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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 42-52, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Carpentier, JC Chachques, C Acar, J Relland, S Mihaileanu, D Bensasson, JP Kieffer, P Guibourt, D Tournay and I Roussin
Since January 1985, the date of the first dynamic cardiomyoplasty, until
April 1992, 52 patients with end-stage heart disease were operated on in
our institution. Mean preoperative New York Heart Association functional
class was 3.3 and ventricular ejection fraction 16% +/- 3%. Associated
procedures in 23 patients comprised ventricular aneurysm resection (10),
valve surgery (9), coronary artery bypass (8), and tumor resection (3).
Thirty-eight patients had a ventricular reinforcement, 13 a ventricular
substitution, and 1 an atrial reinforcement using the left latissimus dorsi
muscle. Preassist mortality rate before full latissimus dorsi muscle
stimulation was 7 of 13 patients (54%) in the 1985 to 1987 period and 5 of
39 (12%) in the 1988 to 1992 period. The causes of death were heart failure
(4), multiorgan failure (4), septicemia (2), ventricular fibrillation (1),
and sudden death (1). Multivariate analysis of factors influencing hospital
mortality showed that age, cardiac suture technique, associated surgical
procedures, biventricular heart failure, and hemodynamic instability plus
inotropic drug support were predictors of unfavorable outcome. All patients
were followed up for from 2 months to 7 years (mean 21 months). Postassist
mortality rate was 8 of 40 (20%). Causes of death included heart failure
(5), ventricular fibrillation (1), myocardial infarction (1), and gastric
bleeding (1). Preoperative risk factors influencing long-term mortality
were permanent New York Heart Association functional class IV,
biventricular heart failure, atrial fibrillation, cardiothoracic ratio
greater than 60%, and ejection fraction less than 15%. Actuarial survival
at 7 years was 70.4% (preassist mortality excluded). Surviving patients
were in a mean New York Heart Association functional class of 1.8
(preoperatively 3.3, p < 0.05). The average ejection fractions
(rest/stress) were 25%/28% at 1 year, 26%/30% at 2 years, and 23%/28% at 3
years. Average cardiothoracic ratios were 57% +/- 3% at 1 year, 56% +/- 2%
at 2 years, and 57% +/- 2.5% at 3 years. Catheterization obtained in 20
patients showed no significant changes at rest in capillary wedge pressure,
pulmonary artery pressure, and diastolic left ventricular pressure when
compared with preoperative pressures. Average ejection fractions increased
from 24% to 30.6%. Maximal oxygen consumption increased from 12.8 +/- 3.5
to 18.6 +/- 4 ml/min per kilogram. The number of rehospitalizations
resulting from congestive heart failure was reduced to 0.4 hospitalizations
per patient per year (preoperatively 2.4, p < 0.05). In 62% of the
patients, pharmacologic therapy was diminished after the operation. Three
patients required orthotopic heart transplantation 6 months, 4 years, and 5
years after cardiomyoplasty.
ARTICLES
Dynamic cardiomyoplasty at seven years
Hopital Broussais, Paris, France.
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J. C. Chachques, M. Tapia, M. Radermercker, M. Pellerin, J. F. Fuzellier, M. J. Tolan, X. Renard, V. Mitz, and A. F. Carpentier Association of Latissimus Dorsi Muscle Expansion With Electrostimulation Before Cardiomyoplasty Ann. Thorac. Surg., January 1, 1996; 61(1): 138 - 142. [Abstract] [Full Text]
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L. F. P. Moreira, N. A. G. Stolf, D. M. Braile, and A. D. Jatene Dynamic Cardiomyoplasty in South America Ann. Thorac. Surg., January 1, 1996; 61(1): 408 - 412. [Abstract] [Full Text]
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J.-C. Chachques, M. Radermercker, M. J. Tolan, E. I.C. Fischer, P. A. Grandjean, and A. F. Carpentier Aortomyoplasty Counterpulsation: Experimental Results and Early Clinical Experience Ann. Thorac. Surg., January 1, 1996; 61(1): 420 - 425. [Abstract] [Full Text]
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R. Lange, F.-U. Sack, B. Voss, R. De Simone, M. Thielmann, A. Nair, J. Brachmann, R. Haussmann, F. Fleischer, and S. Hagl Treatment of Dilated Cardiomyopathy With Dynamic Cardiomyoplasty: The Heidelberg Experience Ann. Thorac. Surg., November 1, 1995; 60(5): 1219 - 1225. [Abstract] [Full Text]
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A. A. Hagege, M. Desnos, F. Fernandez, B. Besse, N. Mirochnik, M. Castaldo, J. C. Chachques, A. Carpentier, and C. Guerot Clinical Study of the Effects of Latissimus Dorsi Muscle Flap Stimulation After Cardiomyoplasty Circulation, November 1, 1995; 92(9): 210 - 215. [Abstract] [Full Text]
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E. A. Bocchi, G. V. Guimaraes, L. F. P. Moreira, F. Bacal, A. V. de Moraes, A. C. P. Barreto, M. Wajngarten, G. Bellotti, N. Stolf, A. Jatene, et al. Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up Circulation, November 1, 1995; 92(9): 216 - 222. [Abstract] [Full Text]
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J. C. Chachques and A. F. Carpentier The scientific development of dynamic cardiomyoplasty J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 1154 - 1155. [Full Text]
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R. Lorusso, G. Coletti, A. D. Valle, G. Steffenino, G. Aliprandi, and O. Alfieri Right Latissimus Dorsi Cardiomyoplasty in Diaphragm Eventration and Cardiac Malposition Ann. Thorac. Surg., August 1, 1995; 60(2): 452 - 454. [Abstract] [Full Text]
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 C. E. Cooke, M. D. Greenberg, S. S. Coughlin, K. Mishark, M. Odawara, K. Yamashita, S. S. Legha, G.W. Dec, and V. Fuster Idiopathic Dilated Cardiomyopathy N. Engl. J. Med., May 18, 1995; 332(20): 1384 - 1386. [Full Text]
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D. A. Kass, K. L. Baughman, P. H. Pak, P. W. Cho, H. R. Levin, T. J. Gardner, H. R. Halperin, J. E. Tsitlik, and M. A. Acker Reverse Remodeling From Cardiomyoplasty in Human Heart Failure : External Constraint Versus Active Assist Circulation, May 1, 1995; 91(9): 2314 - 2318. [Abstract] [Full Text]
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S. Isoda, Y. Yano, Y. Jin, H. L. Walters III, J. Kondo, and A. Matsumoto Influence of a Delay on Latissimus Dorsi Muscle Flap Blood Flow Ann. Thorac. Surg., March 1, 1995; 59(3): 632 - 637. [Abstract] [Full Text]
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A. C. Cernaianu, T. V. Vassilidze, D. R. Flum, J. G. Gallucci, A. Olah, J. H. Cilley Jr, M. A. Grosso, and A. J. DelRossi Latissimus Dorsi and Serratus Anterior Dynamic Descending Aortomyoplasty for Ischemic Cardiac Failure Ann. Thorac. Surg., March 1, 1995; 59(3): 639 - 643. [Abstract] [Full Text]
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G. Watanabe, T. Misaki, M. Takahashi, H. Ohtake, Y. Tsunezuka, M. Wada, and Y. Watanabe Efficacy of a Skeletal Muscle-Powered Dynamic Patch: Part 2. Right Ventricular Assistance Ann. Thorac. Surg., February 1, 1995; 59(2): 313 - 319. [Abstract] [Full Text]
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L. F. P. Moreira, N. A. G. Stolf, E. A. Bocchi, F. Bacal, P. M. Pego-Fernandes, H. Absensur, J. C. Meneghetti, and A. D. Jatene Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 353 - 363. [Abstract] [Full Text]
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