Demand cardiomyoplasty: dynamic girdling is superior to adynamic girdling

摘要

In order to avoid full transformation and early degeneration of the latissimus dorsi (LD), giving better systolic assistance, a new stimulation protocol was developed: fewer impulses per day were delivered, providing the LD wrap with daily periods of rest, based on a heart rate cut-off (Demand activation). We aimed to determine whether Demand dynamic girdling (DemDyn) is superior to passive girdle effect (Adynamic) in term of cardiac assistance, survival and freedom from cardiovascular events. Fourteen patients with dilated myocardiopathy (13/1 = M/F, mean age 58.2 ± 5.8 years, sinus rhythm/atrial fibrillation = 12/2) were submitted in the years from 1993 to 1996 to CMP and at different intervals to Demand protocol. Patients were divided on the basis of mechanographic measurement of the tetanic fusion frequency (TFF) at start of Demand: DemDyn patients with faster LD (high TFF, 7 patients) and Adynamic girdling patients with slower LD (low TFF, 7 patients). Clinical, echocardiographic, mechanographic and cardiac invasive assessment records were reviewed as well as cardiovascular events (death and arrhythmias) occurrence. The mean duration of follow-up was 41.4 ± 21.1 months (range 23 to 69). DemDyn group showed a major decrease in NYHA class (2.14 ± 0.7 vs 0.43 ± 0.5, p = 0.007), a higher percent increment of ejection fraction (13.7 ± 7.1 vs 5.3 ± 2.4%, p = 0.002), a better survival (85.7% vs 28.6%, p = 0.037) and a higher TFF value (38.3 ± 5.8 vs 24.3 ± 2.9, p = 0.002) than Adynamic girdling group. Early started “Demand” girdling offers better results than Adynamic girdling in term of both symptomatic improvement and survival.. Th