MANAGEMENT OF ANESTHESIA DURING DYNAMIC CARDIOMYOPLASTY

Study Objective: To review experience with anesthetic management in te n patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical t echnique that serves as an alternative to heart transplantation. Desig n: Retrospective clinical study. Setting: Cardiothoracic operating roo m at a university hospital. Patients: Ten male functional New York Hea rt Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyopathy, 3 with postischemic cardiomyopathy. Interventions: Und er general anesthesia, the latissimus dorsi muscle was harvested and r otated into the chest through a window in the second rib. The muscle w as then wrapped around the heart. Starting from the second postoperati ve week, the latissimus dorsi was stimulated to provide assistance to a failing heart. Measurements and Main Results: The mean left ventricu lar ejection fraction (LVEF) of the 10 patients was 24.89% +/- 9.17% ( range 10% to 37%). No intraoperative death occurred. Two patients died of multiple organ failure and an apparent arrhythmia on the 15th and 25th postoperative days, respectively. The rest of the patients regain ed good working capacity postoperatively, as evidenced by improvement in NYHA grade. Nevertheless, the LVEF improved in only one patient. No significant differences were evident between preoperative and postope rative blood values, hemodynamic data, or spirometry. Conclusions: Dyn amic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not be nefit from the procedure in the first two postoperative weeks. To date , CMPL seems to be an important alternative to heart transplantation b ecause experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.