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Late hemodynamic results after cardiomyoplasty in congestive heart failure
O Jegaden1, F Delahaye, G Finet
1Department of Cardiovascular Surgery, Hôpital Cardiologique, Lyon, France.
Insights
Cardiomyoplasty improved heart function in patients with severe heart failure, showing enhanced exercise capacity and reduced medical needs. However, some patients experienced failure, necessitating heart transplantation or leading to late mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Heart Failure Management
Background:
- Severe heart failure significantly impacts patient quality of life and prognosis.
- Conventional medical therapies have limitations in advanced heart failure.
- Surgical interventions like cardiomyoplasty are explored for refractory cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of reinforcement cardiomyoplasty in patients with advanced heart failure.
- To assess functional and hemodynamic improvements following the procedure.
- To identify factors associated with cardiomyoplasty success and failure.
Main Methods:
- A cohort of 12 male patients (mean age 59) with New York Heart Association class III heart failure underwent cardiomyoplasty.
- Procedures were either isolated (4 patients) or combined with other cardiac surgeries (8 patients).
- Hemodynamic and functional assessments were performed preoperatively and at various postoperative intervals up to 2 years.
Main Results:
- No perioperative deaths occurred. Actuarial survival was 83% at 1 year and 73% at 2 years.
- Five patients experienced cardiomyoplasty failure due to recurrent heart failure, with 3 late deaths and 2 heart transplants.
- Survivors showed significant improvements in exercise capacity, left ventricular (LV) end-diastolic pressure, and LV ejection fraction at 2 years.
Conclusions:
- Reinforcement cardiomyoplasty can lead to functional improvement and reduced medical therapy in select patients with severe heart failure.
- While survival rates are encouraging, a significant failure rate exists, highlighting the need for careful patient selection.
- Hemodynamic benefits, particularly improved LV function during skeletal muscle stimulation, were observed in some patients.
Abstract:
Between November 1989 and September 1990, a cardiomyoplasty procedure was performed in 12 male patients with a mean age of 59 years. All patients were in New York Heart Association class III. Reinforcement cardiomyoplasty was isolated in 4 patients and associated with a cardiac procedure in 8. There were no perioperative deaths. Failure of cardiomyoplasty occurred in 5 patients because of recurrence of disabling congestive heart failure: 3 patients died late, and 2 had heart transplantation. The actuarial survival rate was 83% at 1 year and 73% at 2 years. Hemodynamic studies were done preoperatively in all patients, at 6 months postoperatively in 11 patients, at 1 year in 8, and at 2 years in 7. At the 2-year follow-up, 6 of the 7 survivors who did not have transplantation were functionally improved with reduced medical treatment. The following indices improved significantly at the 2-year evaluation compared with baseline: exercise capacity (63 +/- 13 W versus 83 +/- 17 W); left ventricular (LV) end-diastolic pressure (20 +/- 7 mm Hg versus 11 +/- 5 mm Hg); and angiographic LV ejection fraction (0.25 +/- 0.09 versus 0.40 +/- 0.15). Pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac index remained unchanged. Four patients underwent beat-to-beat analysis of LV function at 2 years; during skeletal muscle stimulation, stroke volume increased by 7% to 35% and LV end-systolic pressure, by 5% to 9%. In the 5 patients with failed cardiomyoplasty, mean pulmonary artery pressure and LV end-diastolic volume were higher preoperatively than in the 7 survivors.(ABSTRACT TRUNCATED AT 250 WORDS)