DYNAMIC CARDIOMYOPLASTY - INDICATION, SURGICAL TECHNIQUE, AND RESULTS

The efficacy of dynamic cardiomyoplasty is still controversial. To dat e more than 400 patients have been operated worldwide. In recent years the indication and the surgical technique have become more uniform, w hich makes results from different centers eligible for comparison. We performed cardiomyoplasty exclusively in patients with contraindicatio ns for heart transplantation, such as chronic and recurrent infections or severe, irreversible sequelae of diabetes. Between August 1990 and October 1994, 8 isolated cardiomyoplasty procedures were performed in patients with cardiomyopathy (EF 14-32%, all in NYHA III). One patien t died 2 months after surgery. Reported are the results of 7 patients after a mean follow-up of 41.1 +/- 14.1 months. Considerable symptomat ic improvement was found in 6 of 7 patients, 3 of whom went back to wo rk. One patient with severe pulmonary hypertension exhibited no improv ement. In the others NYHA class improved by at least one. Echocardiogr aphy showed an increase in fractional shortening in all patients. LVEF increased from 21.2 +/- 5.2 % to 38.1 +/- 15.9 % (n = 7, p<0.015) at 1 year, to 36.6 +/- 17.6% (n = 6, p < 0.05) at two years, and to 36.4 +/- 18.9 % (n = 5, NS) at three years. Pulmonary artery pressure tende d to decrease at rest over time. Resting lung function showed no chang e of vital capacity and FEV(1). No significant change in exercise leve l and maximal O-2-consumption during treadmill testing was observed. O ne patient died 34 months after the operation from sudden death. Our p reliminary results show that patients after cardiomyoplasty may exhibi t an impressive clinical improvement with less striking changes of obj ective hemodynamic parameters. This data is in agreement with the resu lts of all other investigators. Some possible mechanisms of action are discussed and a risk profile suggested. According to the current stat e of experience with cardiomyoplasty, we do not consider this method a n alternative to heart transplantation, but reserve it for patients wi th contraindications for heart transplantation.