Charles Bridges MD DSc

Cardiothoracic Surgeon

Assistant Professor of Surgery Division of Cardiothoracic Surgery University of Pennsylvania Philadelphia, Pennsylvania

PHYSICIANS ARE CURRENTly considering another alternative method of assist for congestive heart failure called the skeletal muscle ventricle procedure. In this novel approach, a pumping chamber is formed from the latissimus dorsi, which is a muscle located in the back that has been freed up and moved to the chest. The muscle is formed into a "pump" about the same size and shape as the left ventricle.

After the muscle pump is made, it is electrically stimulated for several weeks to make it fatigue resistant. During a second operation, the new pump is connected to the circulation and used as an assistive pump to help the heart.

These pumps have not been used in humans, although the re-

m j suits have been extremely encouraging in animals. In fact, one of these pumps has pumped blood effectively in the circulation of a laboratory animal for more than four years. In other cases, these pumps have been connected to the circulation with valves similar to those in the heart and have pumped blood for more than a year.

One of the advantages of a skeletal muscle ventricle compared with heart assist devices is that everything is implantable, including the special stimulators (which are identical to those used in cardiomyoplasty and aortomy-oplasty). The procedure also has potential advantages over car-diomyoplasty and aortomyoplasty in that almost all of the latissimus muscle is used for the pumping action, and therefore, much more effective support of the circulation can be obtained. In addition, the potential advantage of the procedure over a heart transplant is the absence of rejection because the patient's own tissues are used.

Although the research is promising, the procedure is not yet ready for human trials.

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