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Ann Thorac Surg 1992;53:875-880
© 1992 The Society of Thoracic Surgeons

Articles

Cardiomyoplasty does not preclude heart transplantation

Olivier Jegaden, MD*, François Delahaye, MD, MPH, Pietro Montagna, MD, Catherine Vedrinne, MD, Pascale Blanc, MD, Roland Rossi, MD, Alain Tabib, MD, Alain Saint Pierre, MD, Jean-Pierre Delahaye, MD, Philippe H. Mikaeloff, MD

Hôpital Cardiovasculaire et Pneumologique, Lyon, France

Accepted for publication October 30, 1991.

* Address reprint requests to Dr Jegaden, Service de Chirurgie Cardiaque, Hôpital Cardiovasculaire Louis Pradel, BP Lyon Monchat, 09394 Lyon Cedex 03, France.

Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. Heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of Cardiomyoplasty. Cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of Cardiomyoplasty in humans.




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