Retrospective risk analysis for early heart-related death after cardiomyoplasty. The Worldwide Cardiomyoplasty Group.
BACKGROUND
Dynamic cardiomyoplasty is an evolving treatment for heart failure that uses an electrically stimulated latissimus dorsi muscle wrapped around the heart to improve cardiac function. Preoperative patient characteristics and deaths after cardiomyoplasty have been recorded during the past 5 years in a cumulative database representing worldwide experience of 42 medical centers.


METHODS
Statistical models of hazards (monthly death rates) were used to identify risk factors for transiently increased risk of cardiovascular mortality within 2 months after cardiomyoplasty.


RESULTS
Actuarial survival (n = 261) was 88%, 80%, and 76% at 1, 3, and 6 months after cardiomyoplasty, respectively. The peak hazard of 6% dying per month occurred during the first month after the surgical procedure. Lower ejection fraction, increased number of major coronary arteries with > or = 70% stenotic lesions, and lower chronotropic responses during exercise were independent risk factors for the transient increase in early cardiovascular mortality. Early risk of cardiovascular mortality was significantly reduced as centers gained experience with more than 3 patients.


CONCLUSIONS
Early survival after cardiomyoplasty has improved with experience and might be reduced further by preoperative assessments that identify patients at highest risk.
Rector
T S
TS
Department of Medicine, University of Minnesota Medical School, Minneapolis, USA.
Benditt
D
D
Chachques
J C
JC
Chiu
R C
RC
Delahaye
F
F
Jessup
M
M
Kirkorian
G
G
Thiene
G
G
Titus
J
J
D000206:Actuarial Analysis; D018421:Cardiomyoplasty / Q000401:mortality*; D002423:Cause of Death; D003327:Coronary Disease / Q000453:epidemiology; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010101:Oxygen Consumption / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology