title: Reevaluation of long-term outcomes of dynamic cardiomyoplasty.
abstract: BACKGROUND
  Palliative procedures have been proposed for treatment of dilated cardiomyopathies. This study analyzes long-term outcomes of 43 patients who underwent dynamic cardiomyoplasty.
  
  
  METHODS
  Patients were in New York Heart Association class III (n = 35) or IV (n = 8) before the procedure. Hospital mortality was 2.2%, and patients were followed for 44 +/- 33 months. Thirty-nine patients completed the skeletal muscle adaptation period, and the muscle flaps were stimulated to contract in concert with every cardiac beat (n = 27) or with every other beat (n = 12).
  
  
  RESULTS
  One-year event-free survival was 81.3% +/- 5.9%; 2-year, 65.1% +/- 7.2%; 5-year, 34.7% +/- 7.2%; and 9-year, 10.8% +/- 5.3%. Causes of late deaths were equally divided between progressive heart failure and arrhythmia-related events. Multivariable Cox proportional hazard regression identified that functional class IV, high pulmonary vascular resistance, and muscle flap stimulation synchronized to every cardiac beat were independent predictors of poor event-free survival. The same factors were associated with the occurrence of progressive heart failure, but none was a predictor of arrhythmia-related deaths. Five-year survival of patients maintained with the muscle flap stimulated at every other cardiac beat was 58.3% +/- 14.2%. Skeletal muscle stimulation protocols also influenced the long-term behavior of left ventricular ejection fraction.
  
  
  CONCLUSIONS
  Long-term results of dynamic cardiomyoplasty are limited by the patient's preoperative condition and by a high incidence of sudden cardiac death. These results may be improved using modified skeletal muscle stimulation protocols and cardioverter-defibrillator implantation, while maintaining dynamic cardiomyoplasty as an option for selected patients.
authors.affiliation: Heart Institute (Incor), São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Anderson
authors.initials: A
authors.lastname: Benício
authors.forename: Luiz Felipe P
authors.initials: LF
authors.lastname: Moreira
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Noedir A G
authors.initials: NA
authors.lastname: Stolf
authors.forename: Sérgio A
authors.initials: SA
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000601:surgery*; D018421:Cardiomyoplasty; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left