Latissimus dorsi cardiomyoplasty in severe congestive heart failure: the Lyon experience.
Eleven male patients, New York Heart Association (NYHA) Class III, have undergone cardiomyoplasty (Chachques and Carpentier technique). There were no deaths. Two patients suffered from low cardiac output, one patient suffered a massive aortic bifurcation embolism, and one patient had a Legionella pneumonia. All patients recovered well. The follow-up was 6.9 +/- 2.3 months. One patient had a Cardiomyostimulator Pulse Train Generator failure and had it replaced. The first seven patients were evaluated 6 months after surgery. They all improved (Class II) except for one, who was transplanted. The maximal level of exercise was improved (92 +/- 18 W vs 60 +/- 24 W), as was the heart rate-systolic blood pressure product (30,262 +/- 3,119 vs 19,908 +/- 4,190), mainly due to an increase in systolic blood pressure (200.0 +/- 25.5 vs 141.5 +/- 20.3 mmHg). Echographic parameters, maximal oxygen consumption, left ventricular ejection fraction (LVEF), cardiac index, oxygen arteriovenous difference, and cardiac filling pressures did not change. The left ventricular (LV) angiography always showed good contraction of the latissimus dorsi. A problem needing investigation is the principle of cardiomyoplasty (CMP) itself, as the muscle acts more as a lift than as pincers. Our patients, and patients from other series, improved functionally, and they exercised more. Improvement in survival can be studied only by a randomized clinical trial.
Delahaye
F
F
Unite 30, Hopital Cardiovasculaire et Penumologique, Lyon, France.
Jegaden
O
O
Montagna
P
P
Desseigne
P
P
Blanc
P
P
Vedrinne
C
C
Touboul
P
P
Saint-Pierre
A
A
Perinetti
M
M
Rossi
R
R
D000368:Aged; D001243:Assisted Circulation; D001415:Back / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D005080:Exercise Test; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000502:physiology; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000379:methods* / Q000401:mortality