RETROSPECTIVE RISK ANALYSIS FOR EARLY HEART-RELATED DEATH AFTER CARDIOMYOPLASTY

Background: Dynamic cardiomyoplasty is an evolving treatment for heart failure that uses an electrically stimulated latissimus dorsi muscle wrapped around the heart to improve cardiac function. Preoperative pat ient characteristics and deaths after cardiomyoplasty have been record ed during the past 5 years in a cumulative database representing world wide experience of 42 medical centers. Methods: Statistical models of hazards (monthly death rates) were used to identify risk factors for t ransiently increased risk of cardiovascular mortality within 2 months after cardiomyoplasty. Results: Actuarial survival (n = 261) was 88%, 80%, and 76% at 1, 3, and 6 months after cardiomyoplasty, respectively . The peak hazard of 6% dying per month occurred during the first mont h after the surgical procedure. Lower ejection fraction, increased num ber of major coronary arteries with greater than or equal to 70% steno tic lesions, and lower chronotropic responses during exercise were ind ependent risk factors for the transient increase in early cardiovascul ar mortality. Early risk of cardiovascular mortality was significantly reduced as centers gained experience with more than 3 patients. Concl usion: Early survival after cardiomyoplasty has improved with experien ce and might be reduced further by preoperative assessments that ident ify patients at highest risk.