Aortomyoplasty counterpulsation: Experimental results and early clinical experience

Chachques, Juan-Carlos; Radermercker, Marc; Tolan, Michael; Fischer, Edmundo Cabrera; Grandjean, Pierre; Carpentier, Alain

doi:10.1016/0003-4975(95)01051-3

Cited by 23 publications

(6 citation statements)

References 16 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…We consider this fact a basic requirement for any kind of chronic cardiac assistance derived from skeletal muscles. Contrary to current clinical practice [1,2], patients suffering from severe cardiac failure should have a primary benefit from such a procedure, simply to compensate the risks of surgery. Consequently, the preparation of the LDM should be completed at this point of time.…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic cardiomyoplasty [1] and, nowadays, dynamic aortomyoplasty [2] have found their way into clinical practice. A variety of configurations of skeletal muscle ventricles (SMV) are under experimental evaluation [3].…”

Section: Introductionmentioning

confidence: 99%

Preparation of a Skeletal Muscle Ventricle in Sheep: Severe Damage to the Latissimus dorsi Muscle due to Mobilization before Preconditioning

Lanmüller

Girsch²,

Rab³

et al. 2000

Eur Surg Res

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As part of a study examining the use of a skeletal muscle ventricle for cardiac assistance in sheep, a new concept of muscle preconditioning was put into practice. We aimed to produce a latissimus dorsi muscle (LDM) capable of performing chronic work immediately after the construction of a skeletal muscle ventricle. The left LDM was detached from the thoracic wall, divided longitudinally and reattached in situ to achieve vascular delay. The right LDM was left unaffected. Thereafter, preconditioning of both LDM was started according to the clinically approved stimulation protocol for cardiomyoplasty. Preconditioning of the unaffected right LDM in situ resulted in a complete muscle fiber transformation with no signs of degeneration or necrosis. Mobilization of the left LDM before preconditioning led to a distinct damage of the muscle. During conditioning, the increase in burst duration from 2 to 3 impulses in sheep A and from 3 to 5 impulses in sheep B resulted in a homogenous degeneration of the muscle fibers of the left LDM. Histomorphological analysis showed a dramatic increase in the percent perimysial and endomysial connective tissue. The applied concept of muscle prefabrication proved to be a failure. Muscle splitting and mobilization followed by vascular delay and in situ conditioning as a concept of muscle prefabrication should be strictly avoided.

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“…The primary effects of diastolic counterpulsation (using either IABP or aortomyoplasty) are increasing myocardial oxygen supply (by increasing mean diastolic aortic pressure), and reducing myocardial oxygen consumption (via afterload reduction). Until recently, aortomyoplasty has been limited to research applications; however, clinical experiences using the latissimus dorsi muscle (LDM) have been reported in 28 patients [6,7].…”

mentioning

confidence: 99%

“…Aortomyoplasty is a new form of cardiac assistance whereby autologous skeletal muscle is wrapped around the ascending [7]or descending [2-6, 10, 15, 20-23, 25, 30]thoracic aorta and electrically stimulated to contract during diastole. The underlying mechanisms by which aortomyoplasty can assist a failing heart are analogous to the intra-aortic balloon pump (IABP).…”

mentioning

confidence: 99%

Optimizing muscle wrap orientation for aortomyoplasty

Rovner

Cmolik

Thompson

et al.

Proceedings of the 1996 Fifteenth Southern Biomedical Engineering Conference

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Background: Aortomyoplasty is a treatment for heart failure in which the latissimus dorsi muscle is wrapped around the aorta and stimulated to contract during diastole to provide chronic diastolic counterpulsation. We hypothesized that the manner in which the latissimus dorsi muscle is wrapped around the aorta determines the effectiveness of counterpulsation. Methods: Nine mongrel dogs were studied. The left latissimus dorsi muscle (LDM) was isolated and wrapped around the descending thoracic aorta using three different muscle wrap techniques-a helical coil (HC) wrap, a circumferential (CM) wrap, and a "wringer" (WR) wrap. The three wraps were done in each dog. Left-ventricular and aortic pressures and coronary and aortic blood flows proximal and distal to the muscle-wrapped region were measured. Mean diastolic aortic pressure, endocardial-viability ratio, coronary blood flow, and blood volume ejected from the wrapped segment (wrap stroke volume) were calculated. Results: Wrap stroke volume was greater for the WR (5.24±1.00 mL, p<0.05 compared with HC), compared with the CM (3.70±0.64 mL) or the HC (1.96±0.83 mL). The i ncreases in mean diastolic aortic pressure were similar for the WR (10.6±4.7%) and CM (9.7±4.4%) wraps and these were greater than the HC wrap (4.9±4.7%). Endocardialviability ratio was increased similarly by the WR (19.3±10.8%) and CM (19.8±14.6%) wraps and these increases were greater than observed during the HC wrap (10.5±6.3%). The WR wrap provided the greatest increase in coronary blood flow (24.3±23.0%) compared with the CM (17.8±12.9%) and HC (5.7±4.6%). Conclusion: These data suggest that: 1) all muscle wrap techniques effect diastolic counterpulsation; 2) muscle wrap orientation influences ameliorative potential; and 3) wringer and adjacent are better than helical coil. Chronic studies should be done to test whether the differences are maintained.

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Aortomyoplasty counterpulsation: Experimental results and early clinical experience

Cited by 23 publications

References 16 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

Preparation of a Skeletal Muscle Ventricle in Sheep: Severe Damage to the Latissimus dorsi Muscle due to Mobilization before Preconditioning

Optimizing muscle wrap orientation for aortomyoplasty

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