Cardiomyoplasty

Cardiomyoplasty is a surgical procedure performed to manage heart failure.

Heart failure is also known as congestive heart failure. In this condition, the heart is not able to pump blood efficiently throughout the body. The condition may worsen over the years and limit your daily activities. A heart transplantation can help manage heart failure; however, due to the shortage of donors and difficulty meeting eligibility criteria, other methods such as cardiomyoplasty are considered.

Initially, dynamic cardiomyoplasty, in which a muscle from the abdomen or back is taken and wrapped around the heart to aid in heart function, was one of the methods used for cardiomyoplasty; however, this procedure is no longer performed as it did not show significant benefits. This procedure is now replaced with cellular cardiomyoplasty. Cellular cardiomyoplasty involves injection or delivery of certain type of cells called stem cells into the damaged part of the heart. These cells help replenish myocardial cells (cells in the heart muscle), thus improving heart function and symptoms of heart failure.

Cardiomyoplasty may be performed if you show the following symptoms of heart failure:

• Swelling in the ankles and legs 
• Difficulty breathing 
• Frequent cough that worsens at night 
• Loss of appetite 
• Fatigue 
• Confusion 
• Irregular heartbeat or pounding heartbeats 
• Weight gain or loss
• Bloated tummy 
• Fast heart rate 
• Dizziness
• Anxiety

Cardiomyoplasty may be contraindicated in the following conditions:

• If the muscle of your heart is thinner than 5mm, cellular cardiomyoplasty by catheter-based injection method is contraindicated as there is a risk of perforation of the heart muscle.
• If you cannot undergo magnetic resonance imaging (MRI) test, you may not be eligible for cardiomyoplasty procedures that require an MRI for correct placement of the stem cells.
• You may not be able to have this procedure if you have kidney failure and need dialysis, a blood disorder, current or prior cancer, prior heart surgery, left ventricular aneurysm, preoperative steroid therapy, valvular disease requiring surgery, or are within 6 days of an acute coronary event.

Before undergoing this surgery, you will need the following preparation:

• Your healthcare provider may ask you to undergo a few diagnostic tests to review your overall health. These include:
  • Chest X-ray 
  • Blood tests 
  • Pulmonary function tests (to measure the function of your lungs)
  • Electrocardiogram (to check the electrical movement of the heart) 
  • Ultrasound study 
  • Computed tomography (CT) scan 
  • MRI
• Share a list of all the medications that you take, including prescribed or non-prescribed medicines, minerals, herbs, vitamins, and supplements with your doctor. Your doctor may advise you to stop taking blood-thinning medicines like warfarin, clopidogrel, aspirin, or ibuprofen.
• Tell your doctor if you take any illegal drugs, alcohol, or smoke cigarettes. He/she may ask you to quit these habits before the procedure to ensure quicker recovery afterwards.
• Arrange for a ride to take you home after the surgery.
• You will be asked for your medical history including questions about any recent illnesses or allergies to medicine, food, or surgical components like iodine, skin tapes, or skin-cleansing solution.
• The doctor will ask you to fast from midnight before the surgery.
• You will need to sign a consent form to grant permission for the surgery.

In this procedure, the surgeon injects different stem cells such as embryonic, bone marrow, or skeletal muscle cells into the heart to replace damaged cells.

Once you reach the hospital, the medical staff will provide you with a hospital gown. They will start an intravenous (IV) line in your arm to give you medicines during the surgery. An anesthesiologist will administer general anaesthesia to put you to sleep during the surgery. A healthcare practitioner will shave the surgical area and clean it using an antiseptic solution. This will help reduce the risk of infections.

Then, the surgeon will use one of the following methods to deliver stem cells to your heart:

Epicardial or endovascular delivery approach:

This is performed using the conventional or mini-thoracotomy method as follows:

• The surgeon will make an incision (cut) over your chest bone to expose the area where the injection is to be given.
• He/she will then give you several injections of the cell solution in heart muscle to implant cells inside your heart. 
• A majority of the cell solution is injected around the damaged part of the heart with some portion in the central portion of the damage. 
• After every injection, the surgeon will press the injection site with fingers to avoid leakage of the cell solution.
• Once all the cell solution is injected, the surgeon will close the cut using sutures.

Catheter-based cell implantation:

In this procedure, a catheter (thin tube) will be used to deliver cells into the heart. The surgeon may use the assistance of an MRI to correctly place the catheter. The cells are delivered by any of the following methods:

• Intracoronary approach: A catheter is used to deliver cells into a blood vessel of the heart, which will then carry the cells to the damaged heart muscle. This procedure requires special type of cells like bone marrow and blood progenitor cells. 
• Intramyocardial approach: The cells will be delivered inside the heart muscle either by needle injection or catheter.
• Intravenous approach: The cells are delivered through a catheter placed in a vein, which will deliver the cells to the heart.

It may take about 15 minutes to inject cells inside the heart. When you wake up after the surgery, you will have a tube inside your nose to supply oxygen. A nurse will give you medicines for pain. You will be able to consume liquids after the procedure. Your doctor will monitor your health carefully after discharge as ventricular arrhythmia (abnormal heartbeats) can be seen in the first two weeks after a cardiomyoplasty.

Once you are home, you will need to take the following care:

• Wound care:
  • Avoid applying lotion or cream on the incision area. 
  • You should not soak your wound while bathing for about six weeks. The doctor may permit you to shower. 
  • Make sure the area is clean and dry.
  • Wear loose-fitted clothes.
• Medications: 
  • The doctor will prescribe medications to reduce your pain after the surgery. 
  • You will also have to take antiarrhythmics (used to treat abnormal heart rhythm) following the procedure. 
• Activities:
  • Your doctor may advise a few exercises to help you recover faster 
  • He/she may also advise you to start walking for at least five to 10 minutes each day. 
  • Avoid lifting heavy objects for the initial few weeks. 
  • You can resume your routine work after six to 12 weeks. 
  • The doctor will tell you when it is safe to travel again after the surgery.

When to see the doctor?

You must immediately inform your healthcare provider if you are experiencing the following symptoms after the surgery:

• Fever 
• Chest pain 
• Bleeding from the wound area or pain, redness or warmth at the incision site
• Sudden weakness or numbness in the extremities
• Chills
• Fast heart rate 
• Difficulty breathing

The following risks are associated with this procedure, some of them based on the type of cells used for the procedure:

• Arrhythmia 
• Scar formation
• Tumour formation
• Ventricle rupture due to multiple injection points

You will have a follow-up appointment every three months during the initial year after your surgery, and later in every six months for postoperative evaluation.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.