Heart transplantation following cardiomyoplasty: a biological bridge☆

Abstract

Objective: Dynamic cardiomyoplasty (CMP) was proposed as a treatment for refractory heart failure; more than 2000 procedures have been performed worldwide. Heart transplantation was indicated afterwards in some CMP patients with recurrent heart failure symptoms. This study reviews the multicentric French experience with CMP followed by heart transplantation. Methods: From 1985 to 2007, 212 patients (mean age 53 AE 11 years) with refractory heart failure (LVEF = 22 AE 9%, mean NYHA 3.2) underwent CMP in France. Heart transplantation was performed in 26 patients (12.3%), mean age: 51 AE 11 years, within 2.3 AE 3 years after CMP. Transplantation was indicated for persistent heart failure, i.e. no immediate improvement after CMP (19%) and for recurring heart failure (81%). Results: The surgical technique of heart transplantation following cardiomyoplasty presents few particularities. Routine extracorporeal bypass was instituted between the vena cavas and the ascending aorta. As in most of these patients the CMP procedure had been performed without the need of extracorporeal circulation, hearts were free of previous cannulations for cardiopulmonary bypass. The latissimus dorsi muscle flap was divided as far as possible inside the left pleural cavity and its vascular pedicle was obturated. The proximal portion of the muscle as well as the muscular pacing electrodes were kept in place in the pleural cavity. The adhesions between the flap and the heart were not released so as to achieve an en bloc resection of the heart and the muscle flap. During removal of the recipient's heart, care was taken not to injure the left phrenic nerve that was frequently in tight relation with the latissimus dorsi muscle. Heart transplantation was then performed in a routine manner, the donor heart being anastomosed to remnant atria and great vessels. Mean follow-up was 5.5 years (longest 13.5 years). Survival at 10 years was 40% for early heart transplantation (done within 4 months of CMP) and 57% for transplantation performed at 3 AE 2.8 years after CMP. Conclusions: Heart transplantation after CMP is technically feasible. Hospital mortality was higher when urgent transplantation was required. Long-term survival results are similar to those for primary heart transplantation. Cardiomyoplasty, when it fails, does not preclude transplantation, and when indicated, CMP could be considered as a biological bridge to heart transplantation. #

Autologous Muscular Treatment Options for Endstage Heart Failure — A Critical Appraisal of the Dynamic Cardiomyoplasty (DCMP) vs. a New Concept of a Closed-Loop Controlled DCMP (CLC-DCMP)

“…The first successful clinical application was performed in 1985 (Broussais Hospital, Paris, [1]). Since then, more than 1.000 surgeries have been performed worldwide [2]. The clinical results of the DCMP however did not live up to the expectations due to the loss of muscle strength [3] [4] and muscle damage [5] [6].…”

“…A critical analysis of more than 20 years and more than 1.000 clinical cases should demonstrate it's clinical impact [1], [2], [4][5][6], . Clinical efficacy concerning survival, clinical outcome indicated by NYHA-class, ejection fraction of the left heart ventricle (EF) was evaluated by the use of more than 100 relevant reports.…”

Cardiac assistance from skeletal muscle: a reappraisal☆

“…Furthermore, a review of 127 patients over a 10-year period reported a 2-year survival rate of less than 60% [70]. Although the procedure could be used as a bridge-to-transplant [76,77], this was clearly not the primary intention, and the recurrence of symptoms and poor long-term survival were disappointing.…”

Role of Thoracomyoplasty Procedures in Modern Surgery for Intrathoracic Suppurations

“…The need to have some flaps available in case of postoperative complications is the main argument for the use of muscle-sparing thoracotomies (Nosotti et al, 2010). Intrathoracic muscle transposition (without thoracoplasty) has also some other indications such as reinforcement of high-risk sutures (Abolhoda et al, 2009, Thingnam et al, 2011, repair of esophageal and tracheal defects (Kotzampassakis et al, 2009, Meyer et al, 2004, pericardial and diaphragmatic reconstruction (Kobayashi et al, 2009), dynamic cardiomyoplasty for end-stage heart failure (Chachques et al, 2008), salvage of infected vascular prosthesis (Mitra et al, 2005) etc.…”