Septal Anterior Ventricular Exclusion Procedure for Idiopathic Dilated Cardiomyopathy

Background Eight-year experience with the septal anterior ventricular exclusion procedure for congestive heart failure due to idiopathic dilated cardiomyopathy was evaluated. Methods In 36 patients (27 men and 9 women with a mean age of 60 years) with heart failure; New York Heart Association class III/IV (21/15); and mitral regurgitation 2+ or greater, the procedure was indicated when the diastolic dimension was 75 mm or greater, and the septum was akinetic. A long, narrow oval patch was sutured to form a downsized elliptical left ventricle by excluding the septum and anterior wall. Mitral reconstruction was combined for all patients (26 repairs with undersized ring and 10 replacements with bioprosthesis) and tricuspid repair was added for 16 patients (44%). Results Hospital mortality was 13.8% (5 of 36), with 6.5% (2 of 31) in elective and 60% (3 of 5) in emergency operations. Ejection fraction increased from 20.9% ± 6.4% to 27.5% ± 8.8%, left ventricular diastolic dimension decreased from 81.9 ± 9.2 mm to 70.1 ± 10.0 mm, and left ventricular endodiastolic and endosystolic volume indices decreased from 236.5 ± 65.0 mL/m2 to 183 ± 60.5 mL/m2 and from 181.3 ± 55.4 mL/m2 to 133.5 ± 54.1 mL/m2, respectively. Left ventricular endodiastolic pressure decreased from 24.3 ± 9.7 mm Hg to 19.4 ± 7.6 mm Hg. Brain natriuretic peptide decreased from 975 ± 866 pg/mL to 404 ± 366 pg/mL at 1 to 6 postoperative months. Eleven late deaths were noted and were due to heart failure (6), sudden death (4) and stroke (1). The mean New York Heart Association class was 1.7 among the survivors. One- and 3-year survival rates were 67.5% and 60.7%, respectively. Conclusions The septal anterior ventricular exclusion procedure with mitral reconstruction is a useful option for the treatment of advanced idiopathic dilated cardiomyopathy in extremely dilated left ventricle with akinetic septum.