Surgical therapy for congestive heart failure: indications for transplantation versus cardiomyoplasty
J A Magovern1, G J Magovern, G J Magovern
1Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212.
Insights
Latissimus dorsi cardiomyoplasty offers a potential treatment for severe heart failure when transplantation isn't possible. This procedure may improve cardiac function, especially in patients with preserved right ventricular function.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Regenerative Medicine
Background:
- Heart transplantation is the gold standard for severe congestive heart failure but is limited by donor availability and patient eligibility.
- Many patients with end-stage heart failure are not candidates for transplantation due to comorbidities.
- Alternative surgical interventions are needed to improve outcomes for these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of latissimus dorsi cardiomyoplasty as an alternative surgical option for patients ineligible for heart transplantation.
- To assess the impact of cardiomyoplasty on cardiac function, New York Heart Association (NYHA) class, and long-term survival.
Main Methods:
- Retrospective analysis of 16 patients who underwent latissimus dorsi cardiomyoplasty between 1988 and an unspecified date.
- Patients were selected based on ineligibility for heart transplantation.
- Preoperative and postoperative cardiac function (ejection fraction) and NYHA class were assessed.
Main Results:
- Four operative deaths and three early deaths (within 6 months) occurred.
- Nine patients achieved long-term survival, with seven alive at a mean follow-up of 29 months.
- Long-term survivors improved from NYHA class III/IV to class I/II, with a significant increase in left ventricular ejection fraction (24.9% to 31.8%).
- Patients with preserved right ventricular function had better outcomes compared to those with biventricular failure.
Conclusions:
- Latissimus dorsi cardiomyoplasty may be a beneficial option for heart failure patients with preserved right ventricular function who are not candidates for heart transplantation.
- Heart transplantation remains the preferred therapy for patients with biventricular failure.
- Further research is warranted to optimize patient selection and surgical techniques for cardiomyoplasty.
Abstract:
Heart transplantation is the procedure of choice for patients with severe congestive heart failure, but many patients are not candidates because of associated medical problems and the lack of donor hearts. Since 1988 we have performed 36 heart transplantations. One and 2-year actuarial survival rates have been 82% and 73%. Sixteen patients who were not candidates for heart transplantation have undergone cardiomyoplasty, a procedure in which the left latissimus dorsi is transposed to the myocardium and paced synchronously with the heart to augment cardiac function. The average age was 55 years (range, 39 to 65 years). Preoperative left and right ejection fractions were 24.9% +/- 2.1% and 43% +/- 4.5%. Eleven patients were in the New York Heart Association class IV, and five patients were in class III. Four operative deaths occurred, and three additional deaths occurred within 6 months of surgery. Nine patients became long-term survivors, and seven of nine patients are alive at a mean follow-up of 29 months. All patients are in New York Heart Association class I or II. In long-term survivors, mean left ventricular ejection fraction increased from 24.9% +/- 2.1% to 31.8% +/- 3.5% (p less than 0.01). All but one of the operative and early deaths occurred in patients with biventricular failure (n = 6). One operative death and no early deaths occurred in patients with normal right ventricular ejection fraction. This initial experience suggests that cardiomyoplasty may be helpful for heart failure patients with preserved right ventricular function, but heart transplantation should be the therapy of choice for biventricular failure.
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