DYNAMIC CARDIOMYOPLASTY IN SOUTH-AMERICA

Background. Dynamic cardiomyoplasty has been proposed in the treatment of severe cardiomyopathies. However, few reports to date have shown s ignificant numbers of patients collected on a multicenter basis. Metho ds. From July 1987 to Tune 1994, dynamic cardiomyoplasty was performed in 112 patients in South America. The indications were dilated cardio myopathy in 96 patients, Chagas' disease cardiomyopathy in 13, and isc hemic cardiomyopathy in 3. Left latissimus dorsi muscle was used in al l patients. Results. The thirty-day mortality rate was 8.1%, and patie nts were followed up for 22.1 +/- 18.6 months. Data of surviving patie nts show that 47.3% were in New York Heart Association functional clas s I, 45.6% in class II, and 7% in class III or IV 1 year after the ope ration. The 1-year survival was 78.4%; 2-year, 59.7%; and 5-year, 41.7 %. The survival at 1 year was 86.1% for patients with dilated cardiomy opathy and 40% for those with Chagas' disease. At 5 years, these value s were 49.8% and 9.5%, respectively. Long-term survival was also signi ficantly affected by preoperative functional class and pulmonary vascu lar resistance. However, patients operated on in class III or intermit tent class IV and without elevated pulmonary vascular resistance had s urvival rates of 91.5% at 1 year and 76.7% at 5 years of follow-up. Co nclusions. Cardiomyoplasty improves the functional status of patients with severe cardiomyopathies. Otherwise, long-term survival after this procedure is limited in patients with Chagas' disease and by patients ' condition before the operation.