CLINICAL AND LEFT-VENTRICULAR FUNCTION OUTCOMES UP TO 5 YEARS AFTER DYNAMIC CARDIOMYOPLASTY

Improvement in congestive heart failure and left ventricular function after dynamic cardiomyoplasty has been reported in patients with sever e cardiomyopathies, but the long-term effects of this procedure remain unclear. In this investigation 31 patients undergoing cardiomyoplasty for treatment of idiopathic dilated cardiomyopathy were annually inve stigated with radionuclide scintigraphy, Doppler echocardiography, and right-sided heart catheterization. They were in New York Heart Associ ation functional class III or TV before the operation. Na hospital dea ths occurred, but one patient with progressive heart failure required urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed up from 6 to 70 months (mean 25.6 months) and 1 2 patients died at late follow-up. Actuarial survivals were 86% at 1 y ear, 61.4% at 2 years, and 42.5% at 3 to 5 years of follow-up. Multiva riate analysis of factors influencing outcome showed that long-term su rvival was significantly affected by preoperative functional class and pulmonary vascular resistance. Functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.7 in the surviving patients (p < 0.01). Furthermore, left ventricular ejection fraction improved from 19.8% +/- 3% to 23.9 % +/- 7.2% (p < 0.01), and significant changes in stroke index, arteri al pressure, pulmonary wedge pressure, and left ventricular stroke wor k index were also found at 6 months of follow-up. In the late postoper ative period, the left ventricular ejection fraction tended to decreas e and returned to preoperative levels at 5 years, whereas hemodynamic variables did not change significantly. Thus, despite the tendency of the left ventricular ejection fraction to decrease at late follow-up, the long-term course of these patients seems to be characterized by th e maintenance of hemodynamic improvement. However, long-term survival after cardiomyoplasty is limited by the severity of the patient's cond ition before the operation.