Current status of cardiomyoplasty as surgical alternative for end-stage heart failure.

Heart transplantation is the best option for surgical treatment of end-stage congestive heart failure. However, when heart transplantation is not possible, other surgical options are available, and one of them is cardiomyoplasty. Below is a new multi-step approach for improving cardiomyoplasty results according to our clinical and experimental data. In order to decrease the length of time and damage of cardiomyoplasty operation one can use a lateral approach to mobilize the latissimus dorsi muscle and wrap the heart. In order to receive long-term fatigue resistance in the latissimus dorsi muscle of older patients one can increase the length of time of the pre-assist training of the latissimus dorsi muscle using a more cautious regimen. In order to improve hemodynamic results after muscle conditioning the cardiosynchronization regimen can be changed from 1:2 to 1:4. In order to prolong the period of effective latissimus dorsi muscle performance the electrical stimulation may be switched off at night or changed to a rate of 1:8. New cardiomyostimulator LD-PACE II may be used to change day/night regimen. In order to prevent sudden cardiac death in the patient with severe cardiac arrhythmia it is possible to combine cardiomyoplasty with implantable cardioverter defibrillator (ICD) implantation. In order to implement cardiac assist immediately after cardiomyoplasty it is possible to start with cautious electrical stimulation regimen just after cardiomyoplasty or use cardiac assist in work-rest regimen several hours daily. In order to prevent ischemia-reperfusion damage of latissimus dorsi muscle after subtotal mobilization, the latissimus dorsi muscle can be treated with an application of fibrin sealant with added aprotinin, pyrrolostatin, or deferoxamine. In order to accelerate angiogenesis and indirect myocardial revascularization, fibrin sealant with own endothelial cells can be administrated between the latissimus dorsi muscle and the myocardium.