Biological Assitance with Skeletal Muscle in Heart Failure

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Abstract

Background To evaluate the early and late results in patiens submitted to cardiomyoplasty and aortomyoplasty with latissimus dorsi muscle. The were suffering advanced heart failure due to dilated cardiomyopathy. Material and method Seventeen patients were submitted to 14 cardiomyoplasties and 3 aortomyoplasties. Mean age: 57. Functional class: III-IV of New York Heart Association. Etiologies included: idiopathic 8, ischemic-necrotic 6 and Chagas disease 3. Preoperative and six months postoperative evaluation was obtained considering: functional class, 6-minutes walking test, echocardiography and isotopic ventriculogram. Results Of the 14 patients in the cardiomyoplasty group, one died early in the postoperative period and other, two month later. Survivors diminished there average functional class from 3.1 preoperative to 1.8 at six months. In the same time, 6-minutes walking test increased from 365 meters to 421 meters; left ventricle ejection fraction increased from 22.6 to 29.3%; shortening fraction changed from 14.9 to 21%. Readmission to the hospital due to heart failure dimished from 2 ± 0.7 to 0.4 ± 0.5yearly. Of the three aortomyoplasty cases, one died after surgery during muscle conditioning. The other two are alive in functional class I. One of them, with eight month follow-up, improved ventricular function significantly. Conclusions Skeletal muscle cardiac biological assistance can be accomplished with low perioperative morbimortality. Cardiomyoplasty does significantly improve functional capacity and left ventricle systolic function in patients with advanced heart failure. Aortomyoplasty is therapeutic alternative when the transplantation or cardiomyoplasty are contraindicated.