Optimizing Epicardial Restraint and Reinforcement Following Myocardial Infarction: Moving Towards Localized, Biomimetic, and Multitherapeutic Options

Abstract

The mechanical reinforcement of the ventricular wall after a myocardial infarction has been shown to modulate and attenuate negative remodeling that can lead to heart failure. Strategies include wraps, meshes, cardiac patches, or fluid-filled bladders. Here, we review the literature describing these strategies in the two broad categories of global restraint and local reinforcement. We further subdivide the global restraint category into biventricular and univentricular support. We discuss efforts to optimize devices in each of these categories, particularly in the last five years. These include adding functionality, biomimicry, and adjustability. We also discuss computational models of these strategies, and how they can be used to predict the reduction of stresses in the heart muscle wall. We discuss the range of timing of intervention that has been reported. Finally, we give a perspective on how novel fabrication technologies, imaging techniques, and computational models could potentially enhance these therapeutic strategies.

Elastomeric cardiopatch scaffold for myocardial repair and ventricular support

“…In summary, we were able to successfully integrate the cardiopatch histologically into damaged myocardium and adjacent to healthy tissue, such that it became an artificial ECM that offered adequate cell niches for the homing of stem cells or exosomes [26]. Results from this study substantially contributed to the generation of an elastomeric cardiopatch and opened the way to create cardiowrap-supported bioprostheses that may become clinically applicable in the supportive treatment of ischaemic heart disease and chronic heart failure [1,5,6,15].…”

“…The chronically electrostimulated latissimus dorsi skeletal muscle flap wrapped around the heart works in concert with the myocardium, improving the haemodynamics via an electronic cardiomyostimulator device with electrodes. Less invasive alternative approaches like ventricular restraint therapy using polyester mesh wraps and nitinol devices have been proposed for patients with heart failure; however, these constraint acellular devices have failed to demonstrate clear clinical benefits [15]. A new approach based on myocardial tissue engineering might instead herald myocardial healing and evidence of ventricular support [5].…”

RVEX: Right Ventricular External Device for Biomimetic Support and Monitoring of the Right Heart

“…Previous studies have suggested that cardiac biomaterials should match native anisotropic and regionally heterogeneous mechanical properties so as to not impede cardiac function and improve device‐tissue coupling. [ 18,19 ] In designing a biomimetic sleeve for the RV, the ideal metamaterial should expand and contract in orthogonal directions (longitudinal and circumferential) simultaneously and exhibit spatially varying stiffness. These design requirements led to the choice of auxetic metamaterial structures (possessing a negative Poisson's ratio) to achieve the desired biomimetic performance.…”

Mitral valve replacement and implantation of an extracardial mesh frame in patients with severe heart failure: results of a clinical study and a description of a clinical case 18 years after surgery

“…Каркас АКОР-1 РНЦХ РАМН имеет равную степень растяжимости в обоих направленияхпо длиннику и поперечнику сердца, что обеспечивает более активное участие в сокращении желудочка его верхушки, с которой, собственно, сокращение и начинается. Кроме того, каркас АКОР- ОРИГИНАЛЬНЫЕ СТАТЬИ § ских систем, клеточных технологий [14][15][16][17][18]. Это обстоятельство, наряду с позитивными отдаленными результатами комбинированного («медикаментозная терапия + хирургия») больного М-н, дает основание сделать вывод о целесообразности возобновления экспериментальных и клинических исследований по применению экстракардиального сетчатого каркаса.…”