Driever R, Bugenhagen R, Fuchs S, Minale C, Vetter H O
Department of Cardiothoracic Surgery, Heart Center, University of Witten/Herdecke, Wuppertal - Germany.
Int J Artif Organs. 2001 Mar;24(3):152-6.
Cardiomyoplasty was introduced into clinical practice in 1985 by Alain Carpentier. Since then, the procedure has been performed on more than 400 patients worldwide. The latissimus dorsi muscle is prepared maintaining the vascular supply, then the muscle flap is wrapped around the heart and connected to a cardiomyostimulator. The muscle is later stimulated synchronously with ventricular systole to augment the cardiac contractility.
To evaluate the long-term outcome of cardiomyoplasty, we investigated 3 patients electively undergoing this procedure in our hospital. All of these patients (2 male, 1 female) had severe chronic heart failure which did not respond to optimal medical treatment. The mean follow-up time was 42 months (range 24 - 60). All patients showed symptoms corresponding to NYHA class III, and one patient intermittently showed class IV despite conventional medical therapy. Patients were evaluated at 6-month intervals for 2 years with right heart catheterization, radionuclide scans, echocardiography, as well as questionnaires for assessing quality of life.
There was no operative mortality. One patient experienced sudden death 2 years after operation. There were no significant changes in hemodynamic variables at 6, 12 or 24 months after surgery, respectively. Left ventricular ejection fraction increased from 20.0 ( 9.2 to 40.0 +/- 7.1 % (p = 0.05) 1 year after operation. Considerable improvement of symptoms was seen in all, and 1 patient returned to work. NYHA-class decreased from 3.1 to 2.0 (p = 0.02).
Following cardiomyoplasty, patients may exhibit impressive clinical improvement with less striking changes of objective hemodynamic parameters. Thus, in our patients, dynamic cardiomyoplasty improves quality of life. We do not consider this treatment to be an alternative to heart transplantation. It does, however, provide a therapeutic option for patients for whom transplantation is contraindicated.
1985年，阿兰·卡彭蒂耶将心肌成形术引入临床实践。从那时起，全球已有400多名患者接受了该手术。准备背阔肌时保留其血管供应，然后将肌瓣包裹在心脏周围并与心肌刺激器相连。随后，在心室收缩时同步刺激该肌肉以增强心脏收缩力。
为评估心肌成形术的长期效果，我们对我院3例择期接受该手术的患者进行了调查。所有这些患者（2男1女）均患有严重慢性心力衰竭，对最佳药物治疗无反应。平均随访时间为42个月（范围24 - 60个月）。所有患者均表现出符合纽约心脏协会（NYHA）III级的症状，1例患者尽管接受了传统药物治疗仍间歇性表现为IV级。在2年时间里，每隔6个月对患者进行右心导管检查、放射性核素扫描、超声心动图检查以及评估生活质量的问卷调查。
无手术死亡病例。1例患者术后2年猝死。术后6个月、12个月和24个月时血流动力学变量分别无显著变化。术后1年，左心室射血分数从20.0（±9.2）%增至40.0（±7.1）%（p = 0.05）。所有患者症状均有显著改善，1例患者恢复工作。NYHA分级从3.1降至2.0（p = 0.02）。
心肌成形术后，患者临床症状可能有显著改善，而客观血流动力学参数变化不明显。因此，在我们的患者中，动态心肌成形术改善了生活质量。我们不认为这种治疗方法可替代心脏移植。然而，它确实为移植禁忌的患者提供了一种治疗选择。
