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J Thorac Cardiovasc Surg 1997;114:1097-1106
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS,
MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

NEW METHOD FOR MONITORING THE FUNCTIONAL STATE OF A DYNAMIC CARDIOMYOPLASTY

Norbert W. Guldner , MDa, Peter Klapproth , MSca, J. Michael Hasenkam , MD, DMScb, Thomas Fischer , MDc, Robert Keller , MDa, Ralf Noel , VDd, Britta Keding , MTa, Elrina Joubert-Hübner , MSca, Hermann Kuppe , MD, PhDc, Hans-H. Sievers , MD, PhDa

Supported by Bakken Research Center, Division of Medtronic, Maastricht, The Netherlands, Telectronics Pacing Systems Inc., Englewood, Colo., and A.D. Krauth GmbH, Hamburg, Germany.

Received for publication March 3, 1997 Revisions requested May 8, 1997 Revisions received June 6, 1997 Accepted for publication July 30, 1997 Address for reprints: Norbert W. Guldner, MD, Klinik für Herzchirurgie, Medizinische Universität zu Lübeck, Ratzeburgerallee 160, D-23538 Lübeck, Germany.

Abstract

Objective: To assess the impact of a dynamic cardiomyoplasty on failing hearts, it is essential to estimate the contraction force of the skeletal muscle and how its contraction is synchronized with the heart cycle. Methods: In a 6-month study a small fluid-filled, balloon-mounted catheter was placed between the myocardium and the muscular wrap in five adult female Boor goats and two female domestic pigs. The catheter was connected to a subcutaneous measuring chamber whereby pressure monitoring could be accomplished. Distinct pressure signals as a result of function of the dynamic cardiomyoplasty and the heart were detected initially in all animals. Results: Maximal relative pressure from the dynamic cardiomyoplasty was calculated as 336.2% ± 69.4% on day 24 ± 6.1 (n = 7) and end-stage pressure as 59.8% ± 9.7% on day 174.6 ± 13.1 (n = 4). A functional loss of pressure signals from the dynamic cardiomyoplasty was correlated to severe histologic muscle damage (n = 3). Pressure signals transferred from the contracting myocardium to the catheter showed defined segments of contraction, ejection, and filling periods, allowing a mechanical synchronization of the dynamic cardiomyoplasty to the heart cycle. Conclusions: This monitoring catheter enabled the assessment of the functional state of the dynamic cardiomyoplasty and allowed a synchronization to the heart cycle. It will promote understanding and might help to avoid muscle damage in dynamic cardiomyoplasty for an improved outcome of the surgical treatment of end-stage heart failure.






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