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J Thorac Cardiovasc Surg 1995;110:1775
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

On dynamic cardiomyoplasty

Norman A. Silverman, MD

Division Head
Cardiac and Thoracic Surgery
Henry Ford Hospital
2799 W. Grand Blvd
Detroit, MI 48202

Reply to the Editor:

Living in the Detroit area, I am naturally attracted to the concept of "supercharging." Dr. Ustüner's theoretical technical modification to improve distal muscle perfusion in dynamic cardiomyoplasty is predicated on the theory that a clinical failure of the procedure is solely explained by muscle perfusion. If that is true, then microsurgical wizardry is the panacea. Is that the only reason why systolic performance is not enhanced? If efficacy is predicated on prevention of further ventricular dilatation, then the distal perfusion is an irrelevant issue. Furthermore, this technique does not address other major limitations of the procedure, such as the time needed for transformation and the fact that the procedure does not deal with lethal ventricular arrhythmias. Unfortunately, technical modifications alone cannot always improve the efficacy of a surgical procedure if that operation is incompatible with clinical urgency and pathophysiology.

12/8/68558





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