Chachques J C, Acar C, Portoghese M, Bensasson D, Guibourt P, Grare P, Jebara V A, Grandjean P A, Carpentier A
Service de Chirurgie Cardiovasculaire, Hôpital Broussais, Paris, France.
Eur J Cardiothorac Surg. 1992;6(12):642-7; discussion 647-8. doi: 10.1016/1010-7940(92)90188-4.
The principle of cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the failing heart. Technically, this procedure consists of placing the left LDM flap around the heart via a window created by partial resection of the 2nd or 3rd rib, and subsequent muscle electrostimulation in synchrony with ventricular systole. The aim of cardiomyoplasty is to support ventricular function in ischemic or dilated cardiomyopathies, or to partially replace the ventricular myocardium after large aneurysm or tumor resections. Our clinical experience at Broussais Hospital involves 44 patients. The functional class and quality of life improved after cardiomyoplasty. Improvement of the ventricular performance and limitation of cardiac dilatation were demonstrated over the long-term. The actuarial survival at 6 years was 71%. Risk factors influencing perioperative mortality were: age > 65 years, associated surgical procedures, pulmonary vascular hypertension, and patients hemodynamically unstable or on inotropic drug support. Preoperative risk factors influencing the long-term mortality were: permanent NYHA functional class 4, cardiothoracic ratio > 0.60, LV ejection fraction < 15%, bi-ventricular heart failure, and atrial fibrillation. Cardiomyoplasty does not preclude the use of future orthotopic heart transplantation.
心肌成形术的原理是对包裹在衰竭心脏周围的背阔肌（LDM）进行长期电刺激。从技术上讲，该手术包括通过部分切除第二或第三肋骨形成的窗口将左背阔肌皮瓣置于心脏周围，随后与心室收缩同步进行肌肉电刺激。心肌成形术的目的是支持缺血性或扩张型心肌病的心室功能，或在大动脉瘤或肿瘤切除后部分替代心室心肌。我们在布鲁赛医院的临床经验涉及44例患者。心肌成形术后功能分级和生活质量得到改善。长期来看，心室功能得到改善，心脏扩张受到限制。6年的精算生存率为71%。影响围手术期死亡率的危险因素包括：年龄>65岁、相关外科手术、肺血管高压以及血流动力学不稳定或使用正性肌力药物支持的患者。影响长期死亡率的术前危险因素包括：纽约心脏协会（NYHA）永久性心功能分级4级、心胸比率>0.60、左心室射血分数<15%、双心室心力衰竭和心房颤动。心肌成形术并不排除未来进行原位心脏移植的可能性。
