INTERMEDIATE RESULTS OF CARDIOMYOPLASTY

Cardiomyoplasty (CMP) is a technique of circulatory assistance using a pediculated latissimus dorsi muscle wrapped around the heart and elec trically stimulated during systole. Sixty-four patients, aged 15 to 69 years (average 50.8 +/- 13 years) with cardiac failure underwent CMP between January 1985 and July 1993. The causes of cardiac failure were : ischaemic heart disease (39 cases), dilated cardiomyopathy (18 case s), cardiomyopathy following valvular heart disease (2 cases), cardiac tumours (4 cases) and congenital heart disease (1 case). Twenty-four patients underwent an associated surgical procedure. Intra and postope rative intra-aortic balloon pumping was required in 27 cases. Hospital mortality (before latissimus dorsi stimulation) was 20.3 % (13/64 cas es). Evaluation of the survivors 12 months after surgery showed an imp rovement in functional class (1.,5 versus 3.3 before CMP; p < 0.05), i n isotopic ejection fraction (27 +/- 3 % versus 17 +/- 6 %, p < 0.05) and cardiac index (2.87 +/- 0.63 1/min/m(2) versus 2.38 +/- 0.41 1/min /m(2), p < 0.05). There was no significant change in cardiac filling p ressures. The number of hospital admissions for congestive cardiac fai lure in operated patients was 0.4 per patient per year, compared with 2.5 per patient per year (p < 0.05) before CMP. The preoperative predi ctive factors for late mortality were : permanent functional Class IV (NYHA), severe cardiac dilatation (cardio-thoracic ratio greater than 0.60; left ventricular end diastolic dimension > 75 mm), an isotopic l eft ventricular ejection fraction < 15 %, severe biventricular cardiac failure and irreversible pulmonary hypertension. The actuarial 4 year survival rate was 68.3 %. Four patients have undergone cardiac transp lantation on average 34 months after CMP without major technical diffi culties. A more precise selection of patients, changes in surgical tec hnique, and improved postoperative management have reduced perioperati ve mortality and increased the long-term survival of these patients.