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British Journal of Anaesthesia, Vol 82, Issue 1 140-143, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CASE REPORTS

Dynamic cardiomyoplasty in patients with end-stage heart failure: anaesthetic considerations

A. Lehmann, K. Faust, J. Boldt, J. Lang, E. Thaler and C. Werling
Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany; Department of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany

Dynamic cardiomyoplasty is used increasingly for patients with chronic heart failure, with approximately 500 cases having been performed. The latissimus dorsi muscle is prepared maintaining its vascular supply and the muscle flap is wrapped around the heart and connected to a cardiomyostimulator. The muscle is later stimulated synchronously with ventricular systole to augment the heart. Our experience of 22 patients with chronic heart failure (NYHA III-IV) undergoing dynamic cardiomyoplasty is described from the anaesthetist's point of view. Two patients are reported as case reports. The challenge is to manage patients with severely impaired left ventricular function, who do not obtain immediate benefit from the operation. Our experience supports the importance of early use of inotropic agents.
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