Hemodinamic and Functional Effects of Dynamic Aortomyoplasty in Patients with Advanced Heart Failure

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Abstract

Objective The goal of our study was to evaluate the benefits of aortic counter pulsation by means of dynamic aortomyoplasty in patients with heart failure refractory to pharmacological treatment and contraindications to heart transplant.   Methods In this study we compared preoperative and post-operative data of fifteen selected patients submit-ted to dynamic thoracic aortomyoplasty. This surgical technique implies wrapping the right latissimus dorsi muscle flap around the ascending aorta. This muscle flap was electrically stimulated during diastole, following a muscle conditioning protocol, to obtain diastolic augmentation. After twelve month follow-up, we evaluated, invasively and non-invasively, the hemodynamic, clinical and functional effects of aortomyoplasty.   Results When comparing preoperative data with 12-month follow-up data, we observed a significant decrease in the number of hospitalizations (p < 0.0001), NYHA functional class (p < 0.001), left ventricular diastolic diameter (p < 0.05), left atrium diameter(p < 0.05), pulmonary artery systolic pressure (p <0,01) and wedge pressure (p < 0.01). We also detected a significant increase in the walking test (p< 0.001), peak oxygen consumption (p < 0.05), shortening fraction (p < 0.01), left ventricular ejection fraction (p < 0.01) and cardiac output (p < 0.01).   Conclusions Dynamic biologic chronic contrapulsation assistance with latissimus dorsi in heart failure (dynamicaortomyoplasty), resulted in an important improvement of hemodyanmic parameters, heart functionaldata and clinical functional class in selected patientswith severe heart failure. A larger clinical studywith a longer follow-up period would be useful toevaluate the clinical relevance of this technique.