INNOVATIVE TECHNIQUES IN SKELETAL-MUSCLE CARDIAC ASSISTANCE - FIRST EXPERIMENTAL-STUDY ON MINIMALLY INVASIVE AORTOMYOPLASTY AND CARDIOMYOPLASTY

Skeletal muscle cardiac assistance as a treatment modality for heart f ailure is considered a high-risk procedure subject to strict patient s election. The aim here is to develop minimally invasive techniques to improve surgical outcomes and increase clinical indications. Ten goats (45-55 kg) were studied. In six, the latissimus dorsi muscle (LDM) wa s harvested via an open technique on one side vs a minimally invasive technique on the other using video assistance through two 3 cm incisio ns. Surgical maneuvers and length of procedures were noted. Animals we re recovered, observed daily for local complications, and killed after 1 week for comparative anatomic and histopathologic studies. In four other goats, minimally invasive aortomyoplasty or cardiomyoplasty was performed using video assistance (2 aortomyoplasty, 2 cardiomyoplasty) . In this experimental series, there were no surgical complications. T he minimally invasive LDM harvest required a mean of 81 min (range 55- 116 mn) with no gross evidence of muscle damage. The technique of LDM harvesting was standardized and is reproducible. Aortic and cardiac wr apping were also achieved through three ports and a left minithoracoto my of 4 cm, using the right or left LDM. A scarf technique for the des cending aortomyoplasty using the left LDM, and an anterior wrapping fo r cardiomyoplasty using the left or right LDM was technically feasible with video assistance. This study suggests future clinical applicabil ity.