Clinical cardiomyoplasty: preoperative factors associated with outcome.

Dynamic cardiomyoplasty has been used clinically to augment the ventricular function of a failing heart. Fifteen clinical dynamic cardiomyoplasties have been performed at Allegheny General Hospital since 1985. Left ventricular ejection fraction improved in long-term survivors from a preoperative value of 0.23 +/- 0.02 to 0.32 +/- 0.05 with postoperative cardiomyostimulation (p < 0.05). There was an average reduction of 2 +/- 0.3 New York Heart Association classes (3.6 +/- 0.2 before operation versus 1.6 +/- 0.4 after operation; p < 0.001). Postoperative mortality was 27% (4/15), and early mortality (within 6 months after operation) was 20% (3/15). Significant preoperative differences between survivors and nonsurvivors were found in right ventricular ejection fraction (0.53 +/- 0.03 versus 0.30 +/- 0.07; p < 0.05), pulmonary artery mean pressure (19 +/- 2 versus 34 +/- 6 mm Hg; p < 0.05), pulmonary artery diastolic pressure (12 +/- 1 versus 25 +/- 5 mm Hg; p < 0.05), and pulmonary vascular resistance (1.4 +/- 2 versus 2.5 +/- 0.7 Wood units; p < 0.05). Dynamic cardiomyoplasty can be done with low operative mortality in patients with isolated left ventricular failure, but mortality is high in those with biventricular failure or pulmonary hypertension. Improvement in functional class and ventricular function can be expected in long-term survivors. Application of these findings to patient selection will improve the risk/benefit ratio for dynamic cardiomyoplasty.