ELECTROSTIMULATED CARDIOMYOPLASTY - FROM EXPERIMENTAL TO CLINICAL-STUDIES

Cardiomyoplasty is a method for managing patients with dilated cardiom yopathy. We evaluated the means of carbon fiber electrode stimulation of the nerve to the latissimus dorsi muscle (LDM) in dogs to increase skeletal muscle contractility. Histochemical examination of biopsies o f muscle electrically conditioned by a single pulse stimulator via the thoracodorsal nerve demonstrated transformation of muscle into fatigu e resistant slow fibers without damage to muscle or nerve tissue. Cani ne experiments confirmed that carbon fibers are one of the best electr odes for chronic LDM simulation. Between 1988 and 1992, we operated on ten patients, New York Heart Association (NYHA) Class III (4 patients ) and Class IV (6 patients), with a mean left ventricular ejection fra ction (LVEF) of 23%. The indications for cardiomyoplasty were idiopath ic (7 patients) and ischemic (3 patients) cardiomyopathy refractory to maximum medical therapy. The operative procedure was performed via me dian sternotomy (5 patients) and left thoracotomy (5 patients). There was one operative mortality and two additional deaths during the late follow-up period. The mean postoperative LVEF increased to 27%. Functi onal class, qualify-of-life, and ventricular performance were improved after cardiomyoplasty. Two of the surviving patients are in NYHA Clas s I, four in Class II, and one in Class III.