Stellenwert der dynamischen Kardiomyoplastik

The value of dynamic cardiomyoplasty in the treatment of end-stage heart failure is controversial. After more than 500 patients have been operated worldwide, the indication and the surgical technique have become more uniform, which makes results from different centers eligible for comparison. We performed cardiomyoplasty in patients with contraindications for heart transplantation. Between 8.90-2.94, 8 isolated cardiomyoplasty-procedures in patients with cardiomyopathy (EF 14-32%, NYHA III) were performed. One patient died 2 months atter surgery. Reported are the results of 7 patients after a mean follow-up of 41.1 ± 14.1 months. 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 NYHA-class decreased from 3.0 to 1.9 (p < 0.001). Echocardiography showed an increase in fractional shortening in all patients. LV-EF increased from 21.2 ± 5.2% to 38.1 ± 15.9% (n = 7, p < 0. 015) at 1 year, to 36.6 ± 17.6% (n = 6, p < 0.05) at two years and to 36.4 ± 18.9% (n = 5, NS) at three years. Pulmonary artery pressure tended to decrease at rest over time. No significant change in exercise level and maximal O₂-consumption upon treadmill testing was observed. One patient died 34 months after the operation from sudden death. Our preliminary results show, that patients after cardiomyoplasty may exhibit an impressive clinical improvement with less striking changes of objective hemodynamic parameters. This data is in mutual agreement with all other investigators. According to the current state of experience with cardiomyoplasty, the place for this procedure lies in the treatment of patients with end-stage heart failure and contraindications for heart transplantation. We do not consider cardiomyoplasty an alternative to heart transplantation, however, it may receive further importance as a bridge to Htx.