Anästhesiologisches Management bei Kardiomyoplastie

Dynamic cardiomyoplasty is a therapeutic possibility in irreversible cardiac insufficiency. With this operation, the latissimus dorsi muscle is mobilised and drawn into the thorax where it is placed around the heart. Lateral and supine positioning as well as thoracotomy and direct manipulation of the heart are associated with particular risks during surgery. Eight patients with the diagnosis of cardiomyopathy underwent cardiomyoplasty. The patients were classified as NYHA III-IV. Continuous dobutamine infusions were routinely started after induction of anaesthesia. All patients were intubated with single-lumen tubes. After sternotomy, lidocaine was administered. Monitoring included Swan-Ganz catheterisation and invasive blood pressure measurement. With early use of inotropic and vasodilatator agents the cardiac index and peripheral vascular resistance were adequately maintained. Double-lumen intubation seems to be unnecessary during cardiomyoplasty and only increases patient risk. Prophylactic lidocaine infusions are effective in preventing ventricular tachycardia and fibrillation. We conclude that adequate intraoperative management can improve the haemodynamic status of these patients so that cardiomyoplasty may be performed without significant morbidity.