Cardiomyoplasty: Perspective in the Treatment of Advanced Heart Failure

pp 399-405

Abstract

Background

The purpose of this study was to evaluate the immediate results and those after one year follow-up of cardiomyoplasty in patients presenting cardiac failure with dilated cardiomyopathy and a functional class III-IV (New York Heart Association) despite medical treatment.

Methods

Four male patients (average age: 59 years) underwent surgery. The etiology of the heart disease was idiopathic in three cases and coronary heart disease in the remaining one. The average value of the ejection fraction of the left ventricle was22.5%,diastolic diameter of the left ventricle was 76 mm and 59 mm for the left atrium and the shortening fraction was 13%. In order to assess their functional class more accurately, patients underwent a 6-minute walking test and they had an average performance of 312.6 meters. Surgery was approached by two-ways using the latissimus dorsi muscle and a two-chamber pacemaker. Muscular stimulation was progressive during the second and tenth week after surgery. One case required mitral valvuloplasty under extracorporeal circulation.

Results

No deaths occurred in surgery or during the follow-up period. Post-surgery complications were overcome and, as an average, patients were released 24 days after surgery. The functional class of the four subjects improved within three months after surgery and it reached functional class I-II. The mean values were 33.25% for left ventricle ejection fraction; 73.2mm for diastolic diameter of the left ventricle and 53 mm for the left atrium; and the shortening fraction was 17%. Their mean performance during the 6-minute exercise test was 384.5 meters.

Conclusions

Cardiomyoplasty in patient with advanced heart failure presented neither severe complications nor mortality and it was associated to a clear improvement of the quality of life of the subjects.