Increased coronary artery blood flow with aortomyoplasty in chronic heart failure

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

“…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. The device is designed to be simple to implant, to accommodate aortic anatomic variability, to be safe for the aorta and have a high cycle-life, to provide measurable improvement in hemodynamic variables, to allow mobility, and to be able to be turned down or off or used intermittently if recovery occurs.…”

Circulatory benefits of diastolic counterpulsation in an ischemic heart failure model after aortomyoplasty

“…In summary, aortomyoplasty can provide hemodynamic augmentation comparable to that of the IABP, but without the attendant complications. 9,11,12 We have demonstrated that acute aortomyoplasty counterpulsation improves cardiac function in a chronic ischemic heart failure model. Future studies should establish the ability of aortomyoplasty to provide long-term counterpulsation capable of attenuating the symptoms of ischemic heart disease.…”

“…8 An experimental surgical procedure that generates autologous diastolic counterpulsation is aortomyoplasty, in which the latissimus dorsi muscle (LDM) is wrapped around the ascending or descending thoracic aorta and stimulated to contract during diastole. Aortomyoplasty can increase coronary blood flow through diastolic augmentation [9][10][11] and can decrease left ventricular work through afterload reduction. 12 Although the application of skeletal muscle extra-aortic counterpulsation is not a new idea and has had limited success clinically, indications for its use have been diverse.…”

“…Previous work in our laboratory involved optimizing aortomyoplasty muscle stimulation to cardiac cycle timing, showing an increase in coronary blood flow with aortomyoplasty counterpulsation, optimizing muscle wrap configura-tion to yield the greatest hemodynamic benefits, and demonstrating the integrity of the LDM 6 months after aortomyoplasty. 9,[15][16][17] The purpose of this investigation was to confirm the long-term stability of the aortomyoplasty muscle wrap and to evaluate the efficacy of acute aortomyoplasty counterpulsation in comparison with the IABP in a chronic ischemic heart failure model. We hypothesized that 1 year after the procedure, aortomyoplasty counterpulsation would provide cardiac benefits equivalent to the IABP in a chronically ischemic heart.…”