TREATMENT OF DILATED CARDIOMYOPATHY WITH DYNAMIC CARDIOMYOPLASTY - THE HEIDELBERG EXPERIENCE

Background. Data concerning the efficacy of dynamic cardiomyoplasty ar e still inconsistent, especially in terms of improvement of left ventr icular function.Methods. Between August 1990 and February 1994, eight isolated cardiomyoplasty procedures were performed in patients with ca rdiomyopathy (ejection fraction, 0.14 to 0.32; New York Heart Associat ion class III) and contraindications to heart transplantation. Results . Follow-up was 41.1 +/- 14.1 months. One patient died 2 months and an other 3 years after operation. Considerable symptomatic improvement wa s found in 6 of 7 patients, 3 of whom went back to work. One patient w ith severe pulmonary hypertension exhibited no improvement. Mean New Y ork Heart Association-class decreased from 3.0 to 1.9 (p < 0.001). Ech ocardiography showed an increase in fractional shortening and in peak aortic now velocity in all patients. Left ventricular ejection fractio n increased from 0.21 +/- 0.05 to 0.38 +/- 0.16 (n = 7, p < 0.015) at 1 year, to 0.37 +/- 0.18 (n = 6, p < 0.05) at 2 years, and to 0.36 +/- 0.19 (n = 5,not significant) at 3 years. Pulmonary artery pressure te nded to decrease over time. No significant change in exercise level or maximal oxygen consumption during treadmill testing was observed. Con clusions. Our preliminary results show that patients may exhibit an im pressive clinical improvement after cardiomyoplasty, with only moderat e changes in objective hemodynamic indices. We do not consider cardiom yoplasty an alternative to heart transplantation, but reserve it for p atients with contraindications to heart transplantation.