CARDIOMYOPLASTY AS AN ISOLATED PROCEDURE TO TREAT REFRACTORY HEART-FAILURE

Objective: Cardiomyoplasty represents a controversial therapy for chro nic heart failure. The aim of this study is to review our experience o f such a surgical procedure as an isolated approach to treat refractor y left ventricular dysfunction. Methods: Twenty-two patients were cons idered candidates for cardiomyoplasty because of chronic heart failure . Mean age was 58.7 +/- 5.3 (range 48-71 years), 19 patients were male and 3 were female. Ischemic or idiopathic etiology was present in 11 cases, respectively. Traditional as well as innovative techniques were used to assess hemodynamic function. Pre-operative hemodynamic profil e included mean left ventricular ejection fraction of 20 +/- 5.8% (9-2 8%), absence of severe right ventricular failure, and mean left ventri cular end-diastolic diameter of 75.5 +/- 7.4 mm (range 61-92 mm). All patients were in New York Heart Association Class III or Intermittent IV despite conventional medical therapy. Results: There was no intra-o perative death. No additional surgery was performed. Left latissimus d orsi (LD) muscle was used in 20 cases, and right LD in two patients. E arly mortality occurred in one patient (low cardiac output syndrome), whereas late mortality in five patients (three sudden deaths, one lung cancer, one heart failure). Mean follow-up is 20.7 +/- 16.7 months (3 -51 months). Actuarial survival at 4 years is 70%. Cardiac index incre ased at 6 months (3.08 +/- 0.5 l/min per m(2), P = 0.04), but no other significant changes were observed in the long term (3.03 +/- 0.7 l/mi n per m(2), 3 +/- 0.7 l/min per m(2), and 2.85 +/- 0.7 l/min per m(2), at 12, 24 and 36 months, respectively). Ejection fraction improved at 6 and 12 months (29.1 +/- 1.03%, P = 0.0017; and 27.3 +/- 5.6%, P = 0 .0091, respectively), while no substantial augmentation was documented at 2 and 3 years (25.6 +/- 2.5% and 25.1 +/- 4.0%, respectively). Lef t ventricular end-diastolic diameter was markedly reduced at 6 (73.2 /- 8.0 mm, P = 0.0176), 12 (69.4 +/- 8.5 mm, P = 0.002) and 24 months (71.1 +/- 7.0 mm, P = 0.011), and was then stable (74.0 +/- 9.1 mm, P = 0.47) at 36 months. Postoperative pressure/volume loop evaluation sh owed some improvement of hemodynamic function from skeletal muscle ass istance. Acute pulmonary edema episodes, as well as number of hospital izations, were considerably reduced following cardiomyoplasty. Conclus ions: In our experience, cardiomyoplasty was shown to exert moderate b eneficial influence on left ventricular performance, to significantly reduce cardiac dilatation and to promote the stabilization of the dise ase course. (C) 1997 Elsevier Science B.V.