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Dynamic cardiomyoplasty for long-term cardiac assist
J C Chachques1, C Acar, M Portoghese
1Service de Chirurgie Cardiovasculaire, Hôpital Broussais, Paris, France.
Summary
Cardiomyoplasty, using latissimus dorsi muscle (LDM) electrostimulation, improves heart function and quality of life in patients with heart failure. Long-term survival was 71% at 6 years, with identified risk factors for mortality.
Area of Science:
- Cardiac Surgery
- Regenerative Medicine
- Biomedical Engineering
Background:
- Cardiomyoplasty involves long-term electrostimulation of a latissimus dorsi muscle (LDM) flap wrapped around a failing heart.
- This procedure aims to support ventricular function in cardiomyopathies or replace myocardium after resections.
Purpose of the Study:
- To evaluate the clinical outcomes and long-term survival of cardiomyoplasty.
- To identify risk factors influencing perioperative and long-term mortality.
Main Methods:
- Surgical implantation of a left LDM flap around the heart.
- Subsequent muscle electrostimulation synchronized with ventricular systole.
- Clinical follow-up of 44 patients, assessing functional class, quality of life, ventricular performance, and survival.
Main Results:
- Improved functional class and quality of life observed post-procedure.
- Demonstrated long-term improvement in ventricular performance and limited cardiac dilatation.
- Actuarial survival at 6 years was 71%.
- Identified perioperative risk factors: age > 65, associated surgeries, pulmonary hypertension, hemodynamic instability.
- Preoperative risk factors for long-term mortality: NYHA class 4, cardiothoracic ratio > 0.60, LV ejection fraction < 15%, biventricular failure, atrial fibrillation.
Conclusions:
- Cardiomyoplasty can improve cardiac function and patient quality of life.
- Specific patient characteristics are associated with increased perioperative and long-term mortality risks.
- The procedure does not exclude future orthotopic heart transplantation.