LATE HEMODYNAMIC-RESULTS AFTER CARDIOMYOPLASTY IN CONGESTIVE-HEART-FAILURE

Between November 1989 and September 1990, a cardiomyoplasty procedure was performed in 12 male patients with a mean age of 59 years. All pat ients were in New York Heart Association class III. Reinforcement card iomyoplasty was isolated in 4 patients and associated with a cardiac p rocedure in 8. There were no perioperative deaths. Failure of cardiomy oplasty occurred in 5 patients because of recurrence of disabling cong estive heart failure: 3 patients died late, and 2 had heart transplant ation. The actuarial survival rate was 83% at 1 year and 73% at 2 year s. Hemodynamic studies were done preoperatively in all patients, at 6 months postoperatively in 11 patients, at 1 year in 8, and at 2 years in 7. At the 2-year follow-up, 6 of the 7 survivors who did not have t ransplantation were functionally improved with reduced medical treatme nt. The following indices improved significantly at the 2-year evaluat ion compared with baseline: exercise capacity (63 +/- 13 W versus 83 /- 17 W); left ventricular (LV) end-diastolic pressure (20 +/- 7 mm Hg versus 11 +/- 5 mm Hg); and angiographic LV ejection fraction (0.25 /- 0.09 versus 0.40 +/- 0.15). Pulmonary artery pressure, pulmonary ca pillary wedge pressure, and cardiac index remained unchanged. Four pat ients underwent beat-to-beat analysis of LV function at 2 years; durin g skeletal muscle stimulation, stroke volume increased by 7% to 35% an d LV end-systolic pressure, by 5% to 9%. In the 5 patients with failed cardiomyoplasty, mean pulmonary artery pressure and LV end-diastolic volume were higher preoperatively than in the 7 survivors. Cardiomyopl asty may improve clinical status and exercise capacity in patients wit h disabling heart failure; the late improvement in LV function is limi ted, and the procedure should be reserved for patients with moderately dilated cardiomyopathy without right ventricular dysfunction or pulmo nary hypertension.