated OLCVR (n = 11; Original Group) or PMP combined with OLCVR (n = 14; Integrated Group).

Results: Early deaths occurred in two (8%) from a noncardiac cause and late deaths in six, two from a cardiac and four from a noncardiac cause. Postoperative data in survivors were significantly improved in terms of NYHA functional class (from 3.6 +/- 1.9 to 1.6 +/- 1.1), ejection fraction (from 18 +/- 6% to 31 +/- 8%), left ventricular diastolic dimension (from 73 +/- 9 to 65 +/- 6 mm), and left ventricular end-diastolic volume index (from 194 +/- 81 to 128 +/- 43 mL/m2) (p < 0.05) in selected comparative cases. One-year crude and cause-specific survivals were 70.9% and 83.1%, respectively, at a mean follow-up of 12.8 months. One-year crude survival of the Integrated and Original Group was 85.7% and 55.6%, respectively (p = 0.24).

Conclusions: Although limitations exist in evaluating operative results, we consider OLCVR to be a relatively safe and effective procedure for selected patients with dilated cardiomyopathy. The addition of PMP to OLCVR may enhance the elliptic formation of left ventricle shape and improve mitral valve tethering, but further study is mandatory.