Cardiomyoplasty and aortomyoplasty

Cardiomyoplasty and aortomyoplasty are increasingly being performed in the management of endstage cardiac failure and may represent an alternative to cardiac transplantation in the absence of available donor organs or if the patients are unsuitable for transplantation.

Both procedures involve the mobilization of the left latissimus dorsi muscle with a pedicle still attached. The muscle is then routed through the left chest wall after one or two ribs are partially resected. In cardiomyoplasty the muscle is wrapped around the ventricle, whereas in aortomyoplasty it is wrapped around the aorta. In the latter case, stimulation eventually results in a counterpulsation phenomenon, analogous to that of an intra-aortic balloon pump, which both decreases left ventricular afterload and improves coronary perfusion. In each case, the muscle is not stimulated for several days and is unlikely to offer any support for several weeks.

Such patients have, by definition, limited cardiac reserve and may have some coexisting respiratory disease. The procedure offers no immediate hemodynamic benefit and, in fact, may be detrimental initially.

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