Dynamic Cardiomyoplasty. Latissimus dorsi
dynamic cardiomyoplasty has been used in our institution for
heart failure patients refractory to medical
therapy; 113 cases were operated at Broussais and Pompidou Hospitals and 75 patients by our team abroad, in the scope of an international cooperative program.
Cardiomyoplasty has been associated with better results due to technical improvements, the most significant mini-invasive techniques, the latest the use of
growth factors to enhance muscle vascularization. Risk factors have been identified, resulting in more precise indications, a lower hospital mortality, and a wider use of this operation. There has been a new tendency to associate
cardiomyoplasty with electrophysiological
therapies: implantation of ventricular
defibrillators and multisite cardiac pacing (for atrioventricular and interventricular resynchronization). Cellular
Cardiomyoplasty. Adult myocardium cannot repair after
infarction due to the absence of stem cells.
Cell transplantation strategies for
heart failure have been designed to replace damaged cells with cells that can perform cardiac work. Current possibilities in
cell therapy for
heart failure is the
transplantation into the infarcted myocardium of autologous myoblasts (satellite cells originated from skeletal muscle), fetal cardiomyocytes, autologous heart cells, cells derived from bone marrow stem cells, and smooth muscle cells. Experimental studies demonstrated that
cell transplantation into the myocardium was associated with the recovery of myocardial contractility and compliance, as well as the diastolic pressure-strain relationship in animal models (infarctlike myocardial lesions and
dilated cardiomyopathy models). Healthy myoblasts and myotubes were observed 2 months after myocardial implantation. Clinical studies are now in progress.