Long-Term Results of Right Latissimus Dorsi Cardiomyoplasty

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Abstract
Initial experimental and clinical studies have shown that cardiomyoplasty using the right latissimus dorsi can improve left ventricular (LV) function early after operation. This study presents the long-term clinical results of this procedure. Between March 1991 and November 1992, 16 patients (12 men, 4 women; mean age 57; range 33-77 years) underwent operation. Survivors were evaluated at 6-month intervals for 2 years with right heart catheterization, radionuclide scans, exercise testing, and quality of life questionnaires. The operative mortality was 6% (1/16), but 3 additional patients experienced sudden death within 6 months of operation. Survival was 63% (10/16) at 12 months and 50% (8/16) at 24 months. There were no significant changes in hemodynamic variables at 12 or 24 months after surgery. Left ventricular ejection fraction increased from 26.1 +/- 5.3 to 33.4 +/- 10.3 (p < 0.05) 6 weeks after operation, but was not different from baseline thereafter. The LV end-diastolic volume decreased significantly at 6 months from 306.1 +/- 71 to 249.4 +/- 69 mL (p < 0.01), and remained lower than the preoperative value in subsequent follow-up. Comparison of preoperative LV ejection fraction and LV stroke work index in 24-month survivors (7) and nonsurvivors (9) showed that survivors had better LV function before surgery. Functional status and quality of life were improved. Long-term results of right latissimus dorsi cardiomyoplasty are comparable to results using the left latissimus dorsi. Overall survival was limited by late sudden death, but survivors had improved functional capacity and stable LV function and size.