Dynamic cardiomyoplasty for long-term cardiac assist

Abstract

The principle of cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the failing heart. Technically, this procedure consists of placing the left LDM flap around the heart via a window created by partial resection of the 2nd or 3rd rib, and subsequent muscle electrostimulation in synchrony with ventricular systole. The aim of cardiomyoplasty is to support ventricular function in ischemic or dilated cardiomyopathies, or to partially replace the ventricular myocardium after large aneurysm or tumor resections. Our clinical experience at Broussais Hospital involves 44 patients. The functional class and quality of life improved after cardiomyoplasty. Improvement of the ventricular performance and limitation of cardiac dilatation were demonstrated over the long-term. The actuarial survival at 6 years was 71%. Risk factors influencing perioperative mortality were: age > 65 years, associated surgical procedures, pulmonary vascular hypertension, and patients hemodynamically unstable or on inotropic drug support. Preoperative risk factors influencing the long-term mortality were: permanent NYHA functional class 4, cardiothoracic ratio > 0.60, LV ejection fraction < 15%, bi-ventricular heart failure, and atrial fibrillation. Cardiomyoplasty does not preclude the use of future orthotopic heart transplantation.

Early metabolic adaptations of rabbit fast-twitch muscle to chronic low-frequency stimulation

“…It has been demonstrated that dynamic cardiomyoplasty (Chachques et al 1988(Chachques et al , 1992Magovern et al 1988) and dynamic graciloplasty (Baeten et al 1988;Williams et al 1990;Janknegt et al 1995) represent important medical applications for the use of transformed skeletal muscle and are increasingly used in the treatment of congestive cardiomyopathies and sphincter incontinence. Because the stimulation-induced transformation is a time-dependent process encompassing sequential fast-to-slow ®bre type transitions, it is of interest to study to what extent metabolic adaptations, preceding ®bre type transitions, contribute to confering fatigue-resistance to the stimulated muscle.…”

Dynamic Cardiomyoplasty: Dead or Alive?

“…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].…”

Hemodynamic Effects of Cardiomyoplasty in an Experimental Model of Acute Heart Failure and Atrial Fibrillation

“…The results of cardiomyoplasty in patients presenting atrial fibrillation are frequently unsuccessful (9,10,22). A permanent A-V block can be performed using interventional cardiology methods (radiofrequency catheter ablation).…”