Study of muscular and ventricular function in dynamic cardiomyoplasty: a ten-year follow-up.

摘要: BACKGROUND The basic physiologic principle underlying cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the heart to obtain phasic activity that could be integrated with ventricular kinetics. aim prolong survival and improve quality life patients severe chronic irreversible myocardial failure by improving systolic contraction correcting diastolic dysfunction. METHODS To evaluate outcome cardiomyoplasty, we investigated 82 electively undergoing this procedure in-our hospital. All had did not respond optimal medical treatment. Patients mean age 50 +/- 12 years (84% males). cause was ischemic (55%), idiopathic cardiomyopathy (34%), tumor (6%), other (5%). follow-up 4.3 years. RESULTS New York Heart Association functional class improved after operation from 3.2 1.8. Average radioisotopic left ejection fraction increased 17% 6% 28% 3% (p < 0.05). Stroke volume index 35 9 46 8 ml/beat/m2 size remained stable at long term (evaluated echo computed tomography scanning). After number successive hospitalizations resulting congestive reduced 0.4 hospitalizations/patient/year (before 2.5, p Computed scans showed preserved LDM structure in 82% who underwent operation. Survival probability 7 54% for totality patients, 66% 3. Five transplantation (mean delay 29 months), principally as result natural evolution their disease, without major technical difficulties. CONCLUSIONS Our 10-year clinical experience demonstrates increases fraction, improves class, ameliorates life. Ventricular volumes diameters remain term. maintained if performed avoiding excessive myostimulation. Patient selection most important determinant early late outcome. Late death due sudden death. future incorporate cardioverter-defibrillator cardiomyostimulator, thus results. Cardiomyoplasty may or prevent end-stage need transplantation.