ABSTRACT
Cardiomyoplasty is a method for managing patients with dilated cardiomyopathy. We evaluated the means of carbon fiber electrode stimulation of the nerve to the latissimus dorsi muscle (LDM) in dogs to increase skeletal muscle contractility. Histochemical examination of biopsies of muscle electrically conditioned by a single pulse stimulator via the thoracodorsal nerve demonstrated transformation of muscle into fatigue resistant slow fibers without damage to muscle or nerve tissue. Canine experiments confirmed that carbon fibers are one of the best electrodes for chronic LDM stimulation. Between 1988 and 1992, we operated on ten patients, New York Heart Association (NYHA) Class III (4 patients) and Class IV (6 patients), with a mean left ventricular ejection fraction (LVEF) of 23%. The indications for cardiomyoplasty were idiopathic (7 patients) and ischemic (3 patients) cardiomyopathy refractory to maximum medical therapy. The operative procedure was performed via median sternotomy (5 patients) and left thoracotomy (5 patients). There was one operative mortality and two additional deaths during the late follow-up period. The mean postoperative LVEF increased to 27%. Functional class, quality-of-life, and ventricular performance were improved after cardiomyoplasty. Two of the surviving patients are in NYHA Class I, four in Class II, and one in Class III.
Subject(s)
Cardiomyopathies/surgery , Cardiomyoplasty , Animals , Cardiomyopathies/physiopathology , Cardiomyoplasty/methods , Dogs , Echocardiography , Electric Stimulation , Hemodynamics , Humans , Male , Postoperative Complications , Sternum/surgery , Stroke Volume , ThoracotomySubject(s)
Electric Stimulation Therapy , Heart Ventricles/surgery , Humans , Middle Aged , Preoperative CareABSTRACT
Description and results of the first clinical use of a new method of extended myoventriculoplasty with the simultaneous implantation of a cardiosynchronized programmable electroneurostimulator are presented. Stepwise training of skeletal muscle in order to adapt it to fulfilling the function of the contracting heart was studied. The technique of myoventriculoplasty was used in patients with severe ischaemic heart disease and dilated cardiomyopathy. During the study, an original Soviet-made implanted programmable and cardiosynchronized electroneurostimulator was tested for the first time in clinical practice. Early postoperative results are satisfactory.
