Document Detail


Descending thoracic aortomyoplasty: a technique for clinical application.
MedLine Citation:
PMID:  8561646     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Descending thoracic aortomyoplasty is a form of skeletal muscle-powered cardiac assistance. Its use in clinical settings has been limited by the ligation of intercostal arteries necessary to complete a circumferential wrap of the aorta with the latissimus dorsi. METHODS: This study assessed the feasibility and the efficacy of aortomyoplasty constructed with a modified latissimus dorsi. A pericardial patch was attached to the latissimus dorsi and divided around the preserved intercostal arteries. Nine alpine goats (37 +/- 2 kg) underwent descending aortomyoplasty using this technique. All intercostal arteries were preserved. After a 6-week recovery period, the animals underwent a 6-week, incremental electrical conditioning program. After 90 postoperative days, animals were examined under anesthesia with the myostimulator on and off. RESULTS: Aortomyoplasty activation resulted in augmentation of mean diastolic aortic pressure by 16.0 +/- 0.9 mm Hg (23%). Significant improvements in cardiac index (40%), stroke volume index (37%), left ventricular stroke work index (49%), and mean arterial pressure (19%) were noted. An intravascular sonographic probe placed in the descending aorta revealed circumferential compression of the aorta during counterpulsation. Mean cross-sectional aortic area was reduced by 51.8%, from 210.1 +/- 7.1 to 108.9 +/- 6.7 mm2 during aortomyoplasty activation (p < 0.05). Histologic analysis confirmed the long-term patency of intercostal arteries. CONCLUSIONS: Descending aortomyoplasty, modified with an interposing patch of pericardium, effectively transfers skeletal muscle force across the aortic wall and assists cardiac function. This technique allows preservation of all aortic branches, and with this novel approach, the clinical utility of aortomyoplasty can now be explored.
Authors:
D R Flum; A C Cernaianu; R Meada; L A Lee; K Salartash; M A Grosso; R L Weiss; J H Cilley; A J delRossi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  61     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-02-23     Completed Date:  1996-02-23     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  93-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Medicine and Dentistry of New Jersey, Cooper Hospital/University Medical Center, Camden, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Aorta, Thoracic / surgery*,  ultrasonography
Assisted Circulation*
Cardiomyoplasty
Electric Stimulation
Electrocardiography
Goats
Hemodynamics
Male
Muscle, Skeletal / transplantation*
Ultrasonography, Interventional

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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