Management of anesthesia during dynamic cardiomyoplasty

Elisa Domenegati, Marco Maurelli, Maria G. Chiaudani, Andrea Pagnin, Mauro Rinaldi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Study Objective: To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation. Design: Retrospective clinical study. Setting: Cardiothoracic operating room at a university hospital. Patients: Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyapathy, 3 with postischemic cardiomyopathy. Interventions: Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart. Measurements and Main Results: The mean left ventricular 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 regained 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 postoperative blood values, hemodynamic data, or spirometry. Conclusions: Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.

Original languageEnglish
Pages (from-to)177-181
Number of pages5
JournalJournal of Clinical Anesthesia
Volume7
Issue number3
DOIs
Publication statusPublished - 1995

Fingerprint

Cardiomyoplasty
Anesthesia
Heart Transplantation
Superficial Back Muscles
Stroke Volume
Muscles
Multiple Organ Failure
Spirometry
Intraoperative Complications
Ribs
Operating Rooms
Cardiomyopathies
General Anesthesia
Anesthetics
Cardiac Arrhythmias
Thorax
Retrospective Studies
Hemodynamics
Quality of Life

Keywords

  • Anesthesia, cardiovascular
  • cardiomyoplasty, dynamic

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Management of anesthesia during dynamic cardiomyoplasty. / Domenegati, Elisa; Maurelli, Marco; Chiaudani, Maria G.; Pagnin, Andrea; Rinaldi, Mauro.

In: Journal of Clinical Anesthesia, Vol. 7, No. 3, 1995, p. 177-181.

Research output: Contribution to journalArticle

Domenegati, Elisa ; Maurelli, Marco ; Chiaudani, Maria G. ; Pagnin, Andrea ; Rinaldi, Mauro. / Management of anesthesia during dynamic cardiomyoplasty. In: Journal of Clinical Anesthesia. 1995 ; Vol. 7, No. 3. pp. 177-181.
@article{a30d6ef7368c4f699197893212383614,
title = "Management of anesthesia during dynamic cardiomyoplasty",
abstract = "Study Objective: To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation. Design: Retrospective clinical study. Setting: Cardiothoracic operating room at a university hospital. Patients: Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyapathy, 3 with postischemic cardiomyopathy. Interventions: Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart. Measurements and Main Results: The mean left ventricular 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 regained 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 postoperative blood values, hemodynamic data, or spirometry. Conclusions: Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.",
keywords = "Anesthesia, cardiovascular, cardiomyoplasty, dynamic",
author = "Elisa Domenegati and Marco Maurelli and Chiaudani, {Maria G.} and Andrea Pagnin and Mauro Rinaldi",
year = "1995",
doi = "10.1016/0952-8180(94)00039-7",
language = "English",
volume = "7",
pages = "177--181",
journal = "Journal of Clinical Anesthesia",
issn = "0952-8180",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Management of anesthesia during dynamic cardiomyoplasty

AU - Domenegati, Elisa

AU - Maurelli, Marco

AU - Chiaudani, Maria G.

AU - Pagnin, Andrea

AU - Rinaldi, Mauro

PY - 1995

Y1 - 1995

N2 - Study Objective: To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation. Design: Retrospective clinical study. Setting: Cardiothoracic operating room at a university hospital. Patients: Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyapathy, 3 with postischemic cardiomyopathy. Interventions: Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart. Measurements and Main Results: The mean left ventricular 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 regained 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 postoperative blood values, hemodynamic data, or spirometry. Conclusions: Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.

AB - Study Objective: To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation. Design: Retrospective clinical study. Setting: Cardiothoracic operating room at a university hospital. Patients: Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyapathy, 3 with postischemic cardiomyopathy. Interventions: Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart. Measurements and Main Results: The mean left ventricular 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 regained 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 postoperative blood values, hemodynamic data, or spirometry. Conclusions: Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.

KW - Anesthesia, cardiovascular

KW - cardiomyoplasty, dynamic

UR - http://www.scopus.com/inward/record.url?scp=0029050852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029050852&partnerID=8YFLogxK

U2 - 10.1016/0952-8180(94)00039-7

DO - 10.1016/0952-8180(94)00039-7

M3 - Article

C2 - 7669304

AN - SCOPUS:0029050852

VL - 7

SP - 177

EP - 181

JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

SN - 0952-8180

IS - 3

ER -