Latissimus dorsi cardiomyoplasty. Perioperative management and postoperative evolution

Twelve men aged 45 to 69 years, NYHA class 3 or 4 with low isotopic ejection fraction (18 +/- 7 percent), underwent cardiomyoplasty. Eight required cardiopulmonary bypass to treat an associated cardiac lesion. Preoperatively, all patients needed inotropic support with dobutamine and half of them vasodilators, increasing cardiac index by nearly 100 percent. The SvO2 remained over 67 percent during the different stages of the surgical procedure. The mean operating time was 438 +/- 75 min. None of the patients required intra-aortic balloon counterpulsation. Inotropic and vasodilator support was continued in the ICU and appeared especially important during weaning from mechanical ventilation. The average stay in ICU was 6.8 +/- 4.0 days. Three patients died of cardiac failure respectively 8, 11 and 15 months after CMP. One patient underwent transplantation. The eight other surviving patients showed clinical improvement from the third month, but objective criteria for hemodynamic improvement were noted only after one year. Cardiomyoplasty can be an alternative treatment for selected cases of cardiomyopathy.