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Left ventricular function changes after cardiomyoplasty in patients with dilated cardiomyopathy
A D Jatene1, L F Moreira, N A Stolf
1Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Insights
Dynamic cardiomyoplasty significantly improves left ventricular function in patients with severe heart failure, including dilated cardiomyopathy and Chagas' disease. This surgical treatment offers sustained benefits for over a year, enhancing heart function and potentially halting disease progression.
Area of Science:
- Cardiology
- Cardiac Surgery
- Regenerative Medicine
Background:
- Severe myocardial failure presents significant therapeutic challenges.
- Dilated cardiomyopathy and Chagas' disease are major causes of advanced heart failure.
- Existing treatments for end-stage heart failure have limitations.
Purpose of the Study:
- To evaluate the efficacy of dynamic cardiomyoplasty in improving left ventricular function in patients with severe heart failure.
- To assess the long-term outcomes of dynamic cardiomyoplasty in patients with dilated cardiomyopathy and Chagas' disease.
- To determine the impact of dynamic cardiomyoplasty on New York Heart Association (NYHA) functional class.
Main Methods:
- Prospective study involving thirteen patients with NYHA class III or IV heart failure.
- Dynamic cardiomyoplasty procedure performed on all participants.
- Follow-up assessments included Doppler echocardiography, radioisotopic left ventricular ejection fraction, and cardiac catheterization.
- Long-term follow-up data collected for a mean of 11.5 months.
Main Results:
- No operative deaths; two late deaths during follow-up.
- Significant improvement in left ventricular segmental wall shortening (p < 0.01) and stroke volume (p < 0.01) at 3 months.
- Left ventricular ejection fraction showed improvement (p = 0.06).
- Left ventricular stroke work index increased (p < 0.01), and pulmonary wedge pressure decreased (p < 0.01).
- Functional improvements were sustained at 6 and 12 months.
- Five of nine long-term observed patients improved to NYHA class I or II.
Conclusions:
- Dynamic cardiomyoplasty is a viable treatment option for severe heart failure.
- The procedure leads to significant and sustained improvements in left ventricular function.
- Dynamic cardiomyoplasty may alter the natural progression of severe cardiomyopathies.
Abstract:
Dynamic cardiomyoplasty has been reported in the treatment of severe myocardial failure. In this investigation significant improvement of left ventricular function with dynamic cardiomyoplasty was demonstrated in patients with dilated cardiomyopathy or Chagas' disease for more than 1 year of follow-up. Thirteen patients with advanced heart failure who were in New York Heart Association class III or IV were operated on. There were no operative deaths. Patients were followed up for a mean of 11.5 months, and two patients died during the late follow-up period. Five of nine patients observed long term are in New York Heart Association class I, three in class II, and one in class III. At 3 months of follow-up, Doppler echocardiography demonstrated that left ventricular segmental wall shortening increased from 11.4% +/- 2.3% to 16.4% +/- 3.9% (p less than 0.01), and left ventricular stroke volume from 23.9 +/- 5.7 to 34.4 +/- 10 ml (p less than 0.01). Radioisotopic left ventricular ejection fraction improved from 20.9% +/- 3.3% to 25.4% +/- 7.7% (p = 0.06), and its better increases occurred in patients with lesser left ventricular end-diastolic dimensions. Cardiac catheterization showed that left ventricular stroke work index increased from 14.6 +/- 3.8 to 23.7 +/- 6.7 gm.m/m2 (p less than 0.01), whereas pulmonary wedge pressure decreased from 24.8 +/- 3.7 to 17.2 +/- 5.8 mm Hg (p less than 0.01). At 6 and 12 months of follow-up, all the preceding values remained essentially unchanged. Thus cardiomyoplasty improves left ventricular function and may halt the steady evolution of severe cardiomyopathies.