Jorge Mouras

Dynamic Aortomyoplasty in Treating End-stage Heart Failure

BACKGROUND Dynamic aortomyoplasty is an alternative to heart transplantation. The goal of our study was to evaluate the benefits of aortic counterpulsation obtained using dynamic aortomyoplasty in patients with heart failure refractory to pharmacologic treatment and with contraindications to heart transplant. METHODS In this study, we compared the pre-operative and post-operative data of 15 selected patients who underwent dynamic thoracic aortomyoplasty. In this surgical technique, the right latissimus dorsi muscle flap is wrapped around the ascending aorta. This muscle flap was electrically stimulated during diastole, following a muscle-conditioning protocol, to obtain diastolic augmentation. At 12-month follow-up, we evaluated invasively and non-invasively the hemodynamic, clinical, and functional effects of aortomyoplasty. RESULTS When comparing pre-operative data with 12-month follow-up data, we observed a significant decrease in the number of hospitalizations (p < 0.001) and in the New York Heart Association functional class (p < 0.001), and we observed significant improvement in the walking test (p < 0.001) and in peak oxygen consumption (p < 0.05). CONCLUSIONS Dynamic, biologic, chronic counterpulsation of the aorta using a latissimus dorsi flap (dynamic aortomyoplasty) in selected patients with severe heart failure significantly improved hemodynamic parameters, heart functional data, and clinical functional class. A larger clinical experience with a longer follow-up would be useful in evaluating this techniques clinical relevance.