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Alain Carpentier - One of the best experts on this subject based on the ideXlab platform.

  • A Clinical-pathological Study 2 Years Following Cardiomyoplasty: Intact Latissimus Dorsi Muscle and Metabolic Tranformation of
    2014
    Co-Authors: Fabrice Fontaliran, Juan Carlos Chachques, Frederik Van Der Veen, Alain Carpentier
    Abstract:

    A young patient died suddenly 2 years after Cardiomyoplasty.The anatomo-pathological study showed cardiomegaly and confirmed a classic dilated cardiomyopathy. The Latissimus dorsi muscle (LDM) covered both ventricles and hard adhesions between epicardium and epimisium were seen. The electrodes remained in the original position. Some interstitial fibrosis and fiber atrophy and degeneration, were observed around the electrodes. Histological and enzyme-histochemical studies showed that the muscle morphology of the LDM flap stimulated up to 2 years was well preserved. Morphological changes seen in some fibers were isolated on occasional events. Also in the present case, muscle fiber transformation into fatigue resistant, oxidative type 1 fibers was almost complete after the long-term electric stimulation. Key words: Cardiomyoplasty, Latissimus dorsi muscle, fibers transformation. Basic Appl Myol 7 (6): 369-373, 1997 Dynamic Cardiomyoplasty is a surgical method based upon the use of conditioned Latissimus Dorsi Muscle (LDM) for reinforcement of the cardiac ventricular wall. A program of chronic electrical stimulation of the muscle evokes an adaptive remodelling of the contractile apparatus of the muscle fibers and provides long-term cardiac assistance [7, 13, 19, 21]. In selected patients with chronic heart failure the method is considered a reliable alternative to heart transplantation [1, 16]. Post mortem studies on LDM utilised for Cardiomyoplasty have recently been performed on 3 patients who deceased suddenly 15 months, 2 and 8 years after Cardiomyoplasty [3, 5, 13, 23]. These studies generally indicated a sufficient preservation of histological characteristics of LDM and an enzyme-histochemical "plastic" reorganisation of fiber types after electric stimulation protocol. Additional LDM morphology findings of long-term dynamic Cardiomyoplasty patients at autopsy related to each patients clinical outcome has been recently reporte

  • Cardiac bioassist: results of the French multicenter Cardiomyoplasty study.
    Asian cardiovascular & thoracic annals, 2009
    Co-Authors: Juan C. Chachques, Olivier Jegaden, Thierry Mesana, Yves Glock, Pierre A. Grandjean, Alain Carpentier
    Abstract:

    The French multicenter experience (6 centers) of dynamic Cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88% of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic Cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic Cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation.

  • Cellular Cardiomyoplasty: clinical application.
    The Annals of thoracic surgery, 2004
    Co-Authors: Juan C. Chachques, Jean-noël Fabiani, Christophe Acar, Jesús Herreros, Jorge C. Trainini, Felipe Prosper, Nicola D'attellis, Alain Carpentier
    Abstract:

    Myocardial regeneration can be induced with the implantation of a variety of myogenic and angiogenic cell types. More than 150 patients have been treated with cellular Cardiomyoplasty worldwide, 18 patients have been treated by our group. Cellular Cardiomyoplasty seems to reduce the size and fibrosis of infarct scars, limit postischemic remodelling, and restore regional myocardial contractility. Techniques for skeletal myoblasts culture and ex vivo expansion using autologous patient serum (obtained from plasmapheresis) have been developed by our group. In this article we propose (1) a total autologous cell culture technique and procedures for cell delivery and (2) a clinical trial with appropriate endpoints structured to determine the efficacy of cellular Cardiomyoplasty.

  • From dynamic to cellular Cardiomyoplasty.
    Journal of cardiac surgery, 2002
    Co-Authors: Juan C. Chachques, Abdel Shafy, Fabricio Duarte, Barbara Cattadori, Nathalie Goussef, Lin Shen, Alain Carpentier
    Abstract:

    Dynamic Cardiomyoplasty. Latissimus dorsi dynamic Cardiomyoplasty has been used in our institution for heart failure patients refractory to medical therapy; 113 cases were operated at Broussais and Pompidou Hospitals and 75 patients by our team abroad, in the scope of an international cooperative program. Cardiomyoplasty has been associated with better results due to technical improvements, the most significant mini-invasive techniques, the latest the use of growth factors to enhance muscle vascularization. Risk factors have been identified, resulting in more precise indications, a lower hospital mortality, and a wider use of this operation. There has been a new tendency to associate Cardiomyoplasty with electrophysiological therapies: implantation of ventricular defibrillators and multisite cardiac pacing (for atrioventricular and interventricular resynchronization). Cellular Cardiomyoplasty. Adult myocardium cannot repair after infarction due to the absence of stem cells. Cell transplantation strategies for heart failure have been designed to replace damaged cells with cells that can perform cardiac work. Current possibilities in cell therapy for heart failure is the transplantation into the infarcted myocardium of autologous myoblasts (satellite cells originated from skeletal muscle), fetal cardiomyocytes, autologous heart cells, cells derived from bone marrow stem cells, and smooth muscle cells. Experimental studies demonstrated that cell transplantation into the myocardium was associated with the recovery of myocardial contractility and compliance, as well as the diastolic pressure-strain relationship in animal models (infarctlike myocardial lesions and dilated cardiomyopathy models). Healthy myoblasts and myotubes were observed 2 months after myocardial implantation. Clinical studies are now in progress.

  • dynamic Cardiomyoplasty clinical follow up at 12 years
    European Journal of Cardio-Thoracic Surgery, 1997
    Co-Authors: Juan C. Chachques, Jean-noël Fabiani, J P Marino, N Dattellis, P Lajos, Rachid Zegdi, P Fornes, Alain Carpentier
    Abstract:

    Objective: The purpose of this study is to evaluate the long-term outcome of dynamic Cardiomyoplasty. This surgical technique was conceived to assist the failing heart. The many proposed mechanisms of action of Cardiomyoplasty are: (1) systolic assist; (2) limitation of ventricular dilation; (3) reduction of ventricular wall stress (sparing effect); (4) ventricular remodeling with an active girdling effect; (5) angiogenesis; and (6) a neurohumoral effect. Methods: We investigated 95 patients in our hospital undergoing this procedure due to severe chronic heart failure, refractory to optimal medical treatment. Patients had a mean age of 51912 years. The etiology of heart failure was ischemic 55%, idiopathic 34%, ventricular tumor 6%, and other 5%. The mean follow-up was 44 months. Results: The mean New York Heart Association (NYHA) functional class improved postoperatively from 3.2 to 1.8. Average radioisotopic left ventricular (LV) ejection fraction increased from 179 5t o 279 4% (PB 0.05). Stroke volume index increased from 329 7t o 439 8m l:beat per m 2 (PB0.05). The heart size remained stable over the long term. Following Cardiomyoplasty, the number of hospitalizations due to congestive heart failure was reduced to 0.4 hospitalizations:patient per year (preoperative: 2.5, PB0.05). Computed tomography scans showed at long term a preserved latissimus dorsi muscle structure in 84% of patients. Survival probability at 7 years is 54%. Six patients underwent heart transplant after Cardiomyoplasty (mean delay: 25 months), due to the natural evolution of their underlying heart disease. There were no specific technical difficulties. Conclusions: Clinically, this procedure reverses heart failure, improves functional class and ameliorates quality of life. The latissimus dorsi muscle histological structure is maintained at long-term, when postoperative electrostimulation is performed, avoiding excessive stimulation. Cardiomyoplasty may delay or prevent the progression of heart failure and the indication of cardiac transplantation. © 1997 Elsevier Science B.V.

Juan C. Chachques - One of the best experts on this subject based on the ideXlab platform.

  • ORIGINAL ARTICLE Cardiac Bioassist: Results of the French Multicenter Cardiomyoplasty
    2016
    Co-Authors: Juan C. Chachques, Olivier Jegaden, Thierry Mesana, French Cardiomyoplasty
    Abstract:

    The French multicenter experience (6 centers) of dynamic Cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88 % of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic Cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic Cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation

  • Cardiac bioassist: results of the French multicenter Cardiomyoplasty study.
    Asian cardiovascular & thoracic annals, 2009
    Co-Authors: Juan C. Chachques, Olivier Jegaden, Thierry Mesana, Yves Glock, Pierre A. Grandjean, Alain Carpentier
    Abstract:

    The French multicenter experience (6 centers) of dynamic Cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88% of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic Cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic Cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation.

  • Cellular Cardiomyoplasty: clinical application.
    The Annals of thoracic surgery, 2004
    Co-Authors: Juan C. Chachques, Jean-noël Fabiani, Christophe Acar, Jesús Herreros, Jorge C. Trainini, Felipe Prosper, Nicola D'attellis, Alain Carpentier
    Abstract:

    Myocardial regeneration can be induced with the implantation of a variety of myogenic and angiogenic cell types. More than 150 patients have been treated with cellular Cardiomyoplasty worldwide, 18 patients have been treated by our group. Cellular Cardiomyoplasty seems to reduce the size and fibrosis of infarct scars, limit postischemic remodelling, and restore regional myocardial contractility. Techniques for skeletal myoblasts culture and ex vivo expansion using autologous patient serum (obtained from plasmapheresis) have been developed by our group. In this article we propose (1) a total autologous cell culture technique and procedures for cell delivery and (2) a clinical trial with appropriate endpoints structured to determine the efficacy of cellular Cardiomyoplasty.

  • From dynamic to cellular Cardiomyoplasty.
    Journal of cardiac surgery, 2002
    Co-Authors: Juan C. Chachques, Abdel Shafy, Fabricio Duarte, Barbara Cattadori, Nathalie Goussef, Lin Shen, Alain Carpentier
    Abstract:

    Dynamic Cardiomyoplasty. Latissimus dorsi dynamic Cardiomyoplasty has been used in our institution for heart failure patients refractory to medical therapy; 113 cases were operated at Broussais and Pompidou Hospitals and 75 patients by our team abroad, in the scope of an international cooperative program. Cardiomyoplasty has been associated with better results due to technical improvements, the most significant mini-invasive techniques, the latest the use of growth factors to enhance muscle vascularization. Risk factors have been identified, resulting in more precise indications, a lower hospital mortality, and a wider use of this operation. There has been a new tendency to associate Cardiomyoplasty with electrophysiological therapies: implantation of ventricular defibrillators and multisite cardiac pacing (for atrioventricular and interventricular resynchronization). Cellular Cardiomyoplasty. Adult myocardium cannot repair after infarction due to the absence of stem cells. Cell transplantation strategies for heart failure have been designed to replace damaged cells with cells that can perform cardiac work. Current possibilities in cell therapy for heart failure is the transplantation into the infarcted myocardium of autologous myoblasts (satellite cells originated from skeletal muscle), fetal cardiomyocytes, autologous heart cells, cells derived from bone marrow stem cells, and smooth muscle cells. Experimental studies demonstrated that cell transplantation into the myocardium was associated with the recovery of myocardial contractility and compliance, as well as the diastolic pressure-strain relationship in animal models (infarctlike myocardial lesions and dilated cardiomyopathy models). Healthy myoblasts and myotubes were observed 2 months after myocardial implantation. Clinical studies are now in progress.

  • dynamic Cardiomyoplasty clinical follow up at 12 years
    European Journal of Cardio-Thoracic Surgery, 1997
    Co-Authors: Juan C. Chachques, Jean-noël Fabiani, J P Marino, N Dattellis, P Lajos, Rachid Zegdi, P Fornes, Alain Carpentier
    Abstract:

    Objective: The purpose of this study is to evaluate the long-term outcome of dynamic Cardiomyoplasty. This surgical technique was conceived to assist the failing heart. The many proposed mechanisms of action of Cardiomyoplasty are: (1) systolic assist; (2) limitation of ventricular dilation; (3) reduction of ventricular wall stress (sparing effect); (4) ventricular remodeling with an active girdling effect; (5) angiogenesis; and (6) a neurohumoral effect. Methods: We investigated 95 patients in our hospital undergoing this procedure due to severe chronic heart failure, refractory to optimal medical treatment. Patients had a mean age of 51912 years. The etiology of heart failure was ischemic 55%, idiopathic 34%, ventricular tumor 6%, and other 5%. The mean follow-up was 44 months. Results: The mean New York Heart Association (NYHA) functional class improved postoperatively from 3.2 to 1.8. Average radioisotopic left ventricular (LV) ejection fraction increased from 179 5t o 279 4% (PB 0.05). Stroke volume index increased from 329 7t o 439 8m l:beat per m 2 (PB0.05). The heart size remained stable over the long term. Following Cardiomyoplasty, the number of hospitalizations due to congestive heart failure was reduced to 0.4 hospitalizations:patient per year (preoperative: 2.5, PB0.05). Computed tomography scans showed at long term a preserved latissimus dorsi muscle structure in 84% of patients. Survival probability at 7 years is 54%. Six patients underwent heart transplant after Cardiomyoplasty (mean delay: 25 months), due to the natural evolution of their underlying heart disease. There were no specific technical difficulties. Conclusions: Clinically, this procedure reverses heart failure, improves functional class and ameliorates quality of life. The latissimus dorsi muscle histological structure is maintained at long-term, when postoperative electrostimulation is performed, avoiding excessive stimulation. Cardiomyoplasty may delay or prevent the progression of heart failure and the indication of cardiac transplantation. © 1997 Elsevier Science B.V.

Luiz Felipe P. Moreira - One of the best experts on this subject based on the ideXlab platform.

  • Dynamic Cardiomyoplasty as a therapeutic alternative: current status.
    Heart failure reviews, 2001
    Co-Authors: Luiz Felipe P. Moreira, Noedir Antônio Groppo Stolf
    Abstract:

    Dynamic Cardiomyoplasty was proposed as an alternative surgical treatment for severe cardiomyopathies and has been performed worldwide in more than 1,000 patients. Patients indicated for this procedure are specifically those with dilated or ischemic cardiomyopathies. The ventricular function improvement observed after dynamic Cardiomyoplasty derived from the direct action of synchronized skeletal muscle flap contraction and from a girdling effect that helps to reverse chamber remodeling and to decrease ventricular wall stress. Although long-term benefits of this procedure may be limited by skeletal muscle flap ischemic compromise, technological advances incorporated in the new myostimulators will possibly decrease this complication incidence. Clinical improvement has been reported as a consistent finding in Cardiomyoplasty follow-up and the overall 5-year survival after this procedure ranges from 39 % to 54 %. On the other hand, the mortality after Cardiomyoplasty has been significantly higher for patients in persistent New York Heart Association functional class IV, showing that this procedure needs to be indicated earlier than the heart transplantation. In this regard, only the results of an ongoing randomized trial will potentially define Cardiomyoplasty influence on the survival of patients with severe heart failure. In the meantime, however, there are clearly several functional class III patients whose quality of life and exercise capacity have worsened despite the use of maximum medical therapy, justifying dynamic Cardiomyoplasty indication.

  • mid term results of heart transplantation Cardiomyoplasty and medical treatment of refractory heart failure caused by idiopathic dilated cardiomyopathy
    Journal of Heart and Lung Transplantation, 1996
    Co-Authors: E.a. Bocchi, Luiz Felipe P. Moreira, N. Stolf, Adib D Jatene, G Bellotti, Fernando Bacal, Alfredo Inacio Fiorelli, Alfredo Jose Mansur, F Pileggi
    Abstract:

    Background : Heart transplantation is the surgical procedure of choice for treatment of refractory heart failure. However, it benefits a small number of patients because of the limited number of donors and selection criteria of recipients. Cardiomyoplasty is an alternative surgical procedure for heart failure. The aim of this investigation was to report our experience with heart transplantation, Cardiomyoplasty, and clinical treatment of heart failure caused by idiopathic dilated cardiomyopathy. Methods : Ninety patients with refractory heart failure caused by idiopathic dilated cardiomyopathy were observed from May 1988 to March 1993. The patients had New York Heart Association functional class III or IV symptoms. The patients were divided in three groups according to the treatment received : heart transplantation (33 patients), Cardiomyoplasty (25 patients), or medical treatment (32 patients). We studied the event-free curve, the New York Heart Association functional class, the left ventricular ejection fraction, and the morbidity of the groups in the follow-up of 19 ± 16 months. We considered as an event death or crossover to another group because of severe symptoms. Results : The event-free rate in the Cardiomyoplasty group was 92%, 88%, 79%, 74%, and 62% at 3, 9, 12, 18, and 24 months of follow-up, respectively. The event-free rate after heart transplantation was 82%, 78%, 82%, 75%, and 69% at 3, 9, 12, 18, and 24 months, respectively. The event-free rate in the medical treatment group was 78%, 65%, 61%, 48%, and 48% at 3, 9, 12, 18, and 24 months, respectively. All surviving patients in the heart transplantation group had functional class I symptoms. After Cardiomyoplasty 90% of surviving patients had class I or II symptoms and 10% had class III symptoms. However, in the medical treatment group 27% of surviving patients had class I or II symptoms and 67% had class III or IV symptoms. In the Cardiomyoplasty group left ventricular ejection fraction increased from 20% ± 3% to 24.4% ± 6.3% at 6 months (p < 0.05). In the heart transplantation group the left ventricular ejection fraction normalized, and the mean value of the left ventricular ejection fraction did not change in the medical treatment group. The need for endomyocardial biopsy and the incidence of rejection and infection were characteristics of the heart transplantation group. Conclusions : In properly selected patients, Cardiomyoplasty and heart transplantation seem to be associated with improvement in survival and functional class at mid-term follow-up. Heart transplantation was more effective than Cardiomyoplasty for functional class improvement.

  • Current expectations in dynamic Cardiomyoplasty
    The Annals of thoracic surgery, 1993
    Co-Authors: Luiz Felipe P. Moreira, Noedir Antônio Groppo Stolf, Edimar Alcides Bocchi, Fulvio Pileggi, Adib D Jatene
    Abstract:

    Dynamic Cardiomyoplasty has been evaluated in the treatment of severe cardiomyopathies. This report outlines the results of this procedure in 21 patients with dilated or ischemic cardiomyopathy who were in New York Heart Association class III or IV before operation. There were no operative deaths. Patients were followed up for a mean of 17.6 months. Eight patients died during late follow-up, and actuarial survival rates were 73.2% at 1 year and 65.9% at 2 years of follow-up. Functional class improvement was documented in the surviving patients. Furthermore, significant improvement in left ventricular function was demonstrated by radioisotopic angiography and by heart catheterization for more than 2 years after the operation. These studies documented that left ventricular ejection fraction increased as a result of global improvement in regional wall motion. Absence of clinical and hemodynamic improvement after Cardiomyoplasty seems to be related to muscle flap ischemic compromise, whereas the patient's condition before operation seems to influence the long-term outcome of Cardiomyoplasty.

  • Effects of dynamic Cardiomyoplasty on regional wall motion, ejection fraction, and geometry of left ventricle.
    Circulation, 1992
    Co-Authors: E.a. Bocchi, Luiz Felipe P. Moreira, A. V. De Moraes, Bellotti G, M. N. Gama, N. Stolf, Adib D Jatene, Pileggi F
    Abstract:

    Background. Dynamic Cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of Cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle. Methods and Results. These parameters were determined in 10 patients submitted to Cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5±4.8 months after Cardiomyoplasty with the myostimulator turned on

  • Survival improvement with dynamic Cardiomyoplasty in patients with dilated cardiomyopathy.
    Circulation, 1991
    Co-Authors: Luiz Felipe P. Moreira, E.a. Bocchi, Noedir Antônio Groppo Stolf, Pedro Seferian, Paulo Manuel Pêgo-fernandes, A. C. Pereira-barretto, Adib D Jatene
    Abstract:

    Surgical support to the failing heart has been investigated in the treatment of severe myocardial failure. Dynamic Cardiomyoplasty was indicated in 32 patients with dilated or chagasic cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximum medical therapy. Fifteen patients were operated on, and 17 refused the surgical treatment and were maintained by clinical means. With an average follow-up period of 12.3 months, actuarial survival rates for Cardiomyoplasty patients were 86.6% at 6 months, 78.7% at 1 year, and 65.6% at 2 years of follow-up, whereas patients under medical therapy presented survival rates of 58.8%, 41.1%, and 27.4% at the same periods, respectively (p = 0.03). Furthermore, five of the 11 surviving patients of the Cardiomyoplasty group are in NYHA class I, five in class II, and one in class III. At 6 months of Cardiomyoplasty follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.1 +/- 3.9% to 26.8 +/- 7.5% (p less than 0.01). Cardiopulmonary exercise testing showed that maximum oxygen consumption during treadmill testing improved from 14.7 +/- 3.9 to 18.3 +/- 3.9 ml/kg/min (p = 0.01). At 1 year of follow-up, these data remained essentially unchanged. In conclusion, dynamic Cardiomyoplasty reverses congestive heart failure and improves the long-term survival of patients with severe cardiomyopathies.

Adib D Jatene - One of the best experts on this subject based on the ideXlab platform.

  • mid term results of heart transplantation Cardiomyoplasty and medical treatment of refractory heart failure caused by idiopathic dilated cardiomyopathy
    Journal of Heart and Lung Transplantation, 1996
    Co-Authors: E.a. Bocchi, Luiz Felipe P. Moreira, N. Stolf, Adib D Jatene, G Bellotti, Fernando Bacal, Alfredo Inacio Fiorelli, Alfredo Jose Mansur, F Pileggi
    Abstract:

    Background : Heart transplantation is the surgical procedure of choice for treatment of refractory heart failure. However, it benefits a small number of patients because of the limited number of donors and selection criteria of recipients. Cardiomyoplasty is an alternative surgical procedure for heart failure. The aim of this investigation was to report our experience with heart transplantation, Cardiomyoplasty, and clinical treatment of heart failure caused by idiopathic dilated cardiomyopathy. Methods : Ninety patients with refractory heart failure caused by idiopathic dilated cardiomyopathy were observed from May 1988 to March 1993. The patients had New York Heart Association functional class III or IV symptoms. The patients were divided in three groups according to the treatment received : heart transplantation (33 patients), Cardiomyoplasty (25 patients), or medical treatment (32 patients). We studied the event-free curve, the New York Heart Association functional class, the left ventricular ejection fraction, and the morbidity of the groups in the follow-up of 19 ± 16 months. We considered as an event death or crossover to another group because of severe symptoms. Results : The event-free rate in the Cardiomyoplasty group was 92%, 88%, 79%, 74%, and 62% at 3, 9, 12, 18, and 24 months of follow-up, respectively. The event-free rate after heart transplantation was 82%, 78%, 82%, 75%, and 69% at 3, 9, 12, 18, and 24 months, respectively. The event-free rate in the medical treatment group was 78%, 65%, 61%, 48%, and 48% at 3, 9, 12, 18, and 24 months, respectively. All surviving patients in the heart transplantation group had functional class I symptoms. After Cardiomyoplasty 90% of surviving patients had class I or II symptoms and 10% had class III symptoms. However, in the medical treatment group 27% of surviving patients had class I or II symptoms and 67% had class III or IV symptoms. In the Cardiomyoplasty group left ventricular ejection fraction increased from 20% ± 3% to 24.4% ± 6.3% at 6 months (p < 0.05). In the heart transplantation group the left ventricular ejection fraction normalized, and the mean value of the left ventricular ejection fraction did not change in the medical treatment group. The need for endomyocardial biopsy and the incidence of rejection and infection were characteristics of the heart transplantation group. Conclusions : In properly selected patients, Cardiomyoplasty and heart transplantation seem to be associated with improvement in survival and functional class at mid-term follow-up. Heart transplantation was more effective than Cardiomyoplasty for functional class improvement.

  • Current expectations in dynamic Cardiomyoplasty
    The Annals of thoracic surgery, 1993
    Co-Authors: Luiz Felipe P. Moreira, Noedir Antônio Groppo Stolf, Edimar Alcides Bocchi, Fulvio Pileggi, Adib D Jatene
    Abstract:

    Dynamic Cardiomyoplasty has been evaluated in the treatment of severe cardiomyopathies. This report outlines the results of this procedure in 21 patients with dilated or ischemic cardiomyopathy who were in New York Heart Association class III or IV before operation. There were no operative deaths. Patients were followed up for a mean of 17.6 months. Eight patients died during late follow-up, and actuarial survival rates were 73.2% at 1 year and 65.9% at 2 years of follow-up. Functional class improvement was documented in the surviving patients. Furthermore, significant improvement in left ventricular function was demonstrated by radioisotopic angiography and by heart catheterization for more than 2 years after the operation. These studies documented that left ventricular ejection fraction increased as a result of global improvement in regional wall motion. Absence of clinical and hemodynamic improvement after Cardiomyoplasty seems to be related to muscle flap ischemic compromise, whereas the patient's condition before operation seems to influence the long-term outcome of Cardiomyoplasty.

  • Effects of dynamic Cardiomyoplasty on regional wall motion, ejection fraction, and geometry of left ventricle.
    Circulation, 1992
    Co-Authors: E.a. Bocchi, Luiz Felipe P. Moreira, A. V. De Moraes, Bellotti G, M. N. Gama, N. Stolf, Adib D Jatene, Pileggi F
    Abstract:

    Background. Dynamic Cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of Cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle. Methods and Results. These parameters were determined in 10 patients submitted to Cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5±4.8 months after Cardiomyoplasty with the myostimulator turned on

  • Survival improvement with dynamic Cardiomyoplasty in patients with dilated cardiomyopathy.
    Circulation, 1991
    Co-Authors: Luiz Felipe P. Moreira, E.a. Bocchi, Noedir Antônio Groppo Stolf, Pedro Seferian, Paulo Manuel Pêgo-fernandes, A. C. Pereira-barretto, Adib D Jatene
    Abstract:

    Surgical support to the failing heart has been investigated in the treatment of severe myocardial failure. Dynamic Cardiomyoplasty was indicated in 32 patients with dilated or chagasic cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximum medical therapy. Fifteen patients were operated on, and 17 refused the surgical treatment and were maintained by clinical means. With an average follow-up period of 12.3 months, actuarial survival rates for Cardiomyoplasty patients were 86.6% at 6 months, 78.7% at 1 year, and 65.6% at 2 years of follow-up, whereas patients under medical therapy presented survival rates of 58.8%, 41.1%, and 27.4% at the same periods, respectively (p = 0.03). Furthermore, five of the 11 surviving patients of the Cardiomyoplasty group are in NYHA class I, five in class II, and one in class III. At 6 months of Cardiomyoplasty follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.1 +/- 3.9% to 26.8 +/- 7.5% (p less than 0.01). Cardiopulmonary exercise testing showed that maximum oxygen consumption during treadmill testing improved from 14.7 +/- 3.9 to 18.3 +/- 3.9 ml/kg/min (p = 0.01). At 1 year of follow-up, these data remained essentially unchanged. In conclusion, dynamic Cardiomyoplasty reverses congestive heart failure and improves the long-term survival of patients with severe cardiomyopathies.

Michael A Acker - One of the best experts on this subject based on the ideXlab platform.

  • Dynamic Cardiomyoplasty: at the crossroads
    The Annals of thoracic surgery, 1999
    Co-Authors: Michael A Acker
    Abstract:

    Abstract Background . Dynamic Cardiomyoplasty remains a promising, but still unproven surgical treatment for patients with end-stage heart failure. Lack of a clear survival advantage and ongoing misunderstanding of its mechanism of action have hindered its acceptance as a treatment alternative for patients with end-stage heart failure. This review seeks to update current clinical results and practice of dynamic Cardiomyoplasty and to present its likely mechanism of action. Methods . The method involved a literature review. Results . More than 600 patients have undergone dynamic cardioplasty since 1985. Improvement in average New York Heart Association class was noted in 80% to 85% of hospital survivors. Operative mortality has decreased from 31% in Phase I to less than 3% in the ongoing Phase III trial. Clinical work as well as recent animal work supports the hypothesis that through a combination of long-term elastic constraint and active dynamic assist, dynamic Cardiomyoplasty decreases myocardial wall stress associated with the remodeling process of progressive heart failure. Conclusions . Though dynamic Cardiomyoplasty can be shown to limit the remodeling process of heart failure in animal studies and some patients, its ultimate role in the treatment of heart failure will depend on the outcome of randomized, controlled studies.

  • stabilization of chronic remodeling by asynchronous Cardiomyoplasty in dilated cardiomyopathy effects of a conditioned muscle wrap
    Circulation, 1997
    Co-Authors: Himanshu J Patel, David J Polidori, James J Pilla, Theodore Plappert, David A Kass, Martin St John Sutton, Edward B Lankford, Michael A Acker
    Abstract:

    Background Dynamic Cardiomyoplasty is a promising new therapy for dilated cardiomyopathy. The girdling effects of a conditioned muscle wrap alone have recently been postulated to partly explain its mechanism. We investigated this effect in a canine model of chronic dilated cardiomyopathy. Methods and Results Twenty dogs underwent rapid ventricular pacing (RVP) for 4 weeks to create a model of dilated cardiomyopathy. Seven dogs were then randomly selected to undergo subsequent Cardiomyoplasty, and all dogs had 6 weeks of additional RVP. The Cardiomyoplasty group also received 6 weeks of concurrent skeletal muscle stimulation consisting of single twitches delivered asynchronously at 2 Hz to transform the wrap without active assistance. All dogs were studied by pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of pacing. Systolic indices, including ejection fraction (EF), end-systolic elastance (Ees), and preload-recruitable stroke work (PRSW) were all increased at 10 weeks in the wrap versus controls (EF, 34.0 versus 27.1, P =.008; Ees, 1.65 versus 1.26, P =.09; PRSW, 35.9 versus 25.5, P =.001). Ventricular volumes, diastolic relaxation, and left ventricular end-diastolic pressures stabilized in the Cardiomyoplasty group but continued to deteriorate in controls. Both the end-systolic and end-diastolic pressure-volume relationships shifted farther rightward in controls but remained stable in the Cardiomyoplasty group. Conclusions In addition to potential benefits from active systolic assistance, benefits from dynamic Cardiomyoplasty appear to be partially accounted for by the presence of a conditioned muscle wrap alone. This conditioned wrap stabilizes the remodeling process of heart failure, arresting progressive deterioration of systolic and diastolic function.

  • dynamic Cardiomyoplasty its chronic and acute effects on the failing heart
    The Journal of Thoracic and Cardiovascular Surgery, 1997
    Co-Authors: Himanshu J Patel, David J Polidori, James J Pilla, Theodore Plappert, Martin St John Sutton, Edward B Lankford, Michael A Acker
    Abstract:

    Abstract Objectives: Dynamic Cardiomyoplasty is an alternative therapy for end-stage heart failure. We investigated the mechanisms, both acute and chronic, by which a synchronously stimulated conditioned muscle wrap affects left ventricular function in a chronic canine model of dilated cardiomyopathy. Methods: Nineteen dogs underwent rapid ventricular pacing at a rate of 215 beats/min for 4 weeks to create a model of heart failure. Eight dogs were then randomly selected to undergo Cardiomyoplasty, and all dogs received 6 additional weeks of rapid ventricular pacing. The Cardiomyoplasty group also received a graded muscle conditioning protocol of synchronized burst stimulation to transform the muscle wrap. All dogs were studied with pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of rapid ventricular pacing. Data in the Cardiomyoplasty group were analyzed with the stimulator off, with it augmenting every beat (1:1), and with it augmenting only every other beat (1:2). Results: Stimulator "off" data at 10 weeks of rapid pacing demonstrated chronic effects by enhanced ventricular function (end-systolic elastance=l.80 after myoplasty vs 1.17 for controls, p = 0.005) and a stabilization of volumes and composite end-systolic and end-diastolic pressure-volume relations in the Cardiomyoplasty group when compared with controls. Myoplasty stimulation increased apparent contractility (preload recruitable stroke work=31.3 for stimulator "off" vs 40.6 for stimulator 1:2 assisted beats [ p p Conclusions: Benefits from dynamic Cardiomyoplasty are by at least two mechanisms: (1) the girdling effects of a conditioned muscle wrap, which halts the chronic remodeling of heart failure, and (2) active systolic assistance, which augments the apparent contractility of the failing heart. (J Thorac Cardiovasc Surg 1997;114:169-78)

  • New method for mechanistic studies of Cardiomyoplasty: Three-dimensional MRI reconstructions
    The Annals of thoracic surgery, 1994
    Co-Authors: Peter W. Cho, Howard R. Levin, Christopher C. Moore, Joshua E. Tsitlik, Elliot R. Mcveigh, Timothy J. Gardner, Michael A Acker
    Abstract:

    Abstract The imaging modalities used to study the mechanism of Cardiomyoplasty, such as echocardiography and radionuclide scintigraphy, are seriously limited by their two-dimensional format. Radiofrequency-pulse-tagged magnetic resonance imaging was used to generate three-dimensional reconstructions of the left ventricle throughout the cardiac cycle after Cardiomyoplasty. In 2 dogs that had undergone conditioned, right anterior Cardiomyoplasty, wrap stimulation with alternating heartbeats was found to produce marked translation of the left ventricle in the short-axis plane, rotation around the long axis, and displacement along the long axis with net long-axis compression; there was no augmentation of radial squeeze. The findings from this study suggest that any Systolic augmentation produced by the right anterior wrap is due primarily to long-axis compression. Our study demonstrates a new, more accurate technique of assessing the mechanical effects of Cardiomyoplasty in three dimensions, thus permitting a more rational optimization of wrap configurations, and emphasizes the perils of using standard two-dimensional imaging modalities in this setting of exaggerated three-dimensional motion.

  • New techniques for the study of Cardiomyoplasty
    Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1992
    Co-Authors: Henry R. Halperin, Michael A Acker, Howard R. Levin, Elliot Mc Veigh, Peter W. Cho, William Curtis, Christopher C. Moore, Joshua E. Tsitlik
    Abstract:

    Despite a paucity of objective hemodynamic evidence, Cardiomyoplasty has been shown to subjectively improve functional status and symptoms. In addition, the factors associated with successful Cardiomyoplasty have not been defined. We have been using magnetic resonance techniques to quantify stroke volume and the three-dimensional motion of the heart during Cardiomyoplasty. We have also been studying the regional mechanics and blood flow of partially isolated latissimus dorsi to determine whether the force generation and shortening of the proximal portion of the latissimus dorsi (that have typically been measured) are representative of the distal portion that is in contact with the heart.