Lange R, Sack F U, Voss B, De Simone R, Nair A, Thielmann M, Brachmann J, Fleischer F, Hagl S
Department of Heart Surgery, University Hospital, Heidelberg, Germany.
Thorac Cardiovasc Surg. 1995 Oct;43(5):243-51. doi: 10.1055/s-2007-1013222.
The efficacy of dynamic cardiomyoplasty is still controversial. To date more than 400 patients have been operated worldwide. In recent years the indication and the surgical technique have become more uniform, which makes results from different centers eligible for comparison. We performed cardiomyoplasty exclusively in patients with contraindications for heart transplantation, such as chronic and recurrent infections or severe, irreversible sequelae of diabetes. Between August 1990 and October 1994, 8 isolated cardiomyoplasty procedures were performed in patients with cardiomyopathy (EF 14-32%, all in NYHA III). One patient died 2 months after 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 or 7 patients, 3 of whom went back to work. One patient with severe pulmonary hypertension exhibited no improvement. In the others NYHA class improved by at least one. Echocardiography showed an increase in fractional shortening in all patients. LVEF 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. Resting lung function showed no change of vital capacity and FEV1. No significant change in exercise level and maximal O2-consumption during 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 agreement with the results of all other investigators. Some possible mechanisms of action are discussed and a risk profile suggested. According to the current state of experience with cardiomyoplasty, we do not consider this method an alternative to heart transplantation, but reserve it for patients with contraindications for heart transplantation.
动态心肌成形术的疗效仍存在争议。迄今为止，全球已有400多名患者接受了该手术。近年来，手术适应症和技术已变得更加统一，这使得不同中心的结果具有可比性。我们仅对心脏移植有禁忌症的患者进行心肌成形术，如慢性和复发性感染或严重、不可逆的糖尿病后遗症。1990年8月至1994年10月期间，对8例心肌病患者（射血分数14 - 32%，均为纽约心脏协会心功能III级）进行了单独的心肌成形术。1例患者术后2个月死亡。报告了7例患者平均随访41.1±14.1个月后的结果。6或7例患者有明显的症状改善，其中3例恢复工作。1例严重肺动脉高压患者无改善。其他患者的纽约心脏协会心功能分级至少提高了一级。超声心动图显示所有患者的缩短分数均增加。左室射血分数在1年时从21.2±5.2%增加到38.1±15.9%（n = 7，p < 0.015），2年时增加到36.6±17.6%（n = 6，p < 0.05），3年时增加到36.4±18.9%（n = 5，无显著性差异）。随着时间的推移，静息肺动脉压有下降趋势。静息肺功能显示肺活量和第一秒用力呼气量无变化。在跑步机测试中，运动水平和最大耗氧量无显著变化。1例患者术后34个月猝死。我们的初步结果表明，心肌成形术后的患者可能会有显著的临床改善，但客观血流动力学参数的变化不那么明显。这些数据与其他所有研究者的结果一致。讨论了一些可能的作用机制并提出了风险概况。根据目前心肌成形术的经验，我们不认为该方法可替代心脏移植，而是将其保留用于有心脏移植禁忌症的患者。
