Management of anesthesia during dynamic cardiomyoplasty.
OBJECTIVE
To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation.


METHODS
Retrospective clinical study.


METHODS
Cardiothoracic operating room at a university hospital.


METHODS
Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyopathy, 3 with postischemic cardiomyopathy.


METHODS
Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart.


RESULTS
The mean left ventricular ejection fraction (LVEF) of the 10 patients was 24.89% +/- 9.17% (range 10% to 37%). No intraoperative death occurred. Two patients died of multiple organ failure and an apparent arrhythmia on the 15th and 25th postoperative days, respectively. The rest of the patients regained good working capacity postoperatively, as evidenced by improvement in NYHA grade. Nevertheless, the LVEF improved in only one patient. No significant differences were evident between preoperative and postoperative blood values, hemodynamic data, or spirometry.


CONCLUSIONS
Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.
Domenegati
E
E
Department of Anesthesia and Intensive Care, S. Matteo Hospital, Pavia, Italy.
Maurelli
M
M
Chiaudani
M G
MG
Pagnin
A
A
Rinaldi
M
M
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D018421:Cardiomyoplasty; D004599:Electric Stimulation Therapy; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D018657:Muscle Fibers, Slow-Twitch / Q000601:surgery; D017202:Myocardial Ischemia / Q000601:surgery*; D011292:Premedication; D012189:Retrospective Studies
D007530:Isoflurane