Effects of passive cardiac containment on left ventricular structure and function: verification by volume and flow measurements

Lembcke, Alexander; Wiese, T. H.; Dushe, Simon; Hotz, Holger; Enzweiler, Christian N.H.; Hamm, Bernd; Konertz, Wolfgang

doi:10.1016/s1053-2498(03)00066-4

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…More recently, LV passive support devices have been introduced to limit ventricular dilatation. Results from preliminary animal experiments and clinical studies suggest that ventricular containment may provide long-term reverse remodeling by preventing late dilatation [1][2][3][4]11,14]. In the current study, heart failure was induced in 10 animals through coronary microembolization.…”

Section: Discussionmentioning

confidence: 81%

“…Discrepancies in the effect of LVSD therapy on cardiac function exist in the literature. In two studies by Lembcke et al [2], ACORN placement in 14 patients increased EF from 20% to 28% and produced a higher EF by computed tomography in 9 patients [15]. Similarly, EF was improved from 19% to 30% in sheep with severe heart failure after ACORN placement after one month.…”

Section: Discussionmentioning

confidence: 92%

“…The mechanisms responsible for the benefits of an LVSD have been partially shown previously [1][2][3][4]6]. First, by restraining the ventricular radius and limiting wall thickness, the device decreases wall stress and likely myocardial consumption as well.…”

Section: Discussionmentioning

confidence: 96%

“…Left ventricular passive support devices (LVSD) are surgically implanted to limit progressive dilatation through containment, reducing wall stress and thereby restoring normal left ventricular sphericity [1]. Several benefits of these devices have been documented, including improvements in NYHA class, lower end diastolic volume (EDV), decreased myocardial mass, and improved mitral regurgitation (MR) [2]. Reverse remodeling at a molecular level is similarly seen, with reduced cardiomyocyte hypertrophy, reduced interstitial fibrosis, and a reduced oxygen diffusion distance [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, patients with asynchronous wall motion demonstrate impaired LV filling. It is known that a LVSD reduces sphericity and qualitatively improves wall motion by echocardiography, computed tomography, and magnetic resonance imaging [2,6]. At the current time, it is unknown if LV synchrony improves after LVSD placement and if changes in synchrony affect myocardial function after prolonged duration of device support.…”

Section: Introductionmentioning

confidence: 99%

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Effect of passive cardiac containment on ventricular synchrony and cardiac function in awake dogs

George

Cheng

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: Passive restraint of the left ventricle (LV) has been shown to have beneficial effects on acute hemodynamics and reverse remodeling in both animal and human models. The goals of this study were to test whether a left ventricular support device (LVSD) improves LV synchrony and/ or affects cardiac performance. Methods: Ten dogs were chronically instrumented to measure hemodynamics and LV volume (sonomicrometry). Congestive heart failure (CHF) was induced by repeated intracoronary microembolization via a chronically implanted coronary catheter. The LVSD was implanted after establishment of CHF in five animals, and five animals were observed as controls. All animals were then observed for 8 weeks.A mathematical model to measure LV synchrony was used to evaluate LV motion over time. Results: Mean arterial pressure and LV pressures was significantly increased after LVSD therapy, and LV pressure-volume relationships were shifted leftwards, although no change was seen in ejection fraction, end-systolic elastance, or LV dP/dt versus control. There was no significant change in diastolic function in LVSD animals compared with control animals. End-diastolic volumes were reduced by 15% after 8 weeks with LVSD treatment, versus an increase of 8% in control animals ( p < 0.05). Synchrony was significantly improved with LVSD therapy compared with control (9% vs 76% of baseline) in 1 of 11 ventricular dimension axes (Anterior-Apex). Conclusions: LVSD therapy provided only minimal improvement in ventricular synchrony and partially improved hemodynamics. Further study into mechanisms of benefit are warranted. #

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