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European Journal of Cardio-Thoracic Surgery, Vol 12, 560-567, Copyright © 1997 by European Association for Cardio-thoracic Surgery
JC Chachques, JP Marino, P Lajos, R Zegdi, N D'Attellis, P Fornes, JN Fabiani and A Carpentier
OBJECTIVE: The purpose of this study is to evaluate the long-term outcome
of dynamic cardiomyoplasty. This surgical technique was conceived to assist
the failing heart. The many proposed mechanisms of action of
cardiomyoplasty are: (1) systolic assist; (2) limitation of ventricular
dilation; (3) reduction of ventricular wall stress (sparing effect); (4)
ventricular remodeling with an active girdling effect; (5) angiogenesis;
and (6) a neurohumoral effect. METHODS: We investigated 95 patients in our
hospital undergoing this procedure due to severe chronic heart failure,
refractory to optimal medical treatment. Patients had a mean age of 51 +/-
12 years. The etiology of heart failure was ischemic 55%, idiopathic 34%,
ventricular tumor 6%, and other 5%. The mean follow-up was 44 months.
RESULTS: The mean New York Heart Association (NYHA) functional class
improved postoperatively from 3.2 to 1.8. Average radioisotopic left
ventricular (LV) ejection fraction increased from 17 +/- 5 to 27 +/- 4% (P
< 0.05). Stroke volume index increased from 32 +/- 7 to 43 +/- 8 ml/beat
per m2 (P < 0.05). The heart size remained stable over the long term.
Following cardiomyoplasty, the number of hospitalizations due to congestive
heart failure was reduced to 0.4 hospitalizations/patient per year
(preoperative: 2.5, P < 0.05). Computed tomography scans showed at long
term a preserved latissimus dorsi muscle structure in 84% of patients.
Survival probability at 7 years is 54%. Six patients underwent heart
transplant after cardiomyoplasty (mean delay: 25 months), due to the
natural evolution of their underlying heart disease. There were no specific
technical difficulties. CONCLUSIONS: Clinically, this procedure reverses
heart failure, improves functional class and ameliorates quality of life.
The latissimus dorsi muscle histological structure is maintained at
long-term, when postoperative electrostimulation is performed, avoiding
excessive stimulation. Cardiomyoplasty may delay or prevent the progression
of heart failure and the indication of cardiac transplantation.
ARTICLES
Dynamic cardiomyoplasty: clinical follow-up at 12 years
Department of Cardiovascular Surgery, Broussais Hospital, Paris, France.
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