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Ann Thorac Surg 1993;56:31-37
© 1993 The Society of Thoracic Surgeons

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Articles

Double cardiomyoplasty: Acute versus chronic results

Division of Cardiothoracic Surgery, Wayne State University, School of Medicine, Detroit, Michigan USA

^_* Address reprint requests to Dr Stephenson, Division of Cardiothoracic Surgery, Harper Hospital, Suite 228, 3990 John R St, Detroit, MI 48201-2097.

We previously found that double cardiomyoplasty using both acutely raised, unconditioned latissimus dorsi muscles increased cardiac output by 9.6% (1,547 ± 154 versus 1,695 ± 166 mL/min), stroke volume by 18.2% (12.1 ± 0.6 versus 14.3 ± 0.7 ml), peak left ventricular pressure by 18.4% (98 ± 3 versus 116 ± 5 mm Hg), and peak right ventricular pressure by 62.5% (24 ± 2 versus 39 ± 4 mm Hg) (p < 0.05 for all differences). In this study 10 dogs underwent double cardiomyoplasty: 3 died perioperatively, and 7 underwent 8 weeks of muscle conditioning. After the conditioning period, the muscle flaps did not contrat in 2 of the 7 dogs. Hemodynamics were measured in the remaining 5 dogs. Using fatigueresistant muscle, cardiac output decreased by 3.7% (1,279 ± 262 versus 1,233 ± 274 mL/min), stroke volume decreased by 9.0% (9.5 ±1.2 versus 8.8 ±1.2 mL), and peak left ventricular pressure increased by 10.6% (82.1 ± 6.5 versus 90.8 ± 3.2 mm Hg), but not significantly. Peak right ventricular pressure increased significantly by 31.3% (24.3 ± 2.1 versus 31.9 ± 3.6 mm Hg; p < 0.05). Hemodynamic effects of individual left or right muscle contractions versus bilateral muscle stimulation were not significantly different except for a greater percentage increase in peak right ventricular pressure (right, 24.9 ± 2.1 mm Hg unstimulated versus 28.0 ± 2.1 stimulated; left, 26.3 ± 0.9 mm Hg unstimulated versus 30.7 ± 2.4 mm Hg stimulated; bilateral, 24.3 ± 2.1 mm Hg unstimulated versus 31.9 ± 3.4 mm Hg stimulated; p < 0.05). Double cardiomyoplasty using acutely raised, unconditioned muscle flaps provided hemodynamic augmentation, but double cardiomyoplasty using chronically conditioned muscle showed significant changes only in peak right ventricular pressure. These data indicate the importance of evaluating cardiomyoplasty in a chronic setting with conditioned muscle.

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