Abstract 3005: Surgical Treatment of Severe Right Ventricular Cardiomyopathy
Objective: Chronically depressed right ventricular (RV) function presents an unresolved therapeutic challenge. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient’s quality of life and mortality are frequently unacceptable. The aim of this work is to present the surgical technique and long-term results of RV dynamic cardiomyoplasty applied in patients with RV failure due to isolated RV cardiomyopathies.
Methods: Twelve consecutive patients (8 males, 4 females), mean age 37±9 years, were enrolled. All pts had predominant RV dysfunction, associated with tricuspid regurgitation in 11 cases. Etiology of RV failure was arrhythmogenic cardiomyopathy (8 cases), Uhl’s disease (2 cases) and ischemic (2 cases). Patients were in preoperative NYHA FC III. Mean pre-operative EF measured by isotopic technique, was 20 ± 4.2 % for the RV and 37 ± 8 % for the LV. Right ventricular dynamic cardiomyoplasty consists in wrapping the RV free wall with the left Latissimus Dorsi Muscle (LDM) flap. The distal part of the LDM is fixed to the diaphragm and then electrostimulated in synchrony with cardiac function. Eleven patients required associated tricuspid valve surgery (10 annuloplasty rings and 1 valve replacement). In 6 pts an ICD was implanted prior to surgery.
Results: Nine patients are alive (mean follow-up: 10 ± 3.5 years), seven in NYHA functional class I and two in class II. Three deaths occurred: one patient died postoperatively due to infection, one patient died at day 45 due to gastroenteric complication and one patient died at year 7 due to stroke, while in functional class II. At long term follow-up, mean RVEF is 32 ± 6 % and LVEF is 51 ± 9 %.
Conclusions: The results of this long-term study demonstrate hemodynamic and functional improvements following RV cardiomyoplasty with no long-term malignant arrhythmias and RV dysfunction related deaths. The effects of RV cardiomyoplasty can be related to chronic systolic compression and diastolic dilatation restriction (positive remodeling), which may reduce tension and excitability of myocardial fibers. This study suggests that cardiomyoplasty is a safe alternative or long-term bridge to heart transplantation in these patients with relatively preserved LV function.