Chachques J C, Acar C, Tapia M, Guibourt P, Fiemeyer A, Bensasson D, Berrebi A, Grare P, Bechara M, Baron J F
Service de chirurgie cardiovasculaire, hôpital Broussais, Paris.
Arch Mal Coeur Vaiss. 1994 Jan;87(1):49-56.
Cardiomyoplasty (CMP) is a technique of circulatory assistance using a pediculated latissimus dorsi muscle wrapped around the heart and electrically stimulated during systole. Sixty-four patients, aged 15 to 69 years (average 50.8 +/- 13 years) with cardiac failure underwent CMP between January 1985 and July 1993. The causes of cardiac failure were : ischaemic heart disease (39 cases), dilated cardiomyopathy (18 cases), cardiomyopathy following valvular heart disease (2 cases), cardiac tumours (4 cases) and congenital heart disease (1 case). Twenty-four patients underwent an associated surgical procedure. Intra and postoperative intra-aortic balloon pumping was required in 27 cases. Hospital mortality (before latissimus dorsi stimulation) was 20.3% (13/64 cases). Evaluation of the survivors 12 months after surgery showed an improvement in functional class (1.,5 versus 3.3 before CMP ; p < 0.05), in isotopic ejection fraction (27 +/- 3% versus 17 +/- 6%, p < 0.05) and cardiac index (2.87 +/- 0.63 l/min/m2 versus 2.38 +/- 0.41 l/min/m2, p < 0.05). There was no significant change in cardiac filling pressures. The number of hospital admissions for congestive cardiac failure in operated patients was 0.4 per patient per year, compared with 2.5 per patient per year (p < 0.05) before CMP. The preoperative predictive factors for late mortality were: permanent functional Class IV (NYHA), severe cardiac dilatation (cardio-thoracic ratio greater than 0.60; left ventricular end diastolic dimension > 75 mm), an isotopic left ventricular ejection fraction < 15%, severe biventricular cardiac failure and irreversible pulmonary hypertension. The actuarial 4 year survival rate was 68.3%.(ABSTRACT TRUNCATED AT 250 WORDS)
心肌成形术（CMP）是一种循环辅助技术，它利用带蒂的背阔肌包裹心脏，并在心脏收缩期进行电刺激。1985年1月至1993年7月期间，64例年龄在15至69岁（平均50.8±13岁）的心力衰竭患者接受了心肌成形术。心力衰竭的病因包括：缺血性心脏病（39例）、扩张型心肌病（18例）、瓣膜性心脏病后心肌病（2例）、心脏肿瘤（4例）和先天性心脏病（1例）。24例患者接受了相关的外科手术。27例患者术中及术后需要进行主动脉内球囊反搏。医院死亡率（在背阔肌刺激前）为20.3%（13/64例）。对术后12个月的幸存者进行评估显示，功能分级有所改善（术前为3.3级，术后为1.5级；p<0.05），同位素射血分数（27±3%对17±6%，p<0.05）和心脏指数（2.87±0.63升/分钟/平方米对2.38±0.41升/分钟/平方米，p<0.05）。心脏充盈压无显著变化。接受手术患者因充血性心力衰竭住院的次数为每年每人0.4次，而心肌成形术前为每年每人2.5次（p<0.05）。晚期死亡率的术前预测因素包括：永久性功能IV级（纽约心脏协会分级）、严重心脏扩大（心胸比率大于0.60；左心室舒张末期内径>75毫米）、同位素左心室射血分数<15%、严重双心室心力衰竭和不可逆性肺动脉高压。4年精算生存率为68.3%。（摘要截选至250字）
