Chronic aortic counterpulsation with latissimus dorsi in heart failure: Clinical follow-up

Background: Dynamic aortomyoplasty is an alternative technique to heart tra nsplantation, The goal of our study was to evaluate the benefits of aortic counterpulsation obtained by dynamic thoracic aortomyoplasty in patients wi th heart failure refractory to pharmacologic treatment and contraindication s to heart transplant or cardiomyoplasty. Methods: In this study we compared preoperative and postoperative data from five out of six carefully selected patients who were treated with dynamic thoracic aortomyoplasty. This surgical technique wraps the right latissimus dorsi muscle flap around the ascending aorta. This muscle flap was electri cally stimulated during diastole, following a muscle-conditioning protocol, to obtain diastolic augmentation. At the 6-month follow-up period we evalu ated, invasively and noninvasively, the hemodynamic and clinical effects of aortomyoplasty. Results: We observed a significant decrease in the number of hospitalizatio ns (P = 0.01), NYHA functional class (P = 0.01), cardiothoracic ratio (P = 0.02), right ventricular diameter (P = 0.03), left atrial diameter(P = 0.04 ), and pulmonary artery systolic pressure (P = 0.04); and a significant inc rease in the 6-minute walking test (P = 0.01), cardiac index (P = 0.04), no ninvasive evaluation of diastolic augmentation (P = 0.01), left ventricular shortening fraction (P = 0.01), and radioisotopic left ventricular ejectio n fraction (P = 0.02). We also found a nonsignificant decrease in the left ventricular diameter (P = 0.08) and wedge pressure (P = 0.19); and a nonsig nificant increase in peak oxygen consumption (P = (0.13). Conclusions: Dynamic thoracic aortomyoplasty in heart failure resulted in a n important improvement of hemodynamic parameters, heart functional data, a nd clinical functional class, when comparing preoperative data with the 6-m onth follow-up data.