Background: The long term clinical and hemodynamic results of latissimus dorsi dynamic cardiomyoplasty (LDDC) operations were reviewed.

Methods: Between June 1993 and July 1998, 40 patients (31 male / 9 female, mean age 41 ± 10 years) underwent LDDC. Twenty-nine patients (73%) were in NYHA class III and 11 patients were in class IV (27%), etiology was idiopathic in 26 patients (65%) and ischemic in 14 (35%). The average left ventricle endsystolic volume (LVESV) was 146 ± 36 ml (108-245 ml), enddiastolic volume (LVEDV) was 220 ± 39 ml (150-318 ml), and ejection fraction (LVEF) was 23% ± 7% (10% - 33%).

Results: Ten patients were lost during follow-up. Survival at 5 ± 2.5 years was 50% ± 9% and surviving patients were in class II as of their last follow-ups (p < 0.0001). The average LVEF was 32% ± 10% (18% - 53%; p = 0.0004), LVEDV was 235 ± 100 ml (90-513 ml; p > 0.05), and LVESV was 157 ± 83 ml (44-363 ml; p > 0.05) at the last follow-up. Although postoperative LVEF at each period was higher than the preoperative value, there were no statistical differences in LVESV and LVEDV between the follow-up periods. The factors having untoward effects on long-term survival were preoperative class IV symptomatology (p = 0.001), LVEF < 20% (p = 0.001), LVESD > 60 mm (p = 0.02) and ischemic etiology (p = 0.04). Patients having LVESV > 150 ml, LVEDV > 290 ml and LVEF < 35% at their last follow-up were under risk of demise during follow-up.

Conclusions: The long-term results of LDDC were satisfactory in regard to survival and functional capacity. However, these correlated poorly by echocardiographic findings. To achieve optimal results, patient selection is of pivotal importance.

Keywords : Cardiomyoplasty, heart failure, cardiomyopathy, transplantation