title: Hemodynamic analysis of descending versus ascending aortomyoplasty, and comparison with intra-aortic balloon pump.
abstract: OBJECTIVE
  Descending and ascending aortomyoplasty are two surgical procedures intended to induce hemodynamic benefits similar to those of the intra-aortic-balloon-pump (IABP). To date, there have been no studies comparing the two surgical techniques. The objective of this study was to compare coronary blood flow augmentation and afterload reduction as produced by descending and ascending aortomyoplasty counterpulsation
  
  
  METHODS
  Twenty-two mongrel dogs (18-35 kg) underwent IABP application (n=7), descending (n=8), or ascending (n=7) aortomyoplasty. Left anterior descending (LAD) coronary artery blood flow was measured using a Transonic Doppler flow probe. Left ventricular pressure as well as aortic pressures proximal and distal to either the aortomyoplasty site or the IABP position were monitored continuously.
  
  
  RESULTS
  Descending aortomyoplasty induced higher elevation in the LAD blood flow during assisted beats (27% from 10.8+/-4 to 13.8+/-6 ml/min, P<0.001) than that induced by either ascending aortomyoplasty (19% from 11.7+/-5 to 14+/-5 ml/min, P<0.001) or IABP counterpulsation (18% from 8.6+/-3 to 10.2+/-4 ml/min, P<0.001). Conversely, while ascending aortomyoplasty reduced the left ventricular end-diastolic pressure by 16% (from 60+/-18 to 50+/-22 mmHg, P<0.001), similar to the 16% after load reduction achieved by the IABP counterpulsation, descending aortomyoplasty failed to induce afterload reduction.
  
  
  CONCLUSIONS
  Descending aortomyoplasty produces higher coronary blood flow augmentation than either ascending aortomyoplasty or IABP. However, afterload reduction comparable to that achieved by IABP was observed only with ascending aortomyoplasty and not with descending aortomyoplasty.
authors.affiliation: The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Israel. bolotin@netvision.net.il
authors.forename: Gil
authors.initials: G
authors.lastname: Bolotin
authors.forename: Frederik H
authors.initials: FH
authors.lastname: van der Veen
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Tamir
authors.initials: T
authors.lastname: Wolf
authors.forename: Robert
authors.initials: R
authors.lastname: Sachner
authors.forename: Rona
authors.initials: R
authors.lastname: Shofti
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Shreuder
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
mesh_terms: D000818:Animals; D001011:Aorta / Q000601:surgery*; D001794:Blood Pressure; D003326:Coronary Circulation; D004285:Dogs; D004558:Electric Stimulation; D007423:Intra-Aortic Balloon Pumping; D018482:Muscle, Skeletal / Q000637:transplantation*