[Induced tissue transformation and heart surgery]

This article reports the research which led to the use of animal connective tissues in the construction of valvular prostheses and those which led to the use of electrically stimulated skeletal muscle for cardiac assistance. Although, very different at first glance these research have in common the transformation of biological tissues by physical or chemical means to adapt them to a new function. 1) Once implanted in a different species, animal connective tissues are destroyed by immunological reactions and collagen degeneration. These lesions can be prevented by both maskage of the antigenic groups and intermolecular crosslinking using Glutaraldehyde. The durability of such chemically treated tissues is based upon the stability of the biological material (concept of bioprosthesis) and not upon cell survival or tissue regeneration by host cell ingrowth (concept of graft). The valvular bioprostheses made from Glutaraldehyde treated pericardial tissue, keep after this treatment their advantage of biological tissues: they are not thrombogenic and do not require anticoagulation contrary to mechanical valves. Although they have a limited durability up to 10 to 15 years due to tissue calcification, they represent 40% of the valvular prostheses used in clinical practice today. 2) The clinical use of electrostimulated skeletal muscle has been delayed for a long time because of fatigue lesions. An original protocol of progressive sequential stimulation prior to the use of muscle prevents fatigue by the transformation of type I fatigable myosin into type II non fatigable myosin. The conditionned muscle i.e.: the latissimus dorsi, is then wrapped around the ventricles to either reinforce cardiac contraction or to replace a portion of the heart. In the past 10 years, this new operation of "dynamic cardiomyoplasty", has been performed in 84 patients suffering from the end stage heart failure in our institution and in over 500 patients throughout the world with significant functional improvement.