Dynamic aortomyoplasty to assist left ventricular failure.

Area of Science:

• Biomedical Engineering
• Cardiovascular Surgery
• Skeletal Muscle Physiology

Background:

• Skeletal muscle's contractile force can augment left ventricular function, as seen in cardiomyoplasty.
• Electrostimulated skeletal muscle in an extracardiac position offers an alternative for biomechanical cardiac assistance.
• Previous methods faced thrombotic complications due to prosthetic chambers in skeletal muscle neo-ventricles.

Purpose of the Study:

• To describe and evaluate an autologous counterpulsating device using the native ascending aorta wrapped by an electrostimulated latissimus dorsi muscle flap (LDMF).
• To assess the device's efficacy in improving cardiac function and subendocardial viability.
• To avoid thrombotic complications associated with prosthetic chambers.

Main Methods:

• A right latissimus dorsi muscle flap (LDMF) was transferred to the thoracic cavity in 8 goats.
• In 4 goats, the ascending aorta diameter was enlarged using an autologous pericardial patch.
• The LDMF was wrapped around the ascending aorta and electrostimulated for diastolic counterpulsation, with hemodynamic studies performed.

Main Results:

• Electrostimulated LDMF diastolic counterpulsation significantly improved the subendocardial viability index.
• Improvements were observed both at baseline and after acute heart failure induced by propranolol.
• The group with aortic enlargement showed a greater increase in the subendocardial viability index.

Conclusions:

• An autologous counterpulsating device using an electrostimulated LDMF wrapped around the ascending aorta is feasible.
• This approach effectively improves cardiac function and myocardial viability, offering a potential solution to thrombotic complications.
• Aortic enlargement may further enhance the benefits of this biomechanical cardiac assistance strategy.