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The Annals of Thoracic Surgery, Vol 55, 493-501, Copyright © 1993 by The Society of Thoracic Surgeons
RW Millner, M Burrows, I Pearson and JR Pepper
Dynamic cardiomyoplasty continues to attract interest as a therapeutic
option in the management of heart failure. In a large animal model of
ischemic heart failure, we have compared dynamic cardiomyoplasty with both
adynamic cardiomyoplasty and a control group. Heart failure was induced by
coronary artery ligation in sheep, and under the same anesthetic dynamic
cardiomyoplasty (n = 5), adynamic cardiomyoplasty (n = 4), or no further
procedure was performed (n = 5). After recovery the animals were housed for
a further 3 months. The dynamic cardiomyoplasty underwent a recognized
muscle transformation protocol during this period. At terminal studies, the
animals were hemodynamically assessed, both under baseline conditions and
after colloid volume loading. The data at baseline were compared with
unpaired t tests, and the function curves created by volume loading were
compared by analysis of variance. Although the changes at baseline were
small, there were highly significant improvements in the function curves in
the dynamic cardiomyoplasty group when the stimulators were turned on
compared with stimulators off (p = 0.005) for cardiac output; p = 0.035 for
left ventricular end-diastolic pressure; p = 0.002 for pulmonary artery
capillary wedge pressure; p = 0.004 for stroke volume; and p = 0.003 for
cardiac power). There were also significant improvements in indices of
cardiac performance when the dynamic cardiomyoplasty group was compared
with both the control and adynamic cardiomyoplasty groups. We conclude that
there is experimental evidence that cardiomyoplasty augments cardiac
function in a model of chronic left ventricular failure.
ARTICLES
Dynamic cardiomyoplasty in chronic left ventricular failure: an experimental model
Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom.
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