Chachques J C, Haab F, Cron C, Fischer E C, Grandjean P, Bruneval P, Acar C, Jebara V A, Fontaliran F, Carpentier A F
Department of Cardiovascular Surgery, Broussais Hospital, Paris, France.
Ann Thorac Surg. 1994 Jul;58(1):128-34. doi: 10.1016/0003-4975(94)91085-5.
Aortomyoplasty consists of wrapping the latissimus dorsi muscle (LDM) around the ascending aorta and electrostimulating it during diastole. The ascending aorta will act as an ectopic neo-ventricle compressed during diastole, thus reproducing the effects of long-term diastolic counterpulsation. In 5 goats, the right LDM was transferred to the thoracic cavity after removal of the second rib. The ascending aorta was enlarged by a pericardial patch and wrapped with the LDM. Postoperative electrostimulation was delivered in a counterpulsating manner. Hemodynamic studies were performed at 12 and 24 months postoperatively. Percent increase in the subendocardial viability index (diastolic pressure-time index/systolic tension-time index) was calculated using unassisted and assisted cardiac cycles with the stimulator off versus the stimulator on at a 1:1 ratio in the basal state and after acute heart failure was induced by the administration of high doses of propranolol hydrochloride. Diastolic counterpulsation of the ascending aorta resulted in significant improvement in the subendocardial viability index long term, both in basal state conditions and after induced cardiac failure. During heart failure, aortomyoplasty increased the cardiac output and decreased systemic vascular resistance. Histopathologic studies up to 24 months showed preservation of the histologic structure of the aortic wall and no evidence of thromboembolism. Tight adhesions developed between the aortic wall (including the pericardial patch) and the LDM. The diameters of the enlarged aortas showed no significant differences compared with diameters immediately postoperatively. In conclusion, aortomyoplasty produces chronic diastolic augmentation with preservation of aortic structure. After induction of heart failure, aortomyoplasty offers efficient circulatory support.
主动脉成形术包括将背阔肌包裹在升主动脉周围，并在舒张期对其进行电刺激。升主动脉将充当在舒张期被压缩的异位新心室，从而再现长期舒张期反搏的效果。在5只山羊中，切除第二根肋骨后将右侧背阔肌转移至胸腔。用心包补片扩大升主动脉并用背阔肌包裹。术后以反搏方式进行电刺激。在术后12个月和24个月进行血流动力学研究。使用无辅助和辅助心动周期，在基础状态下以及在给予高剂量盐酸普萘洛尔诱导急性心力衰竭后，以1:1的比例在刺激器关闭与刺激器开启的情况下计算心内膜下存活指数（舒张压-时间指数/收缩压张力-时间指数）的百分比增加。升主动脉的舒张期反搏长期导致心内膜下存活指数显著改善，无论是在基础状态还是在诱导心力衰竭后。在心力衰竭期间，主动脉成形术增加心输出量并降低全身血管阻力。长达24个月的组织病理学研究显示主动脉壁组织结构得以保留，且无血栓栓塞迹象。主动脉壁（包括心包补片）与背阔肌之间形成紧密粘连。与术后即刻的直径相比，扩大的主动脉直径无显著差异。总之，主动脉成形术可产生慢性舒张期增强并保留主动脉结构。在诱导心力衰竭后，主动脉成形术提供有效的循环支持。
