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Ann Thorac Surg 1999;68:1675
© 1999 The Society of Thoracic Surgeons

Invited Commentaries

Juan Carlos Chachques, MD, PhDa

a Department of Cardiovascular Surgery, Broussais Hospital, 75014 Paris, France

Invited commentary

A large proportion of the drug refractory heart failure patients need a therapeutic approach other than the current standard modalities, due to the restricted number of heart donors and the high cost and drawbacks of mechanical assist devices. It has become evident that there is an international need for autologous biological heart support systems.

The rationale for the development of the aortomyoplasty procedure is appealing. The electrostimulated latissimus dorsi muscle compresses the aorta during diastole, reproducing the hemodynamic effects of intraaortic balloon counterpulsation by the following physiologic mechanisms: (1) decreasing left ventricular afterload, and (2) increasing the coronary perfusion pressure.

The intraaortic balloon pump has become a widely used form of circulatory assistance. Its major limitations are the need for an external energy source with additional risks of infection, ischemic and thormboembolic complications of the lower limbs, and severe mobility restrictions for the patient, as well as it essentially being a short-term modality.

Aortomyoplasty consists of a completely implantable autologous and hemocompatible counterpulsation system that can be used for long-term circulatory support. The aim of aortomyoplasty is to transform the ascending or descending aorta into a new cavity ("neoventricle") which is contractile and biocompatible. Aortomyoplasty could potentially be an efficient technique to assist patients with severe refractory cardiac failure. New experimental and clinical studies, such the present one, are necessary to clearly assess the benefits of this procedure.


Related Article

Acute descending aortomyoplasty induces coronary blood flow augmentation
Gil Bolotin, Tamir Wolf, Frederik H. van der Veen, Rona Shofti, Roberto Loruso, Jan J. Shreuder, and Gideon Uretzky
Ann. Thorac. Surg. 1999 68: 1668-1675. [Abstract] [Full Text] [PDF]




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