Cardiomyoplasty as an isolated procedure to treat refractory heart failure

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Abstract
OBJECTIVE: Cardiomyoplasty represents a controversial therapy forchronic heart failure. The aim of this study is to review our experience ofsuch a surgical procedure as an isolate approach to treat refractory leftventricular dysfunction. METHODS: Twenty-two patients were consideredcandidates for cardiomyoplasty because of chronic heart failure. Mean agewas 58.7 +/- 5.3 (range 48-71 years), 19 patients were male and 3 werefemale. Ischemic or idiopathic etiology was present in 11 cases,respectively. Traditional as well as innovative techniques were used toassess hemodynamic function. Pre-operative hemodynamic profile includedmean left ventricular ejection fraction of 20 +/- 5.8% (9-28%), absence ofsevere right ventricular failure, and mean left ventricular end-diastolicdiameter of 75.5 +/- 7.4 mm (range 61-92 m). All patients were in New YorkHeart Association Class III or Intermittent IV despite conventional medicaltherapy. RESULTS: There was no intra-operative death. No additional surgerywas performed. Left latissimus dorsi (LD) muscle was used in 20 cases, andright LD in two patients. Early mortality occurred in one patient (lowcardiac output syndrome), whereas late mortality in five patients (threesudden deaths, one lung cancer, one heart failure). Mean follow-up is 20.7+/- 16.7 months (3-51 months). Actuarial survival at 4 years is 70%.Cardiac index increased at 6 months (3.08 +/- 0.5 l/min per m2, P = 0.04),but no other significant changes were observed in the long term (3.03 +/-0.7 l/min per m2, 3 +/- 0.7 l/min per m2, and 2.85 +/- 0.7 l/min per m2, at12, 24 and 36 months, respectively). Ejection fraction improved at 6 and 12months (29.1 +/- 1.03%, P = 0.0017; and 27.3 +/- 5.6%, P = 0.0091,respectively), while no substantial augmentation was documented at 2 and 3years (25.6 +/- 2.5% and 25.1 +/- 4.0%, respectively). Left ventricularend-diastolic diameter was markedly reduced at 6 (73.2 +/- 8.0 mm, P =0.0176), 12 (69.4 +/- 8.5 mm, P = 0.002) and 24 months (71.1 +/- 7.0 mm, P= 0.011), and was then stable (74.0 +/- 9.1 mm, P = 0.47) at 36 months.Postoperative pressure/volume loop evaluation showed some improvement ofhemodynamic function from skeletal muscle assistance. Acute pulmonary edemaepisodes, as well as number of hospitalizations, were considerably reducedfollowing cardiomyoplasty. CONCLUSIONS: In our experience, cardiomyoplastywas shown to exert moderate beneficial influence on left ventricularperformance, to significantly reduce cardiac dilatation and to promote thestabilization of the disease course.

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