Dynamic cardiomyoplasty: indication, surgical technique, and results.
The efficacy of dynamic cardiomyoplasty is still controversial. To date more than 400 patients have been operated worldwide. In recent years the indication and the surgical technique have become more uniform, which makes results from different centers eligible for comparison. We performed cardiomyoplasty exclusively in patients with contraindications 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 patient died 2 months after surgery. Reported are the results of 7 patients after a mean follow-up of 41.1 +/- 14.1 months. Considerable symptomatic improvement was found in 6 or 7 patients, 3 of whom went back to work. One patient with severe pulmonary hypertension exhibited no improvement. In the others NYHA class improved by at least one. Echocardiography 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 tended to decrease at rest over time. Resting lung function showed no change of vital capacity and FEV1. No significant change in exercise level and maximal O2-consumption during treadmill testing was observed. One patient died 34 months after the operation from sudden death. Our preliminary results show that patients after cardiomyoplasty may exhibit an impressive clinical improvement with less striking changes of objective hemodynamic parameters. This data is in agreement with the results of all other investigators. Some possible mechanisms of action are discussed and a risk profile suggested. According to the current state of experience with cardiomyoplasty, we do not consider this method an alternative to heart transplantation, but reserve it for patients with contraindications for heart transplantation.
Lange
R
R
Department of Heart Surgery, University Hospital, Heidelberg, Germany.
Sack
F U
FU
Voss
B
B
De Simone
R
R
Nair
A
A
Thielmann
M
M
Brachmann
J
J
Fleischer
F
F
Hagl
S
S
D009202:Cardiomyopathies / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D018421:Cardiomyoplasty / Q000379:methods* / Q000401:mortality; D000075202:Contraindications; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D018579:Patient Selection; D011788:Quality of Life; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome