Dynamic aortomyoplasty in treating end-stage heart failure

Trainini, Jorge C.; Fischer, Edmundo Cabrera; J, Barisani; Christen, Alejandra; Mouras, Jorge; Paz, Jorge de; Elencwajg, Benjamin; Chachques, Juan Carlos

doi:10.1016/s1053-2498(02)00438-2

Cited by 13 publications

(6 citation statements)

References 13 publications

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“…Other methods of chronic counterpulsation as either a bridge-totransplant or as 'destination therapy' have shown good success in selected patients in NYHA Classes III and IV heart failure. 1,12 In this study, to facilitate placement of all instrumentation and to avoid significant retraction, the 3rd rib was excised and the internal mammary vessels ligated and divided. It is however possible to place the device through an uncomplicated incision anterio-laterally in the 3rd intercostal space.…”

Section: Discussionmentioning

confidence: 99%

“…There is also long-term follow-up of patients having undergone ascending aortoplasty with Dacron wrapping which has not led to undue adverse events, and similarly, clinical aortomyoplasty has also proven safe to the ascending aorta. 1 In clinical use, there remains the risk of damage to the ascending aorta, particularly if moderate-severe atheromatous disease is present, a contraindication to use of the EAB. In ischaemic patients the incidence of moderate-severe ascending aortic disease is 15-18%.…”

Section: Discussionmentioning

confidence: 99%

“…The stimulation in diastole of skeletal muscle wrapped around the ascending or descending thoracic aorta (aortomyoplasty), has been developed for long-term support and used successfully in patients suffering chronic heart failure. 1 The technique involves considerable preparation and training of the latisimus dorsi muscle, and the level of augmentation and pre-systolic unloading are not necessarily accurately adjustable. [2][3][4][5][6][7][8][9][10][11] An inflatable patch, sewn into the wall of the descending thoracic aorta, has been successfully tested in a pilot An extra-aortic balloon (EAB) (C-Pulse TM ; Sunshine Heart, Inc., Sydney, Australia) has been proposed as a nonblood contacting ambulatory heart assist device in patients suffering moderate-severe heart failure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Extra-Ascending Aortic Versus Intra-Descending Aortic Balloon Counterpulsation—Effect on Coronary Artery Blood Flow

Davies

Peters

et al. 2005

Heart, Lung and Circulation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extra-Ascending Aortic Versus Intra-Descending Aortic Balloon Counterpulsation—Effect on Coronary Artery Blood Flow

Davies

Peters

et al. 2005

Heart, Lung and Circulation

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“…Cardiomyoplasty and aortomyoplasty were born in 1980s from the use of skeletal muscle flaps from plastic and reconstructive surgery and by the demonstration of musclefatigue resistance induced by stimulation [1,[11][12][13]. The biological support of these operations consists of chronic muscle electrostimulation that induces a physiological adaptation of skeletal muscle to cardiac work.…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation following cardiomyoplasty: a biological bridge☆

Chachques

Jegaden

Bors

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Dynamic cardiomyoplasty (CMP) was proposed as a treatment for refractory heart failure; more than 2000 procedures have been performed worldwide. Heart transplantation was indicated afterwards in some CMP patients with recurrent heart failure symptoms. This study reviews the multicentric French experience with CMP followed by heart transplantation. Methods: From 1985 to 2007, 212 patients (mean age 53 AE 11 years) with refractory heart failure (LVEF = 22 AE 9%, mean NYHA 3.2) underwent CMP in France. Heart transplantation was performed in 26 patients (12.3%), mean age: 51 AE 11 years, within 2.3 AE 3 years after CMP. Transplantation was indicated for persistent heart failure, i.e. no immediate improvement after CMP (19%) and for recurring heart failure (81%). Results: The surgical technique of heart transplantation following cardiomyoplasty presents few particularities. Routine extracorporeal bypass was instituted between the vena cavas and the ascending aorta. As in most of these patients the CMP procedure had been performed without the need of extracorporeal circulation, hearts were free of previous cannulations for cardiopulmonary bypass. The latissimus dorsi muscle flap was divided as far as possible inside the left pleural cavity and its vascular pedicle was obturated. The proximal portion of the muscle as well as the muscular pacing electrodes were kept in place in the pleural cavity. The adhesions between the flap and the heart were not released so as to achieve an en bloc resection of the heart and the muscle flap. During removal of the recipient's heart, care was taken not to injure the left phrenic nerve that was frequently in tight relation with the latissimus dorsi muscle. Heart transplantation was then performed in a routine manner, the donor heart being anastomosed to remnant atria and great vessels. Mean follow-up was 5.5 years (longest 13.5 years). Survival at 10 years was 40% for early heart transplantation (done within 4 months of CMP) and 57% for transplantation performed at 3 AE 2.8 years after CMP. Conclusions: Heart transplantation after CMP is technically feasible. Hospital mortality was higher when urgent transplantation was required. Long-term survival results are similar to those for primary heart transplantation. Cardiomyoplasty, when it fails, does not preclude transplantation, and when indicated, CMP could be considered as a biological bridge to heart transplantation. #

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“…14,15 The material used in this study (Dacron) is a biocompatible and has been extensively used in replacing human vessels.…”

Section: Discussionmentioning

confidence: 99%

Juxtaaortic Counterpulsation: Comparison with Intraaortic Counterpulsation in an Animal Model of Acute Heart Failure

et al. 2004

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This study was designed to compare the effects of juxtaaortic balloon counterpulsation (JABC), performed in ascending aorta and the aortic arch, with those yielded by intraaortic balloon counterpulsation (IABC) in descending aorta, in experimental animals during induced cardiac failure.JABC was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the wrapped aorta.JABC resulted in a significant increase of cardiac output (from 2.33 ؎ 0.82 to 2.61 ؎ 1.12 L/min, p < 0.05), cardiac index (from 0.071 ؎ 0.025 to 0.080 ؎ 0.033 L/min/kg, p < 0.05) and diastolic pressure augmentation evaluated through diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index (from 0.94 ؎ 0.21 to 1.10 ؎ 0.33, p < 0.01). End diastolic aortic pressure showed a significant decrease with JABC (from 31.90 ؎ 7.09 to 27.83 ؎ 9.72 mm Hg, p < 0.05). A close association between percentage of DABAC/SABAC increases obtained with IABC and JABC was observed (r 2 ‫؍‬ 0.67; p < 0.001).Counterpulsation obtained by a juxtaaortic catheter placed in the arch and the ascending wrapped aorta results in an effective hemodynamic improvement comparable with that achieved by an intraaortic catheter in open chest sheep.

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Dynamic aortomyoplasty in treating end-stage heart failure

Cited by 13 publications

References 13 publications

Extra-Ascending Aortic Versus Intra-Descending Aortic Balloon Counterpulsation—Effect on Coronary Artery Blood Flow

Extra-Ascending Aortic Versus Intra-Descending Aortic Balloon Counterpulsation—Effect on Coronary Artery Blood Flow

Heart transplantation following cardiomyoplasty: a biological bridge☆

Juxtaaortic Counterpulsation: Comparison with Intraaortic Counterpulsation in an Animal Model of Acute Heart Failure

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