Myosplint implantation and ventricular shape change in patients with dilative cardiomyopathy- first clinical experience

Schenk, S.; Reichenspurner, H.; Groezner, J.G.; Boehm, Dieter H.; Schirmer, Johannes; Scheidt, Wolfgang von; Reichart, Bruno

doi:10.1016/s1053-2498(00)00474-5

Cited by 12 publications

(10 citation statements)

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“…Passive constraint devices including the Acorn CorCap and the Myosplint (Myocor, Inc., Maple Grove, MN) have had experimental success in inducing LV reverse remodeling in patients with heart failure but have not led to significant improvements in clinical outcomes. 17,18 Left ventricular assist device therapy, on the other hand, has significantly improved survival and quality of life in patients with end-stage heart failure. However, data concerning LV reverse remodeling with CF device therapy are sparse.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Reverse Remodeling With a Continuous Flow Left Ventricular Assist Device Measured by Left Ventricular End-Diastolic Dimensions and Severity of Mitral Regurgitation

Morgan¹,

Brewer²,

Nemeh³

et al. 2012

ASAIO Journal

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Pulsatile flow left ventricular assist devices (LVADs) maximally unload the left ventricle (LV), leading to reverse remodeling of the myopathic LV that manifests as decreased LV end-diastolic dimension (LVEDD) and decreased severity of mitral regurgitation (MR). There is a paucity of data, however, regarding the ability of continuous flow (CF) pumps to adequately decompress the LV to induce similar reverse remodeling. We sought to evaluate the effects of CF-LVADs on LV reverse remodeling. From March 2006 through July 2011, one hundred patients with chronic heart failure underwent implantation of CF-LVAD (93 HeartMate II LVADs and seven HeartWare LVADs) as bridge-to-transplant (n = 68) and destination therapies (n = 32). Echocardiograms and right heart catheterizations were reviewed preoperatively and at 1 and 6 months post-LVAD implantation. Mean age was 52.1 ± 12.1 years; etiology of heart failure was ischemic cardiomyopathy in 34 patients and nonischemic dilated cardiomyopathy in 66 patients. Median LVAD support time was 378.3 days; 371.5 days for patients who received bridge-to-transplant therapy and 422.2 days for patients who underwent destination therapy. Left ventricular end-diastolic dimension significantly decreased at 1 month post-LVAD implantation from 71.6 ± 12.4 to 58.3 ± 13.8 mm (p < 0.001). Severity of MR also significantly decreased from 76.0% of patients having moderate or severe MR preoperatively to 8.0% with moderate or severe MR at 1 month post-LVAD (p < 0.001). These reductions were maintained at 6 months. These data demonstrate the ability of a CF-LVAD to significantly decompress the LV, leading to significant reductions in LVEDD and severity of MR. This reverse remodeling was apparent in the early postoperative period and was sustained at 6 months. Further studies are warranted to investigate whether this correlates with clinical LV recovery.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Reverse Remodeling With a Continuous Flow Left Ventricular Assist Device Measured by Left Ventricular End-Diastolic Dimensions and Severity of Mitral Regurgitation

Morgan¹,

Brewer²,

Nemeh³

et al. 2012

ASAIO Journal

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“…Because the dilated ventricle is the cornerstone of DCM, attempts have been made to alter this inexorable disease course through physical support and restraint of the heart. (1–7, 21–23) However, whether and to what degree myocardial blood flow patterns are acutely altered by HeartNet Implant placement in the context of DCM remains unknown. Accordingly, in the present study we evaluated two versions of the HeartNet Implant in a clinically relevant model of DCM to examine the effects of acute HeartNet Implant placement on hemodynamics and myocardial blood flow patterns.…”

Section: Discussionmentioning

confidence: 99%

“…(1–7, 21–23) The CorCap Cardiac Support Device (Acorn Cardiovascular, Inc, St. Paul, MN) has been examined in several experimental models of heart failure and has advanced to clinical trials, demonstrating sustained reduction in LV end diastolic and systolic volumes compared to controls. (1) While the CorCap consists of a polyester-weave device which is placed around both ventricles, other devices have employed a splint approach to cardiac support.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamics and myocardial blood flow patterns after placement of a cardiac passive restraint device in a model of dilated cardiomyopathy

Dixon

Goodman²,

Gaillard

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Background The present study examined a cardiac passive restraint device which applies epicardial pressure (HeartNetTM Implant) in a clinically relevant model of dilated cardiomyopathy (DCM) to determine effects on hemodynamic and myocardial blood flow patterns. Methods DCM was established in 10 pigs (3 weeks atrial pacing, 240 beats per minute). Hemodynamic parameters and regional left ventricle (LV) blood flow were measured under baseline conditions and following acute HeartNet (Paracor Medical Inc, Sunnyvale, CA) placement. Measurements were repeated following adenosine infusion, allowing maximal coronary vasodilation and coronary flow reserve determination. Results LV dilation and systolic dysfunction occurred relative to baseline as measured by echocardiography. LV end diastolic dimension increased and LV fractional shortening decreased (3.8±0.1 vs 6.1±0.2cm and 31.6±0.5 vs 16.2±2.1%, both p<0.05 respectively) consistent with the DCM phenotype. The HeartNet was successfully deployed without arrhythmias and a computed median mid-LV epicardial pressure of 1.4 mmHg was applied by the HeartNet throughout the cardiac cycle. Acute HeartNet placement did not adversely affect steady state hemodynamics. With the HeartNet in place, coronary reserve was significantly blunted. Conclusions In a large animal model of DCM, the cardiac passive restraint device did not appear to adversely affect basal resting myocardial blood flow. However, following acute HeartNet placement, LV maximal coronary reserve was blunted. These unique results suggest that cardiac passive restraint devices which apply epicardial transmural pressure can alter myocardial blood flow patterns in a DCM model. Whether this blunting of coronary reserve holds clinical relevance with chronic passive restraint device placement remains unestablished.

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“…Unter all diesen Aspekten erscheint eine signifikante Verbesserung der Herzfunktion mit diesem Verfahren nicht möglich. So wurden dann auch enttäuschende Ergebnisse berichtet [74]: Durch die Implantation der Myosplints ® wurde eine bedeutsame Mitralklappeninsuffizienz erzeugt, die eine Mitralklappenrekonstruktion erforderte. Weder die Ejektionsfraktion, das Schlagvolumen noch die Belastbarkeit der Patienten verbesserten sich deutlich.…”

Section: Myosplint®unclassified

Chirurgische Therapie der chronischen Herzinsuffizienz

Christiansen

Brose

Autschbach

2003

Herz

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Heart failure is still associated with a poor prognosis despite great advances in drug therapy, so that surgical procedures are necessary in patients with end-stage cardiac failure. Cardiac transplantation was the therapy of choice during the last decades, but due to its disadvantages and the increasing scarcity of donor organs other surgical procedures were developed. Multisite pacing improves quality of life, but a longterm survival benefit remains to be proved. Coronary artery bypass grafting and valve surgery demonstrated to improve quality of life and to increase long-term survival. Ventricular assist devices are effective in bridging up to 70% of patients to cardiac transplantation, but the number of complications must be reduced. Partial left ventriculectomy may be performed with results similar to those obtained of cardiac transplantation, but long-term results are not yet available. Dynamic cardiomyoplasty and Myosplint implantation were not successful, but it must be awaited, if passive cardiomyoplasty leads to better results. Xenotransplantation is under intense investigation, but cannot be used clinically until now due to the hurdles of rejection and transfer of infectious diseases. This work provides a summary of today's knowledge about surgical procedures for end-stage heart failure.

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Myosplint implantation and ventricular shape change in patients with dilative cardiomyopathy- first clinical experience

Cited by 12 publications

References 0 publications

Left Ventricular Reverse Remodeling With a Continuous Flow Left Ventricular Assist Device Measured by Left Ventricular End-Diastolic Dimensions and Severity of Mitral Regurgitation

Left Ventricular Reverse Remodeling With a Continuous Flow Left Ventricular Assist Device Measured by Left Ventricular End-Diastolic Dimensions and Severity of Mitral Regurgitation

Hemodynamics and myocardial blood flow patterns after placement of a cardiac passive restraint device in a model of dilated cardiomyopathy

Chirurgische Therapie der chronischen Herzinsuffizienz

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