Mesana T G, Ferzoco S J, Reul R M, Sayeed-Shah U, Karamichalis J M, Laurence R G, Schoen F J, Cohn L H
Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA.
ASAIO J. 1997 Sep-Oct;43(5):M791-6.
Skeletal muscle cardiac assistance as a treatment modality for heart failure is considered a high-risk procedure subject to strict patient selection. The aim here is to develop minimally invasive techniques to improve surgical outcomes and increase clinical indications. Ten goats (45-55 kg) were studied. In six, the latissimus dorsi muscle (LDM) was harvested via an open technique on one side vs a minimally invasive technique on the other using video assistance through two 3 cm incisions. Surgical maneuvers and length of procedures were noted. Animals were recovered, observed daily for local complications, and killed after 1 week for comparative anatomic and histopathologic studies. In four other goats, minimally invasive aortomyoplasty or cardiomyoplasty was performed using video assistance (2 aortomyoplasty, 2 cardiomyoplasty). In this experimental series, there were no surgical complications. The minimally invasive LDM harvest required a mean of 81 min (range 55-116 mn) with no gross evidence of muscle damage. The technique of LDM harvesting was standardized and is reproducible. Aortic and cardiac wraping were also achieved through three ports and a left minithoracotomy of 4 cm, using the right or left LDM. A scarf technique for the descending aortomyoplasty using the left LDM, and an anterior wrapping for cardiomyoplasty using the left or right LDM was technically feasible with video assistance. This study suggests future clinical applicability.
骨骼肌心脏辅助作为心力衰竭的一种治疗方式，被认为是一种高风险手术，需要严格筛选患者。此处的目的是开发微创技术以改善手术效果并增加临床适应症。对10只山羊（45 - 55千克）进行了研究。在6只山羊中，一侧通过开放技术获取背阔肌（LDM），另一侧通过两个3厘米切口借助视频辅助的微创技术获取。记录手术操作和手术时长。动物恢复后，每天观察局部并发症情况，并在1周后处死以进行比较解剖学和组织病理学研究。在另外4只山羊中，借助视频辅助进行微创主动脉成形术或心肌成形术（2例主动脉成形术，2例心肌成形术）。在这个实验系列中，没有手术并发症。微创获取LDM平均需要81分钟（范围55 - 116分钟），没有明显的肌肉损伤迹象。LDM获取技术得到了标准化且可重复。使用右侧或左侧LDM，还可通过三个端口和一个4厘米的左胸小切口实现主动脉和心脏包裹。在视频辅助下，使用左侧LDM进行降主动脉成形术的围巾技术以及使用左侧或右侧LDM进行心肌成形术的前路包裹技术在技术上是可行的。这项研究表明了其未来的临床适用性。
