Search

To the Editor: Stem cell therapy has shown potential benefit in heart failure caused by ischemic heart disease ([1][1]). There is no data on the role of stem cell therapy in nonischemic dilated cardiomyopathy. We undertook a pilot study of intracoronary stem cell implantation in patients with

AN INNOVATIVE PROCEDURE is muscling its way into the cardiac surgeon's repertoire. Known as cardiomyoplasty , it involves fashioning the patient's own back muscle into a wrap that embraces the heart. Surgeons here and abroad are reporting encouraging early results, holding out hope for the thousands of persons with end-stage heart failure who cannot withstand the rigors of bypass surgery or a transplant. Meanwhile, a more complex procedure—using skeletal muscle pouches to augment, ventricular function—appears to be back on track after initial promise turned to disappointment ( JAMA 1986; 255:1977-1979, 1987;257:2001). Investigators predict this approach eventually will prove successful, but are still working out the ideal configuration. European Origins Cardiomyoplasty was introduced in Europe in the mid-1980s. Surgeons remove a rib, free one of the latissimus dorsi muscles from connective tendons, snake it through the rib cage, and wrap it over the heart, preserving the thoracodorsal nerve and major blood vessel. A

Initial experimental and clinical studies have shown that cardiomyoplasty using the right latissimus dorsi can improve left ventricular (LV) function early after operation. This study presents the long-term results of clinical application of this procedure. Between March 1991 and November 1992, 16 patients (12 men, 4 women; mean age 57; range 33-77 years) underwent operation. Survivors have now been followed for 18 months with serial right heart catheterization and radionuclide angiography at 6 month intervals. The operative mortality was 6% (1/16), but 3 additional patients experienced sudden death within 6 months of operation. Survival was 62.5% (10/16) at 12 months and 56.3% (9/16) at 18 months. The LV stroke work index (LVSWI) was improved at each postoperative interval, but the differences were not statistically significant. Left ventricular ejection fraction (LVEF) significantly increased from 26.1 ± 5.3 to 33.4 ± 10.3 ( p l 0.05), 6 weeks after operation and was not different from baseline thereafter. The LV end-diastolic volume decreased significantly at 6 months from 306.1 ± 71 to 249.4 ± 69 mL ( p l 0.01), and remained lower than the preoperative value in subsequent follow-up. Comparison of preoperative LVEF in 24 month survivors (51 and non-survivors (8) revealed that survivors had an LVEF of 30.2 ± 4.38 and nonsurvivors were 22.7 ± 2.58 ( p l 0.05). Preoperative LVSWI was also significantly greater in survivors 36.4 ± 6.91 gm-cm/m 2 vs 20.1 ± 8.26 gm-cm/m 2 , ( p l 0.05). Overall survival was limited by the occurrence of sudden death, but survivors had improved functional capacity and stabilization of cardiac size and function. We conclude that careful selection of patients with better preserved, preoperative LV function may yield improved long-term survival in right latissimus cardiomyoplasty.