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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John M. Alvarez Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alvarez, J. M. Search for Related Content PubMed Articles by Alvarez, J. M. Related Collections Cardiac - other Coronary disease

Ann Thorac Surg 2002;73:346-347
© 2002 The Society of Thoracic Surgeons

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Correspondence

Dynamic cardiomyoplasty: "the truth that dare not speak its name"

^a Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, W. Australia 6009, Australia

To the Editor

I believe Barron and colleagues [1] are to be congratulated on an excellent study relating to how a latissimus dorsi (LD) muscle should be managed best if it is to produce optimal performance as a transformed, fatigue resistant, skeletal muscle used as a viable biological assist device. Both senior authors, Pepper and Salmons [1] previously added substantially to the advancement of knowledge in this field. Importantly, by a novel preconditioning program that is radically different to what human cardiomyoplasty (CMP) patients had to their respective LD, not only did the all important distal half of the LD have better preservation of its cellular integrity, but the type of fiber induced (type IA) as the authors point out has "distinct advantages in terms of cardiac assistance" compared with type I of the typical CMP LD patient [2].

The authors also demonstrated that a timed delay of 2 weeks from division of intercostal perforating vessels to full mobilization of the LD yielded the best perfusion characteristics of the distal half of the LD in all three groups. As the authors point out this bit of knowledge dates to 1597 (400 years ago or more). We too have demonstrated the profound impact that a timed delay has on demonstrable angiogenic collateralization of the distal half of the LD from its thoracodorsal pedicle in the sheep [2, 3]. Indeed, in the sheep the extent of histologic confirmed muscle necrosis after full LD mobilization would challenge whether preconditioning alone would be sufficient to prevent the damage from subsequent full mobilization. Carroll and colleagues [4] have also clearly demonstrated the efficiency of vascular delay in improving survival and function of this important distal half of the LD. Both Carroll and colleagues [4] and we too have implied the obvious based on our findings.

Therefore, Barron and colleagues [1] have added further compelling evidence leading to an obvious conclusion that is conspicuously absent from the Comment section in their article. Namely, the way that the CMP operation has been performed in humans was the least likely way for it to be successful. This is not to say that by optimizing how the LD is harvested, transformed, and wrapped it is a guarantee of effective long-lasting muscle assist, because it may still be inadequate. However, until we perform this most ambitious procedure in the best fashion, it is premature to discard it to the wastebasket bin of surgical history like Brantigan’s lung volume reduction operation of the early 1950s. Hence, I ask the authors, from your data, is this not the truth of this operation?

References

1. Barron D.J., Etherington P.J., Winlove P., Jarvis J.C., Salmons S., Pepper J.R. Combination of preconditioning and delayed flap elevation: evidence for improved perfusion and oxygenation of the latissimus dorsi muscle for cardiomyoplasty. Ann Thorac Surg 2001;71:852-861.[Abstract/Free Full Text]
2. Alvarez J.M., Carter M., McKie G. Endoscopic ligation of intercostal arterial perforators to the latissimus dorsi muscle with a timed delay improves collateral blood supply. Asia Pacific Heart J 1998;7:108-113.
3. Alvarez J.M. Vascular delay and cardiomyoplasty. Ann Thorac Surg 1997;64:1872.[Free Full Text]
4. Carroll S.M., Carroll C.M., Stremel R.W., Heilman S.J., Tobin G.R., Barker J.H. Vascular delay of the latissimus dorsi muscle: an essential component of cardiomyoplasty. Ann Thorac Surg 1997;63:1034-1040.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John M. Alvarez Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alvarez, J. M. Search for Related Content PubMed Articles by Alvarez, J. M. Related Collections Cardiac - other Coronary disease