Related Experiment Videos
Dynamic cardiomyoplasty: long-term clinical results in patients with dilated cardiomyopathy
D M Braile1, M F Godoy, G H Thèvenard
1Faculdade de Medicina de São José do Rio Preto-Medical School FAMERP, and Hospital Beneficência Portuguesa de São José do Rio Preto, São Paulo, Brazil. domingo@braile.com.br
Insights
Dynamic cardiomyoplasty shows variable long-term survival in heart failure patients. Chagasic cardiomyopathy is a contraindication, and ventricular fibrillation necessitates prophylactic antiarrhythmic treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Dynamic cardiomyoplasty (DCM) is a surgical option for end-stage heart failure.
- It serves as an alternative to heart transplantation.
Purpose of the Study:
- To critically evaluate the long-term outcomes of dynamic cardiomyoplasty.
- To assess the efficacy of DCM in patients with dilated cardiomyopathy.
Main Methods:
- A cohort of 52 patients with dilated cardiomyopathy underwent dynamic cardiomyoplasty.
- Long-term follow-up extended up to 110 months.
Main Results:
- Survival rates varied significantly based on cardiomyopathy etiology.
- Non-Chagasic cardiomyopathy showed higher survival (14.9% at 110 months) compared to Chagasic (0% at 60 months).
- Ventricular fibrillation was a major cause of mortality.
Conclusions:
- Chagasic cardiomyopathy may be a contraindication for dynamic cardiomyoplasty.
- Prophylactic antiarrhythmic drugs or implantable cardioverter-defibrillators are recommended due to frequent ventricular fibrillation.
Background:
Dynamic cardiomyoplasty has been considered to be an effective method of surgical treatment of patients with end-stage heart failure, and is an alternative to heart transplantation.
Methods:
We critically evaluated the long-term course of 52 patients with dilated cardiomyopathy who underwent dynamic cardiomyoplasty and were followed-up for up to 110 months.
Results:
Dilated cardiomyopathy was due to undetermined cause in 42 patients (80.8%), Chagas disease in 8 (15.4%), viral infection in 1 (1.9%), and peripartum cardiomyopathy in 1 (1.9%). In the nonchagasic group the survival rates were 79.5% +/- 6.1%, 67.8% +/- 7.1%, 53.7% +/- 8.3%, 49.9% +/- 8.3%, 14.9% +/- 12.2%, and 14.9% +/- 12.2%, respectively, at 12, 24, 48, 60, 80 and 110 months of follow-up. In the chagasic patients the survival rates were 37.5% +/- 17.1%, 12.5% +/- 11.7%, 12.5% +/- 11.7% and 0%, respectively, at 12, 24, 48, and 60 months of follow-up, making chagasic cardiomyopathy a possible contraindication for dynamic cardiomyoplasty.
Conclusions:
There was no correlation between the clinical improvement and hemodynamic data. Ventricular fibrillation was a frequent cause of immediate and late death, suggesting the need for prophylactic use of antiarrhythmic drugs or implantable cardioverter/ defibrillators.