[Cardiomyoplasty as treatment of chronic severe cardiac failure]. / Cardiomioplastia como tratamiento de la insuficiencia cardíaca crónica severa.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Cardiac assistance from skeletal muscle is now emerging as an alternative to transplant surgery. The principle of cardiomyoplasty is chronic electrostimulation of the latissimus muscle flap wrapped around the heart to obtain a phasic activity which can be integrated to ventricular kinetics. Cardiomyoplasty is appropriate for patients with cardiac insufficiency refractory to optimal medical treatment. This includes cardiac failure of ischemic and non-obstructive cardiomyopathies. Worldwide clinical experience with this technique involves more than 500 cases. MATERIAL AND METHODS: The Broussais Hospital clinical experience involves 80 patients, operated between 1985 and 1995. All of them were closely followed in the postoperative period. RESULTS: Recent basic and clinical data have shown that cardiomyoplasty effects on ventricular performance are due to 1) augmentation of pump function 2) limitation of cardiac dilatation; 3) reduction of ventricular wall stress, and 4) reverse remodeling of the left ventricular geometry. Remarkably, continuous fatigue free contraction of the latissimus dorsi muscle at the frequency of the heart has been obtained for periods exceeding 10 years in humans. Five patients underwent cardiac transplantation due to refractory heart failure. CONCLUSIONS: Clinical experience has demonstrated that cardiomyoplasty is an efficient technique to assist patients with severe refractory cardiac failure. In the great majority of cases it reverses the heart failure and increases life expectancy. Moreover, the functional class and the quality-of-life are significantly improved. Cardiomyoplasty does not preclude the use of future orthotopic heart transplantation.