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Effect of cardiomyoplasty on systolic and diastolic function
1Division of Cardiovascular Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Paced latissimus dorsi cardiomyoplasty improves systolic function in heart failure patients. However, non-paced cardiomyoplasty impairs cardiac function, while delayed procedures prevent muscle damage.
Area of Science:
- Cardiovascular Surgery
- Heart Failure Research
- Surgical Innovation
Background:
- Cardiomyoplasty is a recognized treatment for end-stage heart failure.
- The impact of latissimus dorsi cardiomyoplasty on cardiac function remains unclear.
Purpose of the Study:
- To evaluate the effects of paced and non-paced latissimus dorsi cardiomyoplasty on systolic and diastolic function.
- To assess the efficacy of a two-stage procedure in preventing ischemic injury.
Main Methods:
- Measurements included maximal elastance of the left ventricle (Emax), stroke volume, preload recruitable stroke work, and diastolic compliance in an experimental heart failure model.
- Collateral blood vessels to the latissimus dorsi were ligated two weeks prior to cardiomyoplasty.
- Histological examination of muscle biopsies confirmed muscle architecture preservation.
Main Results:
- Non-paced cardiomyoplasty adversely affected both systolic and diastolic function.
- Paced latissimus dorsi cardiomyoplasty improved systolic function but did not significantly affect diastolic function.
- The delayed, two-stage procedure successfully prevented ischemic injury to the muscle flap.
Conclusions:
- Non-paced latissimus dorsi cardiomyoplasty acutely impairs cardiac function.
- Delayed cardiomyoplasty, performed two weeks after collateral ligation, effectively prevents ischemic injury to the muscle flap.
- Pacing of the latissimus dorsi muscle during cardiomyoplasty can enhance systolic function in heart failure models.
Unlabelled:
Although cardiomyoplasty has become a recognized treatment for end-stage heart failure, the effects of this procedure on systolic and diastolic function are still unclear. To determine the effects of paced and non-paced latissimus dorsi cardiomyoplasty on systolic and diastolic function, the maximal elastance of the left ventricle (Emax), stroke volume, preload recruitable stroke work and diastolic compliance were measured in an experimental heart failure model. Collateral blood vessels to the latissimus dorsi were ligated 2 weeks before cardiomyoplasty in order to reduce the risk of ischemic injury. Histological examination of muscle biopsies confirmed that the two-stage procedure preserved normal muscle architecture. The non-paced cardiomyoplasty wrap adversely affected both systolic and diastolic function. Paced Latissimus Dorsi during heart failure improved systolic function but had no measurable effect on diastolic function.
Conclusions:
1. Non-paced, or unstimulated, latissimus dorsi cardiomyoplasty acutely impairs cardiac function. 2. Delayed cardiomyoplasty, 2 weeks after collateral ligation, prevents ischemic injury to the muscle flap.