Dynamic cardiomyoplasty improves left ventricular function and survival of patients with severe cardiomyopathies. The purpose of this study was to investigate the factors influencing cardiomyoplasty results in 22 patients operated upon at the Heart Institute. All patients were in New York Heart Association class III or IV, despite the use of maximal medical therapy. Eighteen patients had idiopathic dilated cardiomyopathy, in two patients the cardiomyopathy was due to Chagas' disease and in two due to ischemic ethiology. There were no operative death and patients were followed up for a mean of 20.5 months. Nine patients died at late follow-up period, and actuarial survival rates were 76.1% at 1 year and 63.8% at 2 years of follow-up. Six patients are presently in functional class I and six in class II. The mortality and the absence of functional improvement at 1 year were associated to episodes of pulmonary thromboelbolysm and to heart failure progression in patients with severe muscle flap ischemic compromise at the immediate postoperative period (creatinokinase peak level > 14001. U.) (p=0.03). In addition, the improvement of left ventricular ejection fraction at 6 months of follow-up was more significant in patients who presented lower values of creatinokinase after the surgical procedure (p=0.02). Otherwise, the influence of left ventricular dimension on ejection fraction changes was documented only when patients with severe muscle flap compromise were withdrawn from the analysis (p=0.06). Despite the absence of functional class influence on 1 year results of cardiomyoplasty, patients operated upon in class IV presented a less significant survival than patients operated upon in class III at 2 years of follow-up (33.3% versus 78.1 %, p= 0.04). In conclusion, quality of life and left ventricular function improvement after cardiomyoplasty may be limited by muscle flap ischemic compromise. Patient's condition prior to surgery and the degree of left ventricular dilation may also influence cardiomyoplasty results in patients with severe cardiomyopathies.
cardiomyoplasty; cardiomyopathies