Latissimus dorsi and serratus anterior dynamic descending aortomyoplasty for ischemic cardiac failure.
Dynamic descending aortomyoplasty for cardiac assistance is a form of extraaortic, skeletal muscle-driven counterpulsation. Controversy exists regarding its clinical applicability and the most suitable muscle autograft for the procedure. Specifically, the ligation of intercostal vessels required for descending aortomyoplasty may not be tolerated clinically. This study compared the hemodynamic profiles and long-term function of latissimus dorsi (LD) aortomyoplasty to a split serratus anterior (SA) descending aortomyoplasty in which all intercostal vessels were preserved. Descending aortomyoplasty was performed in 11 goats. In 5, the SA was harvested and its distal end divided, facilitating a wrap of the aorta without ligation of intercostal arteries. In 6, the LD was used as a circumferential aortic wrap. At 90 days, an occluder placed on the left anterior descending artery created an ischemic event. Hemodynamic studies with and without assistance were performed in the ischemic and nonischemic states. Latissimus dorsi aortomyoplasty improved cardiac output 24% and 5.6%, stroke volume 29% and 66%, left ventricular stroke work index 30% and 166%, and coronary flow 4% and 3% in the normal and ischemic heart, respectively. Serratus anterior aortomyoplasty improved cardiac output 36% and 10%, stroke volume 42.8% and 13.5%, left ventricular stroke work index 64% and 21%, and coronary flow 8% and 4.3%, in the normal and ischemic heart, respectively. Two of the SA autografts were fibrotic and nonfunctional at 3 months. Aortomyoplasty with either SA or LD muscle improves cardiac function in the normal and ischemic heart. However, divided SA is associated with a higher rate of fibrosis and may be less suitable for the procedure.
Cernaianu
A C
AC
Department of Surgery, Cooper Hospital/University Medical Center, Camden, New Jersey 08103.
Vassilidze
T V
TV
Flum
D R
DR
Gallucci
J G
JG
Olah
A
A
Cilley
J H
JH
Grosso
M A
MA
DelRossi
A J
AJ
D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery*; D001794:Blood Pressure; D002302:Cardiac Output; D018421:Cardiomyoplasty / Q000379:methods*; D003326:Coronary Circulation; D006041:Goats; D008026:Ligation; D018482:Muscle, Skeletal / Q000637:transplantation*; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome