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Latissimus dorsi cardiomyoplasty in severe congestive heart failure: the Lyon experience
F Delahaye1, O Jegaden, P Montagna
1Unite 30, Hopital Cardiovasculaire et Penumologique, Lyon, France.
Insights
Latissimus dorsi cardiomyoplasty improved exercise capacity and functional class in heart failure patients. While not improving all cardiac parameters, this surgical technique offers a potential benefit for selected individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Rehabilitation
Background:
- Heart failure significantly impacts patient quality of life and exercise capacity.
- Surgical interventions are explored to improve outcomes for patients with advanced heart failure.
Purpose of the Study:
- To evaluate the efficacy of latissimus dorsi cardiomyoplasty in patients with New York Heart Association (NYHA) Class III heart failure.
- To assess changes in exercise tolerance, hemodynamic parameters, and echocardiographic findings post-surgery.
Main Methods:
- Eleven male patients with NYHA Class III heart failure underwent latissimus dorsi cardiomyoplasty using the Chachques and Carpentier technique.
- Patients were monitored for complications, functional status, exercise capacity, and cardiac function via echocardiography and angiography.
Main Results:
- No surgical deaths occurred; complications included low cardiac output, embolism, and pneumonia, with all patients recovering.
- Seven patients evaluated at 6 months improved to NYHA Class II, with one requiring heart transplantation.
- Maximal exercise level and heart rate-systolic blood pressure product significantly increased, primarily due to elevated systolic blood pressure.
Conclusions:
- Latissimus dorsi cardiomyoplasty demonstrates functional improvement and enhanced exercise capacity in NYHA Class III heart failure patients.
- While certain echocardiographic and hemodynamic parameters did not change, the observed functional gains warrant further investigation.
- The mechanism of action, potentially acting as a lift rather than a pincer, requires further study, and survival benefits need evaluation in randomized clinical trials.
Abstract:
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.