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Ann Thorac Surg 1995;60:1219-1225
© 1995 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Treatment of Dilated Cardiomyopathy With Dynamic Cardiomyoplasty: The Heidelberg Experience

Rüdiger Lange, MD, Falk-Udo Sack, MD, Bernhard Voss, MD, Raffaele De Simone, MD, Matthias Thielmann, Angélique Nair, MD, Johannes Brachmann, MD, Rainer Haussmann, MD, Franz Fleischer, MD, Siegfried Hagl, MD

Abt Herzchirurgie, Abt Innere Medizin III, and Klinik für Anaesthesiologie, Universitätsklinik, Heidelberg, Germany

Accepted for publication May 31, 1995.

Background. Data concerning the efficacy of dynamic cardiomyoplasty are still inconsistent, especially in terms of improvement of left ventricular function.

Methods. Between August 1990 and February 1994, eight isolated cardiomyoplasty procedures were performed in patients with cardiomyopathy (ejection fraction, 0.14 to 0.32; New York Heart Association class III) and contraindications to heart transplantation.

Results. Follow-up was 41.1 ± 14.1 months. One patient died 2 months and another 3 years after operation. 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 New York Heart Association-class decreased from 3.0 to 1.9 (p < 0.001). Echocardiography showed an increase in fractional shortening and in peak aortic flow velocity in all patients. Left ventricular ejection fraction increased from 0.21 ± 0.05 to 0.38 ± 0.16 (n = 7, p < 0.015) at 1 year, to 0.37 ± 0.18 (n = 6, p < 0.05) at 2 years, and to 0.36 ± 0.19 (n = 5, not significant) at 3 years. Pulmonary artery pressure tended to decrease over time. No significant change in exercise level or maximal oxygen consumption during treadmill testing was observed.

Conclusions. Our preliminary results show that patients may exhibit an impressive clinical improvement after cardiomyoplasty, with only moderate changes in objective hemodynamic indices. We do not consider cardiomyoplasty an alternative to heart transplantation, but reserve it for patients with contraindications to heart transplantation.


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Invited Commentary
James A. Magovern
Ann. Thorac. Surg. 1995 60: 1225. [Extract] [Full Text]



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