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J Thorac Cardiovasc Surg 2002;123:1067-1073
© 2002 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Circulatory benefits of diastolic counterpulsation in an ischemic heart failure model after aortomyoplasty

From the University Hospitals of Cleveland,^a Case Western Reserve University School of Medicine, and the Cleveland Veterans Affairs Medical Center,^b Cleveland, Ohio.

Supported by: Office of Research and Development, Medical Research Service, Department of Veterans Affairs and American Heart Association, Ohio Valley Affiliate. Dr Hedayati is an Allen Fellow supported by the Jay L. Ankeney Endowed Professorship in Cardiothoracic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Read at the Eighty-first Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif, May 6-9, 2001.

Received for publication May 15, 2001. Revisions requested Sept 12, 2001; revisions received Oct 8, 2001. Accepted for publication Nov 7, 2001. Address for reprints: Brian L. Cmolik, MD, University Hospitals of Cleveland, Cardiothoracic Surgery, 11100 Euclid Ave, Cleveland, OH 44106-5011 (E-mail: blc3{at}po.cwru.edu).

Objective: Aortomyoplasty is an experimental surgical procedure in which the latissimus dorsi muscle is wrapped around the thoracic aorta and stimulated to contract during diastole, providing diastolic counterpulsation. We hypothesized that aortomyoplasty could improve cardiac function in a chronic ischemic heart failure model, similar to the improvement seen with the intra-aortic balloon pump.
Methods: Six dogs (25-30 kg) successfully underwent aortomyoplasty followed by serial coronary microembolization. Ejection fraction decreased from 63.5% to 36.5%. Two weeks after the final microembolization, the muscle was conditioned for 4 months to achieve fatigue resistance. One year after aortomyoplasty, hemodynamic studies during 1 hour of aortomyoplasty and 1 hour of intra-aortic balloon counterpulsation determined mean diastolic aortic pressure, peak left ventricular pressure, and endocardial viability ratio for assisted and unassisted beats. Cardiac output, stroke volume, and parameters of cardiac function were also measured.
Results: Endocardial viability ratio increased by 23.8% ± 7.9% (P = .001) with aortomyoplasty counterpulsation and by 22.7% ± 12.9% (P = .021) with the intra-aortic balloon pump. Both aortomyoplasty and the intra-aortic balloon pump significantly increased mean diastolic aortic pressure and reduced peak left ventricular pressure. Improvements in cardiac function with aortomyoplasty and the intra-aortic balloon pump were similar. Cardiac output increased from 2.61 ± 0.88 to 3.07 ± 1.06 L/min (P = .006), and index of afterload decreased from 5.4 ± 1.4 to 4.8 ± 1.4 mm Hg/mL (P = .02) during 1 hour of aortomyoplasty counterpulsation.
Conclusion: One year after the procedure, aortomyoplasty counterpulsation provided diastolic augmentation and improved cardiac performance similar to the improvement provided by the intra-aortic balloon pump in a chronic ischemic heart failure model. Aortomyoplasty has the potential to benefit patients with ischemic heart disease refractory to current therapies.

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