Clinical cardiomyoplasty: Preoperative factors associated with outcome

Furnary, Anthony P.; Magovern, James A.; Christlieb, Ignacio Y.; Orie, Judith E.; Simpson, Kathleen A.; Magovern, George J.

doi:10.1016/0003-4975(92)90083-g

Cited by 40 publications

(10 citation statements)

References 8 publications

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“…[17,[30][31] 0-8.1% 38.7% +4.1% 42.5% at 5 years Magovern [32][33] 6-11% 33% 0% 50% at 2 years Furnary [5,9] 12-27% -+2-10% 68% at 1 year Chachques [18] 0% 46% +10% 54% at 7 years Lange [34] 0% 37.5% +17% 62. 5% at 5 years…”

Section: Resultsmentioning

confidence: 97%

“…Mitral or tricuspid regurgitation should not exceed II grade, and the serum creatinine should be £2.5 mg/dl with no organs failure [3,5,14]. Moreover, it was well established that a combined DCMP and cardioverter defibrillator implantation intervention improves the survival in patients with ventricular arrhythmias [15][16].…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…In the 80s the dynamic cardiomyoplasty was considered [1][2][3][4][5] a real alternative to the heart transplant for heart failure treatment, but in the 90s its has use declined due to the poor long term results [6][7] because of the early latissimus dorsi (LD) degeneration. To maintain longterm partial transformation of the LD wrap avoiding excessive muscular degeneration, fewer impulses per day than in standard clinical stimulation should be delivered, providing the LD wrap with daily periods of rest (demand stimulation protocol), based on a heart rate cut-off [8].…”

Section: Introductionmentioning

confidence: 99%

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Dynamic Cardiomyoplasty: Dead or Alive?

Rigatelli¹,

Rigatell²

2011

Int J Angiol

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The dynamic cardiomyoplasty provide an active girdle effect by the wrap of the electrostimulated left latissimus dorsi muscle around the heart. The technique has been almost abandoned in the last five years because the chronic continuous electrical stimulation degenerates the muscle, lowering the long-term results of the intervention. An activity-rest stimulation protocol, which avoid full transformation of the skeletal muscle, maintaining muscular properties overtime, has been proposed showing in humans good results in term of NYHA class, EF and survival improvement. The debate about the capability of this unique kind of cardiocirculatory bio-assist is virtually open: the economic and cost-saving demand dynamic cardiomyoplasty avoiding immunosuppression therapy, extracorporeal circulation equipment and expensive follow-up, probably will be still alive.

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Section: Resultsmentioning

confidence: 97%

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamic Cardiomyoplasty: Dead or Alive?

Rigatelli¹,

Rigatell²

2011

Int J Angiol

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“…Der Burst-Impuls wird so programmiert, dal3 der Beginn mit dem Mitralklappenschlul3 zusammenf~llt. 29% der Patienten, die sich vor der Operation in NYHA III befunden hatten, verstarben postope-In multivariaten Analysen wurden als Risikofaktoren fª eine erhOhte postoperative Letalit~it folgende Faktoren identifiziert: Vorhoffiimmern, pulmonalarterieller Widerstand >600 dyn x s x cm 4, ausgepr~igte Rechtsinsuffizienz, linksventrikulfire Auswurffraktion (LV-EF) < 15%, maximale O2-Aufnahme <10 mi/kg/ruin, LVEDP > 35 mm Hg und pr~ioperativ NYHA IV [4,12]. In der Studie der ,,Worldwide Cardiomyoplasty Study Group" [3] betrug die mittelfristige Letalitfit bei 349 Patienten, die sich vor der Operation in NYHA-Klasse III befanden, 69%, 56% und 47% nach einem, zwei und drei Jahren.…”

Section: Summary: Dynamic Cardiomyoplastyunclassified

Dynamische Kardiomyoplastik

Lange

Thielmann

Hagl

1997

Herz

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Between 1965 and 1995 the incidence of heart failure has been constantly rising and the mortality from this disease has increased fivefold. The introduction of ACE-inhibitors and of adrenergic beta-blockers have resulted in major symptomatic improvements in patients with mild to moderate heart failure. For end-stage disease, heart transplantation offers by now the only therapeutic option and yields excellent results. The permanent implantation of left heart assist-devices is just gaining increasing importance. Yet, both methods also have inherent drawbacks and may not be available to all patients, so that new methods are constantly evaluated. Cardiomyoplasty was introduced into clinical practice in 1985 by Alain Carpentier and since then more than 700 patients have been operated worldwide. After dissection of the latissimus dorsi muscle it is wrapped around the heart in a clockwise fashion (Figure 1). Two sensing electrodes are placed on the anterior aspect of the right ventricle and two stimulation electrodes between the proximal branches of the thoracodorsal nerve (Medtronic SP 5548). The electrodes are then connected with a burststimulator (Cardiomyostimulator, Medtronic 4710) (Figure 2). During the first 2 weeks following the operation the muscle is not stimulated in order to allow for the healing process. Thereafter, a stimulation protocol with a programmed, staged increase of the stimulation frequency is started, to induce transformation of the skeletal muscle into a "fatigue resistant" tissue. After 3 months the muscle is stimulated with every second heart beat (2:1 mode) with full burstimpulses containing 6 single impulses per burst for a duration of 185 ms (Figure 3). Cardiomyoplasty was conceived for patients in NYHA III and severely impaired myocardial function, in whom drug treatment does not produce the expected benefits. The criteria for patient selection are strictly followed, since it has been shown in the past, that the preoperative condition of the patient is of specific importance for the postoperative outcome. Contraindications are NYHA IV, advanced right ventricular dysfunction, secondary pulmonary hypertension (> 600 dyn x s x cm-5), LV end-diastolic diameter > 70 mm und AV-valve incompetence > Grad II. Between July 1985 und October 1996 647 patients received a cardiomyoplasty with the Medtronic Cardiomyoplasty System and the results from 438 patients were analyzed from the "Worldwide Cardiomyoplasty Study Group". One and 2 years following the operation NYHA-class had improved by one class in 41.9% and 53.3%, respectively, and by 2 classes in 38.1% and 30.5%, respectively. In 16% and 15% no improvement was found (Figure 4). Prospective investigation of the quality of life by a score revealed a considerable improvement in the level of daily activities and social interaction. In contrast, two years after the operation, only a small, but significant increase in LV-EF from 22.9 +/- 8.1% to 25.8 +/- 9.7% (p < 0.05) was shown. Heart rate, maximal O2-consumption, total exercise time, cardiac index,...

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“…Vários autores têm demonstrado a elevação significativa da fração de ejeção do VE após a realização da cardiomioplastia entre 20% e 30% em relação aos valores pré-operatórios, através de métodos não invasivos 10,14,27,29,30. Embora esse fato também tenha sido observado neste estudo, aumentos mais expressivos desse parâmetro foram previamente documentados através da cineventriculografia esquerda em 10 pacientes desta série 6 e em outros relatos da literatura 10, 19 . A análise computadorizada da movimentação regional das paredes do VE pela cineventriculografia revela, adicionalmente, que a elevação pós-operatória da fração de ejeção está relacionada à melhora global da contratilidade e modificações na forma da câma-ra ventricular 6.…”

Section: Alterações Da Função Ventricularunclassified

Evolução clínica e comportamento da função ventricular no pós-operatório tardio da cardiomioplastia

Moreira¹,

Stolf²,

Bocchi³

et al. 1995

Rev Bras Cir Cardiovasc

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RESUMO : A cardiomioplastia tem sido proposta, como uma alternativa ao transplante cardíaco, no tratamento de pacientes com insuficiência miocárdica em fase avançada. O objetivo deste trabalho é estudar a evolução clínica e o comportamento da função ventricular no pós-operatório tardio desse procedimento em 34 pacientes portadores de cardiomiopatia dilatada, que foram operados no período de maio de 1988 a setembro de 1994. Vinte e sete pacientes estavam em classe funcional 111 e 7 pacientes em classe IV no pré-operatório, apesar do uso de terapêutica clínica otimizada. A mortalidade hospitalar foi de 2,9% e 1 paciente que evoluiu em choque cardiogênico foi submetido a transplante cardíaco 42 dias após a cardiomioplastia. O tempo de seguimento pós-operatório variou entre 2 e 73 meses , com média de 27,4 meses. Aos 6 meses de pós-operatório, 12 pacientes estavam em classe funcional I, 15 pacientes em classe 11 e 3 pacientes em classe 111 (p=0 ,001) em relação ao pré-operatório. Quatorze pacientes faleceram até 5 anos de pós-operatório e os índices de sobrevi da foram 84,7% em 1 ano, 67 ,7% em 2 anos e 39,6% aos 5 anos de seguimento, sendo que, em 9 pacientes, os óbitos ocorreram por progressão da insuficiência cardíaca, e 5 pacientes faleceram subitamente . A análise de regressão de Gox mostrou que a mortalidade nos pacientes operados em classe funcional IV foi 5,5 vezes maior do que nos pacientes operados em classe 111 (p=O,006) , cuja sobrevida foi de 52 ,7% aos 5 anos de pós-operatório. O estudo sistemático da função ventricular através da angiografia com radioisótopos, da ecocardiografia com Doppler e do cateterismo cardíaco direito documentou a melhora da fração de ejeção do ventrículo esquerdo (V E) de 19,8 ± 3 para 23,9 ± 7,2% (p

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Clinical cardiomyoplasty: Preoperative factors associated with outcome

Cited by 40 publications

References 8 publications

Dynamic Cardiomyoplasty: Dead or Alive?

Dynamic Cardiomyoplasty: Dead or Alive?

Dynamische Kardiomyoplastik

Evolução clínica e comportamento da função ventricular no pós-operatório tardio da cardiomioplastia

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