Dynamic aortomyoplasty: Clinical experience and thoracoscopic surgery feasibility study

Background: Surgical procedures using the latissimus dorsi (LD) muscle to a ssist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplast y (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach. Materials and Me thods: A clinical pilot study on dynamic descending AMP started in June 199 5 and included four patients. Two of them could benefit from LD counterpuls ation, surviving 6 months and 18 months. Following this clinical experience , we investigated, on an animal model, minimally invasive thoracoscopic sur gery for this procedure. Twelve goats underwent endoscopic LD harvest and v ideo-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint. Results: Clinical AMP using open tec hniques provided extraaortic counterpulsation in NYHA Class IV patients con traindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better pati ent outcome. Minimally invasive thoracoscopic surgery was feasible and repr oducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrate d. We concluded that thoracoscopic AMP may provide a minimally invasive app roach to cardiac assistance and thus, a new surgical option for patients pr esenting with chronic heart failure.