Abstract
Aim
End-stage heart failure is a growing clinical problem with only a few satisfactory therapeutical options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanically containing the dilated heart with a special net.
Methods
In 16 pigs (50 ± 7 kg) DCM congestive heart failure was initiated by rapid ventricular pacing (220 b/m). In series 1 (n=8) a polyester net was placed around both ventricles before pacing was induced, whereas in series 2 (n=8) ventricular wrapping was performed when DCM was established.
Results
Comparing hemodynamic data before re-operation of group II-animals, the decrease of CO and dp/dtmax was significantly lower in series 1 than in series 2 compared to the baseline values before pacing (CO: series 1:-22.6±3.3%, series 2:-52.4±6.4%, P&0.05; dp/dt: series 1: +16.4±2.8%, series 2: −51.5±5.9%, P&0.05).
In series 2, after net implantation, we could furthermore show that deterioration of the animal stopped and hemodynamic data improved significantly in the following 2 weeks (CO: +62.9±10.5% and dp/dt +37.0±6.8%).
Conclusion
Ventricular containment with a polyester net seems to be a therapeutic option in cardiac insuffiency caused by ventricular dilation. This cardioplasty induced a reverse remodeling of the dilated hearts with a significant improvement in diastolic and systolic ventricular function.
Keywords
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