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J Thorac Cardiovasc Surg 1997;113:173-181
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

A COMPARISON OFTHE EARLY AND MIDTERM RESULTS AFTER DYNAMIC CARDIOMYOPLASTY IN PATIENTSWITH ISCHEMIC OR IDIOPATHIC CARDIOMYOPATHY

Ouz Tademir, MD^a, Süha D. Küçükaksu, MD^a, Kerem M. Vural, MD^a, Fehmi S. Katirciolu, MD^a, Emine Kütük, MD^b, Kemal Bayazit, MD^a

Received for publication Oct. 19, 1995 revisions requested Dec. 5, 1995 Revisions received August 2, 1996 Accepted for publication August 8, 1996 Address for reprints: Ouz Tademir,MD, Türkiye Yüksek htisas Hastanesi, KardiovaskülerCerrahi Klinii, 06100, Sihhiye, Ankara, Turkey.

Abstract

Objective: The main goal of this study is todetermine the efficiency of the cardiomyoplasty procedure on patientswith cardiomyopathy of different origins (ischemic and idiopathicorigins). Method: Between June 1993 and August 1995, 24patients underwent dynamic cardiomyoplasty with the left latissimusdorsi muscle in our institution. Early and midterm results, as well asthe changes in hemodynamics and functional status during follow-up, werecompared. Results: Early mortality rate was 20.8%(five patients). Concomitant coronary revascularization, a preoperativeleft ventricular ejection fraction below 20%, and a functionalcapacity of class IV (intermittently) were associated with earlymortality. The mean follow-up time was 17.3 months. Survival analysis(including early mortality) extending to the twenty-fourth monthrevealed no difference between the ischemic and idiopathic groups(55% vs 85%, respectively, p = 0.09). Functional status improved inthe both groups. Ejection fractions were improved after cardiomyoplastyin all patients, regardless of their cause. Cardiac indices were higher6 months after the operation. Changes in pulmonary capillary wedgepressure, peak pulmonary artery pressure, and left ventricularend-diastolic volume were not significant. Conclusion: Although cardiomyoplasty improvesfunctional capacity and hemodynamics in patients with both idiopathicand ischemic cardiomyopathy, the idiopathic group is thought to achieveoptimal benefit with regard to lower complication rates and lower earlymortality expectancy owing to the absence of concomitant coronaryrevascularization. (J Thorac Cardiovasc Surg1997;113:173-81)

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