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Eur J Cardiothorac Surg 1999;14:304-310
© 1999 Elsevier Science NL

Preconditioning of the latissimus dorsi muscle in cardiomyoplasty: vascular delay or chronic electrical stimulation¹

Jewish Hospital Cardiothoracic Surgical Research Institute, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA

Received 29 September 1997; received in revised form 5 April 1998; accepted 12 May 1998.

Corresponding author. 511 S. Floyd Street, MDR Building #315, University of Louisville, Louisville, KY 40292, USA. Tel.: +1 502 8524345; fax: +1 502 8521795.

Objectives: In standard single stage cardiomyoplasty (CMP), the latissimus dorsi muscle (LDM) is not preconditioned prior to surgery. We hypothesized that latissimus dorsi preconditioning by vascular delay or by chronic electrical stimulation would result in an improved LV hemodynamic function early (14 days) after CMP. Methods: Mongrel dogs had preconditioning of the latissimus dorsi by a vascular delay procedure followed by CMP 14–18 days later (group I VD). Dogs in group II underwent 4 weeks of chronic stimulation (CS) of the latissimus dorsi (2 V/30 Hz, six bursts/min) followed by CMP. The latissimus dorsi muscle was fully stimulated from 48 h after cardiomyoplasty in both groups (2 V/30 Hz, three bursts/min). Two weeks after myoplasty, injecting 2.0–3.0x10⁵ 90 µm latex microspheres in the left main coronary artery induced global cardiac dysfunction. Hemodynamic function was then evaluated for latissimus dorsi muscle assisted (S) beats and non-stimulated beats (NS) in each group by measuring peak systolic aortic pressure (AOP), left ventricular pressure (LVP) and end diastolic pressure (LVEDP), and by calculating maximum and minimum dP/dt. Results: Dogs with vascular delay of the latissimus dorsi showed a marked increase for all hemodynamic indices (AOP: 23.9±2.5%, LVP: 23.5±2.2%, max dP/dt: 49.4±3.3%) for LDM assisted (S) beats compared to non-stimulated beats (P<0.001). Animals with chronic electrical training did not demonstrate a significant increase in any hemodynamic parameter with LDM stimulation. Conclusion: Preconditioning the LDM may play an important role in providing early cardiac assistance in CMP. Preconditioning the LDM with vascular delay resulted in improving performance of the LDM with consistent increases in LV hemodynamics. This was not observed after preconditioning with chronic electrical stimulation. Vascular delay of the latissimus dorsi can significantly improve muscle performance in CMP and could provide hemodynamic assistance early after surgery.

Key Words: Cardiomyoplasty • Vascular delay • Preconditioning • Chronic stimulation

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