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[Value of dynamic cardiomyoplasty]
1Abt. Herzchirurgie, Chirurgische Universitáatsklinik, Heidelberg.
Insights
Dynamic cardiomyopathy surgery offers significant symptomatic improvement for end-stage heart failure patients ineligible for heart transplantation. While objective measures show modest changes, many patients experience enhanced quality of life and return to work.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Dynamic cardiomyopathy is a controversial treatment for end-stage heart failure.
- Surgical techniques and indications are becoming more standardized globally.
- Over 500 patients have undergone this procedure worldwide.
Purpose of the Study:
- To evaluate the efficacy of dynamic cardiomyopathy in patients with end-stage heart failure who are not candidates for heart transplantation.
- To assess clinical outcomes and hemodynamic changes following the procedure.
Main Methods:
- Retrospective analysis of 8 patients who underwent isolated dynamic cardiomyopathy procedures between March 1990 and April 1994.
- Patients had ejection fractions (EF) between 14-32% and were in New York Heart Association (NYHA) class III.
- Follow-up averaged 41.1 months, including clinical assessment, echocardiography, and treadmill testing.
Main Results:
- Six of seven surviving patients showed considerable symptomatic improvement, with three returning to work.
- Mean NYHA class decreased from 3.0 to 1.9 (p < 0.001).
- Left ventricular ejection fraction (LV-EF) increased significantly at one and two years post-surgery.
- Pulmonary artery pressure tended to decrease, but exercise capacity did not significantly change.
Conclusions:
- Dynamic cardiomyopathy can lead to impressive clinical improvement in carefully selected end-stage heart failure patients.
- The procedure is a viable option for patients with contraindications to heart transplantation.
- It may serve as a bridge to heart transplantation rather than a definitive alternative.
Abstract:
The value of dynamic cardiomyopathy in the treatment of end-stage heart failure is controversial. After more than 500 patients have been operated worldwide, the indication and the surgical technique have become more uniform, which makes results from different centers eligible for comparison. We performed cardiomyopathy in patients with contraindications for heart transplantation. Between 8.90-2.94, 8 isolated cardiomyopathy-procedures in patients with cardiomyopathy (EF 14-32%, NYHA III) were performed. One patient died in 2 months after surgery. Reported are the results of 7 patients after a mean follow-up of 41.1 +/- 14.1 months. Considerable symptomatic improvement was found in 6 of 7 patients, 3 of whom went back to work. One patient with severe pulmonary hypertension exhibited no improvement. Mean NYHA-class decreased from 3.0 to 1.9 (p < 0.001). Echocardiography showed an increase in fractional shortening in all patients. LV-EF increased from 21.2 +/- 5.2% to 38.1 +/- 15.9% (n = 7, p < 0.015) at 1 year, to 36.6 +/- 17.6% (n = 6, p < 0.05) at two years and to 36.4 +/- 18.9% (n = 5, NS) at three years. Pulmonary artery pressure tended to decrease at rest over time. No significant change in exercise level and maximal O2-consumption upon treadmill testing was observed. One patient died 34 months after the operation from sudden death. Our preliminary results show, that patients after cardiomyopathy may exhibit an impressive clinical improvement with less striking changes of objective hemodynamic parameters. This data is in mutual agreement with all other investigators. According to the current state of experience with cardiomyopathy, the place for this procedure lies in the treatment of patients with end-stage heart failure and contraindications for heart transplantation. We do not consider cardiomyopathy an alternative to heart transplantation, however, it may receive further importance as a bridge to Htx.