Cardiomyoplasty: ventricular reconstruction after tumor resection.
OBJECTIVE
Although cardiac transplantation has been performed for complete removal of ventricular tumors, complete surgical resection with ventricular reconstruction is desirable. Thus patients with benign tumors would probably be cured, and those with malignant tumors would have a better prognosis. In this study extensive and complete surgical resection of ventricular tumors is followed by anatomic and functional ventricular reconstruction with a dynamic cardiomyoplasty procedure.


METHODS
Seven patients (mean age, 32.7 years) underwent complete resection of ventricular tumors. Histologic types were distributed as follows: fibroma in 2 patients and sarcoma, lymphosarcoma, hemangioma, lipoma, and metastatic angiosarcoma, respectively, in the remaining 5 patients. Six of the patients were considered candidates for heart transplantation because of the extent of tumor invasion. Surgery consisted of 4 steps: (1) tumor resection; (2) coronary artery resection (when invaded by the tumor) and coronary artery bypass grafting; (3) valvular reconstruction (when possible) or replacement; and (4) ventricular wall reconstruction with a pericardial patch for closure of the ventricular defect (neoendocardium) covered by the electrostimulated latissimus dorsi muscle flap (neomyocardium).


RESULTS
All patients survived surgical intervention, but 2 late postoperative deaths are reported. Among the surviving patients, early complications played a major role in their postoperative course and consisted of arrhythmias, atrioventricular block necessitating a dual-chamber pulse generator, respiratory insufficiency, and heart failure. Two patients were assisted postoperatively with an intra-aortic balloon pump. On postoperative follow-up (mean, 72.4 +/- 8.5 months), an improvement in the patients' functional status was observed. Patients moved from a mean New York Heart Association functional class of 2.8 to a mean functional class of 1.2.


CONCLUSIONS
The excellent long-term evolution without recurrence, ventricular dysfunction, and/or thromboembolic complications implies that cardiomyoplasty could be recommended as an alternative to heart transplantation for the therapy of large ventricular tumors.
Chachques
Juan-Carlos
JC
Department of Cardiovascular Surgery, Broussais and Pompidou Hospitals, Paris, France. j.chachques@brs.ap-hop-paris.fr
Argyriadis
Pantelis G
PG
Latremouille
Christian
C
D'Attellis
Nicola
N
Fornes
Paul
P
Bruneval
Patrick
P
Couetil
Jean-Paul
JP
Carpentier
Alain F
AF
D000328:Adult; D018421:Cardiomyoplasty / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome