Effects of dynamic cardiomyoplasty on left ventricular performance and myocardial mechanics in dilated cardiomyopathy

Lee, K. Francis; Dignan, Rebecca; Parmar, Jitendra; Dyke, Cornelius; Benton, Gary; Yeh, Thomas; Abd‐Elfattah, Anwar S.; Wechsler, Andrew S.

doi:10.1016/s0022-5223(19)36591-2

Cited by 85 publications

(3 citation statements)

References 15 publications

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“…Lee et al . (24) and Bellotti et al . (25) have shown independently that cardiomyoplasty results in decreased left ventricular wall stress, which in turn results in lower oxygen demand.…”

Section: Cardiomyoplastysupporting

confidence: 64%

Skeletal Muscle as a Myocardial Substitute

Astra

Stephenson

2000

Proc Soc Exp Biol Med

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Abstract. Skeletal muscle has long been used in the field of cardiac surgery. Its use has progressed from providing myocardial reinforcement to assisting the heart by actively pumping blood. Early experiments revealed that skeletal muscle assistance could augment pressures and blood flow; however, the results were short‐lived due to muscle fatigue. It was later shown that skeletal muscle can be conditioned electrically to be fatigue resistant and therefore may be useful for performing cardiac‐type work. Once the details were formed of how to stimulate and manipulate the muscle to assist the heart, several configurations were devised. Cardiomyoplasty and aortomyoplasty refer to wrapping skeletal muscle around the heart or aorta, respectively. These techniques have been applied in humans; however, the effectiveness is controversial. Although most patients improve clinically, the hemodynamic parameters have not shown consistent improvements, and survival data are unknown. Skeletal muscle ventricles offer a promising alternative to both cardiomyoplasty and aortomyoplasty. These are completely separate pumping chambers constructed from skeletal muscle and connected to the circulation in a variety of configurations. Although these have not been tried in humans, the animal data appear quite convincing. The skeletal muscle ventricles have shown the greatest improvements on hemodynamic parameters with great stability over time.

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“…Lee et al . (24) and Bellotti et al . (25) have shown independently that cardiomyoplasty results in decreased left ventricular wall stress, which in turn results in lower oxygen demand.…”

Section: Cardiomyoplastysupporting

confidence: 64%

Skeletal Muscle as a Myocardial Substitute

Astra

Stephenson

2000

Proc Soc Exp Biol Med

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“…In an acute experiment on a chronically dilated heart, after-load matching increased the cardiac output by 21 Ofo. 5 In clinical cardiomyoplasty, determination of myocardial wall stress during myoplastic assistance has not been performed. This will be an important area for future investigation.…”

Section: Normalization Of Afterload Mismatchmentioning

confidence: 99%

Theoretical Considerations in the Use of Dynamic Cardiomyoplasty to Treat Dilated Cardiomyopathy

1991

Journal of Cardiac Surgery

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Clinical data describing the hemodynamic benefits of cardiomyoplasty are inconclusive, and there has not been any study detailing the mechanisms by which dynamic cardiomyoplasty may improve the functional and mechanical Impairments of the falling heart. The left ventricle in dilated cardiomyopathy is characterized by increased end‐diastolic volume, inadequate systolic myocardial wall thickening, increased wall stress, and decreased stroke volume. Based on experimental and preliminary clinical data, we propose that cardiac assistance by dynamic cardiomyoplasty is the consequence of enhanced volume translocation rather than increased potential for pressure generation. A small augmentation of dimensional shortening results in a large increment of stroke volume because of the enlarged resting chamber volume. Key geometric effects are enhanced systolic chamber shortening and increased wall thickening, resulting in a net decrease of myocardial wall stress. The contractile skeletal muscle may improve myocardial mechanics, and normalization of the afterload mismatch may be an important mechanism by which dynamic cardiomyoplasty augments cardiac output.

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“…Up to the present, most experiments of circulatory assistance have been performed in acute or chronic animal models of heart failure with preserved normal sinus rhythm; however, sinus rhythm is not always observed in clinical practice (4, 8,11,12).…”

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confidence: 99%

Hemodynamic Effects of Cardiomyoplasty in an Experimental Model of Acute Heart Failure and Atrial Fibrillation

et al. 1996

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The aim of our work was to study the hemodynamic effects of dynamic cardiomyoplasty on an acute animal model of atrial fibrillated heart failure. Eight anesthetized open chest dogs suffering from atrial fibrillation and heart failure, obtained by topic acetylcholine and propranolol, were treated by a cardiomyoplasty procedure performed with an electrostimulated latissimus dorsi muscle flap (LDMF). Values considered for analysis during LDMF stimulation were selected from cardiac cycles with R‐R intervals similar to those when the LDMF was not stimulated (±20 ms). Atrial fibrillated heart failure showed a significant increase of systemic vascular resistance, end diastolic left ventricular pressure (EDLVP) and right atrial pressure (p < 0.05), and a significant decrease in cardiac output, systolic left ventricular pressure (SLVP), and mean aortic pressure (p < 0.05) compared with control values. LDMF stimulation in atrial fibrillated heart failure resulted in a significant increase of SLVP, cardiac output, and mean aortic pressure (p < 0.05) and a significant decrease of systemic vascular resistance, EDLVP, and right atrial pressure (p < 0.05) compared with nonstimulated values. The highest LVP values were obtained with R‐R intervals long enough to allow an adequate LV filling. We conclude that dynamic cardiomyoplasty provides an appropriate recovery in this animal model of atrial fibrillated heart failure. Cardiomyoplasty is an appropriate procedure for cardiac assist when R‐R intervals allow an adequate LV filling.

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Effects of dynamic cardiomyoplasty on left ventricular performance and myocardial mechanics in dilated cardiomyopathy

Cited by 85 publications

References 15 publications

Skeletal Muscle as a Myocardial Substitute

Skeletal Muscle as a Myocardial Substitute

Theoretical Considerations in the Use of Dynamic Cardiomyoplasty to Treat Dilated Cardiomyopathy

Hemodynamic Effects of Cardiomyoplasty in an Experimental Model of Acute Heart Failure and Atrial Fibrillation

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