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The Journal of Cardiovascular Surgery 1999 April;40(2):217-22

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Unpreconditioned free revascularized dynamic cardiomyoplasty Is it feasible?

Chen Y. S., Yu H. Y., Ko W. J., Chu S. H.

From the Department of Surgery National Taiwan University Hospital Taipei, Taiwan * Department of Surgery Chi-Mei Foundation Hospital, Tainan, Taiwan


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Back­ground. Car­di­om­yo­plasty is a new ven­tric­ular bio-­assist ­device for myo­car­dial ­failure. But there are ­some lim­i­ta­tions in stan­dard car­di­om­yo­plasty, ­such as the orien­ta­tion of the ­muscle and ­fiber and the effi­ciency of the con­trac­tile seg­ment of the ­flap. ­Free revas­cu­lar­ized lat­is­simus ­dorsi ­flap may be a ­good ­idea for ­solving ­these prob­lems.
­Methods. We ­designed a ­canine ­free lat­is­simus ­dorsi ­flap by revas­cu­lar­izing the ­flap ­with the ­left ­internal tho­racic ves­sels by ­micro-sur­gical tech­nique. ­Group I (n=3) as con­trol was per­formed by stan­dard car­di­om­yo­plasty, and the ­Group II (n=10) was per­formed by the revas­cu­lar­ized ­method. The ­heart was ­then ­wrapped by the revac­ular­ized ­flap. ­Group II was ­divided ­into IIa (n=6, no pre-treat­ment ­before revas­cu­lar­iza­tion) and IIb (n=4, ­normal ­saline pre-treat­ment ­before revas­cu­lar­iza­tion) by the dif­ferent pres­er­va­tion ­methods. Hemo­dy­namic ­data ­were ­recorded.
­Results. ­Group I all sur­vived the 8-­week ­training ­period. But ­Group II, ­Group IIa and IIb, all ­died in 3 ­days, but sur­vived ­more ­than 12 ­hours. The hemo­dy­namic anal­ysis in ­Group I did not ­show any sig­nif­i­cant ­change ­except ­left ven­tric­ular end dia­stolic pres­sure. It ­showed ele­vated ­left ven­tric­ular pres­sure ­when the car­di­os­tim­u­lator was ON.
Con­clu­sions. ­According to the ­result of ­this experi­ment, it ­seemed impos­sible to get a sat­is­fac­tory ­result of ­more ­than 3 ­days for ­free revas­cu­lar­ized car­di­om­yo­plasty at ­present. ­There ­were a lot of prob­lems ­waiting to be ­solved, ­such as pres­er­va­tion ­method ­during ­ischemia, ­bulky ­mass of the ­flap, and the poten­tial ­problem of neu­ro­mus­cular ­atrophy.

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