Hill A B, Chiu R C
Montreal General Hospital, McGill University, Quebec, Canada.
Clin Cardiol. 1989 Dec;12(12):681-8. doi: 10.1002/clc.4960121203.
Dynamic cardiomyoplasty is a new surgical procedure proposed for treatment of the failing heart. Clinically, the latissimus dorsi muscle is raised as a pedicled flap and wrapped around the heart. The skeletal muscle is transformed to produce a myocardium-like fatigue-resistant muscle. It is stimulated to contract in synchrony with the heart in hope of assisting the myocardial contraction. An R-wave synchronous pacemaker provides a pulse-train form of stimulation to simulate, for the skeletal muscle, the contractile characteristics of the myocardial syncytium. We have undertaken a critical review of the clinical results of dynamic cardiomyoplasty reported to date. Objective evidence of clinical improvement after dynamic cardiomyoplasty resulting from the contractile assistance of the myoplasty has been modest. Many of the beneficial results reported could be explained by concomitant procedures done, such as aneurysmectomy or coronary artery bypass grafting. Hemodynamic studies have failed to demonstrate consistent and convincing improvement as a result of the cardiomyoplasty stimulation. We have, however, identified an interesting subgroup of patients, in whom a striking hemodynamic response to cardiomyoplasty stimulation has been reported. These patients all possess large resting heart volumes characteristic of dilated cardiomyopathy. Thus, case selection may ultimately be one of the most important factors in determining the success of dynamic cardiomyoplasty for the treatment of heart failure.
动力性心肌成形术是一种用于治疗心力衰竭的新手术方法。临床上，背阔肌作为带蒂皮瓣掀起并包裹心脏。将骨骼肌转化为产生类似心肌的抗疲劳肌肉。刺激它与心脏同步收缩，以期辅助心肌收缩。一个R波同步起搏器提供脉冲串形式的刺激，为骨骼肌模拟心肌合胞体的收缩特性。我们对迄今为止报道的动力性心肌成形术的临床结果进行了批判性回顾。动力性心肌成形术通过肌成形术的收缩辅助导致临床改善的客观证据并不显著。报道的许多有益结果可以用同时进行的手术来解释，如动脉瘤切除术或冠状动脉搭桥术。血流动力学研究未能证明心肌成形术刺激能带来持续且令人信服的改善。然而，我们发现了一个有趣的患者亚组，据报道他们对心肌成形术刺激有显著的血流动力学反应。这些患者都具有扩张型心肌病特有的静息心腔容积增大的特点。因此，病例选择可能最终是决定动力性心肌成形术治疗心力衰竭成功与否的最重要因素之一。
