DYNAMIC CARDIOMYOPLASTY - CLINICAL FOLLOW-UP AT 12 YEARS

Objective: The purpose of this study is to evaluate the long-term outc ome of dynamic cardiomyoplasty. This surgical technique was conceived to assist the failing heart. The many proposed mechanisms of action of cardiomyoplasty are: (1) systolic assist; (2) limitation of ventricul ar dilation; (3) reduction of ventricular wall stress (sparing effect) ; (4) ventricular remodeling with an active girdling effect; (5) angio genesis: and (6) a neurohumoral effect. Methods: We investigated 95 pa tients in our hospital undergoing this procedure due to severe chronic heart failure, refractory to optimal medical treatment, Patients had a mean age of 51 +/- 12 years. The etiology of heart failure was ische mic 55%, idiopathic 34%, ventricular tumor 6%, and other 5%. The mean follow-up was 44 months. Results: The mean New York Heart Association (NYHA) functional class improved postoperatively from 3.2 to 1.8. Aver age radioisotopic left ventricular (LV) ejection fraction increased fr om 17 +/- 5 to 27 +/- 4% (P < 0.05). Stroke volume index increased fro m 32 +/- 7 to 43 +/- 8 ml/beat per m(2) (P < 0.05). The heart size rem ained stable over the long term. Following cardiomyoplasty, the number of hospitalizations due to congestive heart failure was reduced to 0. 4 hospitalizations/patient per year (preoperative: 2.5, P < 0.05). Com puted tomography scans showed at long term a preserved latissimus dors i muscle structure in 84% of patients. Survival probability at 7 years is 54%. Six patients underwent heart transplant after cardiomyoplasty (mean delay: 25 months), due to the natural evolution of their underl ying heart disease. There were no specific technical difficulties. Con clusions: Clinically, this procedure reverses heart failure, improves functional class and ameliorates quality of life. The latissimus dorsi muscle histological structure is maintained at long-term, when postop erative electrostimulation is performed, avoiding excessive stimulatio n. Cardiomyoplasty may delay or prevent the progression of heart failu re and the indication of cardiac transplantation. (C) 1997 Elsevier Sc ience B.V.