Mesana T G, Mouly-Bandini A, Ferzoco S J, Collart F, Caus T, Reul R M, Monties J R, Schoen F J, Cohn L H
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts USA.
J Card Surg. 1998 Jan;13(1):60-9. doi: 10.1111/j.1540-8191.1998.tb01057.x.
Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach.
A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint.
Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure.
使用背阔肌（LD）辅助治疗慢性心力衰竭的外科手术会给重症患者带来重大创伤。一种侵入性较小的方法可能会被证明是有益的。本文的目的是回顾我们动态主动脉成形术（AMP）的临床和实验方法，并强调有必要将手术技术重新导向新的方向以及采用侵入性较小的胸腔镜方法。
一项关于动态降主动脉AMP的临床试点研究于1995年6月开始，纳入了4例患者。其中2例受益于LD反搏，分别存活了6个月和18个月。基于这一临床经验，我们在动物模型上研究了该手术的微创胸腔镜手术。12只山羊接受了内镜下LD采集和视频辅助主动脉包裹，并在手术恢复后从解剖学和功能角度进行了研究。
使用开放技术的临床AMP为其他手术治疗禁忌的纽约心脏协会（NYHA）IV级患者提供了主动脉外反搏。然而，手术技术和策略需要改进，以实现最佳的心脏辅助和更好的患者预后。微创胸腔镜手术在山羊身上是可行且可重复的，与人类的开放技术相比，其解剖学和生理学效果得到了改善。当使用适当的包裹技术和刺激方案时，可实现最佳反搏。我们得出结论，胸腔镜AMP可能为心脏辅助提供一种微创方法，从而为慢性心力衰竭患者提供一种新的手术选择。
