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Ann Thorac Surg 1999;67:1022-1029
© 1999 The Society of Thoracic Surgeons

Original Articles

Dynamic abdominal and thoracic aortomyoplasty in heart failure: assessment of counterpulsation

Edmundo I. Cabrera Fischer, MDa, Alejandra I. Christen, MDa, Eduardo de Forteza, EEnga, Marcelo R. Risk, EEnga

a Basic Sciences Research Institute, Favaloro University, Buenos Aires, Argentina

Accepted for publication September 21, 1998.

Address reprint requests to Dr Cabrera Fischer, Basic Sciences Research Institute, Favaloro University, Solís 453, (1078) Buenos Aires, Argentina
e-mail: fischer{at}favaloro.edu.ar

Background. Aortic counterpulsation, either biologic or mechanical, is a useful technique to support circulation during left ventricular dysfunction.

Methods. In this study we used an induced cardiac failure model in acute open chest sheep to compare hemodynamic improvements between thoracic and abdominal aortic counterpulsation. This was achieved with left latissimus dorsi and left hemidiaphragm muscle flaps.

Results. Thoracic and abdominal aortic counterpulsation in heart failure resulted in a significant improvement of hemodynamic parameters. Subendocardial viability index, defined as diastolic pressure-time index to systolic tension-time index, in thoracic and abdominal aortomyoplasty showed significant improvement (p < 0.05) when cardiac assistance was performed by electrical stimulation of each muscle flap. A new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve was tested, obtaining a correlation coefficient with the subendocardial viability index of 0.758 (p < 0.001). Values of subendocardial viability index and counterpulsation index showed minimal variability.

Conclusions. Treatment of experimentally induced cardiac failure with dynamic abdominal aortic counterpulsation allows an effective hemodynamic improvement in open chest sheep. Furthermore, this diastolic arterial pressure augmentation could be evaluated through a new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve.




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