PMID- 12754029
OWN - NLM
STAT- MEDLINE
DCOM- 20030814
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 23
IP  - 5
DP  - 2003 May
TI  - Determinants of long-term mortality of current palliative surgical treatment for 
      dilated cardiomyopathy.
PG  - 756-63; discussion 763-4
AB  - OBJECTIVE: Dynamic cardiomyoplasty and partial left ventriculectomy have shown 
      limited and controversial results in the treatment of dilated cardiomyopathies. 
      This study investigates causes and determinants of long-term mortality after 
      these procedures. METHODS: Forty-three patients submitted to dynamic 
      cardiomyoplasty and 43 who underwent partial ventriculectomy were studied. 
      Patients were in New York Heart Association (NYHA) class III or IV before the 
      procedures. In dynamic cardiomyoplasty group, hospital mortality was 2.2% and 
      patients were followed for 48+/-31 months. Nine hospital deaths occurred after 
      partial ventriculectomy and the remaining patients were followed for 38+/-29 
      months. RESULTS: For patients submitted to dynamic cardiomyoplasty, 1-year 
      event-free survival was 81.3+/-5.9%; 2-year, 65.1+/-7.2%; and 6-year, 
      23.1+/-6.7%. Partial left ventriculectomy patients presented event-free survival 
      rates of 58.1+/-7.5%, 46.6+/-7.6% and 21.6+/-6.4% at the same periods, 
      respectively. Late deaths were equally related to heart failure progression and 
      arrhythmia events in both groups. Preoperative NYHA class IV, pulmonary 
      hypertension and absence of left ventricular (LV) function improvement at the 
      time of the final event were identified as independent predictors of poor 
      long-term event-free survival and heart failure progression in cardiomyoplasty 
      patients, while NYHA class IV, elevated serum nor-epinephrine and absence of LV 
      function improvement were associated with these events after partial left 
      ventriculectomy. Arrhythmia related deaths were only predicted by previous events 
      of sustained ventricular tachycardia in partial left ventriculectomy group. 
      CONCLUSIONS: Long-term results of dynamic cardiomyoplasty and partial left 
      ventriculectomy are limited by patients' preoperative condition, by the loss of 
      LV function benefits and by high incidence of sudden cardiac death. Palliative 
      surgical treatment of dilated cardiomyopathies needs to be indicated earlier and 
      may achieve better efficiency with the combination of different procedures to 
      provide sustained improvement of LV function, to interrupt the progressive 
      remodeling process and to prevent sudden cardiac death.
FAU - Moreira, Luiz Felipe P
AU  - Moreira LF
AD  - Division of Surgery, Heart Institute (INCOR), University of Sao Paulo Medical 
      School, Sao Paulo, SP, Brazil. dcimoreira@incor.usp.br
FAU - Benicio, Anderson
AU  - Benicio A
FAU - Bacal, Fernando
AU  - Bacal F
FAU - Bocchi, Edimar A
AU  - Bocchi EA
FAU - Stolf, Noedir A G
AU  - Stolf NA
FAU - Oliveira, Sergio A
AU  - Oliveira SA
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cardiac Output
MH  - Cardiac Output, Low/etiology
MH  - Cardiomyopathy, Dilated/mortality/physiopathology/*surgery
MH  - Cardiomyoplasty/*methods/mortality
MH  - Death, Sudden, Cardiac/etiology
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Transplantation
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Palliative Care
MH  - Risk Factors
MH  - Ventricular Remodeling
EDAT- 2003/05/20 05:00
MHDA- 2003/08/15 05:00
CRDT- 2003/05/20 05:00
PHST- 2003/05/20 05:00 [pubmed]
PHST- 2003/08/15 05:00 [medline]
PHST- 2003/05/20 05:00 [entrez]
AID - S1010794003001088 [pii]
AID - 10.1016/s1010-7940(03)00108-8 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2003 May;23(5):756-63; discussion 763-4. doi: 
      10.1016/s1010-7940(03)00108-8.