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J Thorac Cardiovasc Surg 1995;110:280
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Effect of cardiomyoplasty on coronary artery flow

LCH
Bonner Rd.
London E2, United Kingdom

To the Editor:

Cardiomyoplasty is being evaluated as a therapeutic option for patients with chronic heart failure. The current form of cardiomyoplasty has a number of limitations. A major drawback of cardiomyoplasty is the high early and late mortality in patients in New York Heart Association class IV, particularly those with ischemic cardiomyopathy. ¹ In arecent publication in this Journal, Tsukube and associates ² measured coronary artery flow in dogs undergoing cardiomyoplasty. The peak blood flow velocity was measured with a Doppler catheter inserted into the left main coronary artery. They found that peak velocity of coronary blood flow was increased by 26% in systole and by 4% in diastole. The augmentation of the left main coronary artery blood flow was attributed to the enhancement of systolic cardiac function. Unfortunately they did not mention whether the muscle wrap was complete, because incomplete posterior wrap is unlikely to affect the blood flow of the left anterior descending coronary artery to the same degree as a complete wrap.

Tsukube and associates ² claimed: "A detailed analysis of the hemodynamic effects of this procedure [cardiomyoplasty] on coronary blood flow has never been undertaken." In 1991 Odim, Adoumie, and Chiu ³ measured myocardial oxygen extraction rate in normal canine heart after cardiomyoplasty. On observing an increase in coronary sinus blood flow during cardiac assistance, they concluded that cardiomyoplasty may increase oxygen extraction and that the coronary arteries adjust by increasing total flow during muscle stimulation. More recently, Soltero and coworkers ⁴ reported significant reduction of flow through the left anterior descending and circumflex coronary arteries in acute cardiomyoplasty in dogs. This dramatic observation was found in three cardiomyoplasty configurations: left cardiocostal, right cardiocostal, and double cardiomyoplasty. The worst scenario was in double cardiomyoplasty, wherein the left anterior descending and the circumflex coronary artery flows dropped by 35% and 27%, respectively.

Because of these highly contradictory laboratory findings, an urgent need exists for assessment of the effect of clinical cardiomyoplasty on coronary blood flow, particularly in patients with ischemic heart disease.

References

1. Grandjean PA, Austin L, Chan S, Terpestra B, Bourgeois IM. Dynamic cardiomyoplasty: clinical follow up results. J Card Surg 1991;6:80-8.[Medline]
   
2. Tsukube T, Okada M, Mukai T, Kashem MA, Ota T: Effect of dynamic cardiomyoplasty on phasic coronary arterial flow velocity in canine hearts. J THORAC CARDIOVASC SURG 1994;108:609-15.[Abstract/Free Full Text]
   
3. Odim J, Adoumie R, Chiu RJ. Does the latissimus dorsi muscle wrap compromise coronary blood flow? [Abstract.] Proceedings of Cardiovascular Science and Technology Conference, Bethesda, Maryland:1991:70.
   
4. Soltero ER, Glaeser DH, Michael LH, Hartley CJ, Earle NR, Lawrie GM. Acute impairment of coronary blood flow by dynamic cardiomyoplasty. Ann Thorac Surg 1994;58:121-7.[Abstract]
   

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