Cardiac bioassist: results of the French multicenter cardiomyoplasty study.
The French multicenter experience (6 centers) of dynamic cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88% of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation.
Chachques
Juan C
JC
Department of Cardiovascular Surgery, Pompidou Hospital, 75015 Paris, France. j.chachques@brs.aphp.fr
Jegaden
Olivier
O
Mesana
Thierry
T
Glock
Yves
Y
Grandjean
Pierre A
PA
Carpentier
Alain F
AF
D000293:Adolescent; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D018421:Cardiomyoplasty / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D005602:France; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016276:Ventricular Function; D055815:Young Adult