Passive Containment and Reverse Remodeling by a Novel Textile Cardiac Support Device

Konertz, Wolfgang; Shapland, J. Edward; Hotz, Holger; Dushe, Simon; Braun, J.; Stantke, Katrin; Kleber, Franz X.

doi:10.1161/hc37t1.094525

Cited by 98 publications

(62 citation statements)

References 15 publications

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“…[1][2][3][4][5][6][7][8]20,21 To date, no study has evaluated LV mechanics in restraint or the effect of adjustable restraint. Current ventricular restraint techniques, such as the Acorn Cardiac Support Device (Acorn Cardiovascular, St. Paul, Minn) and the Paracor (Paracor Medical Systems, Sunnyvale, Calif), do not allow for either the quantitative adjustment of restraint level or the measurement of P tm .…”

Section: Discussionmentioning

confidence: 99%

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Adjustable, Physiological Ventricular Restraint Improves Left Ventricular Mechanics and Reduces Dilatation in an Ovine Model of Chronic Heart Failure

et al. 2007

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Background-Ventricular restraint is a nontransplantation surgical treatment for heart failure. The effect of varying restraint level on left ventricular (LV) mechanics and remodeling is not known. We hypothesized that restraint level may affect therapy efficacy. Methods and Results-We studied the immediate effect of varying restraint levels in an ovine heart failure model. We then studied the long-term effect of restraint applied over a 2-month period. Restraint level was quantified by use of fluid-filled epicardial balloons placed around the ventricles and measurement of balloon luminal pressure at end diastole. At 4 different restraint levels (0, 3, 5, and 8 mm Hg), transmural myocardial pressure (P tm ) and indices of myocardial oxygen consumption (MV O 2 ) were determined in control (nϭ5) and ovine heart failure (nϭ5). Ventricular restraint therapy decreased P tm and MV O 2 , and improved mechanical efficiency. An optimal physiological restraint level of 3 mm Hg was identified to maximize improvement without an adverse affect on systemic hemodynamics. At this optimal level, end-diastolic P tm and MV O 2 indices decreased by 27% and 20%, respectively. The serial longitudinal effects of optimized ventricular restraint were then evaluated in ovine heart failure with (nϭ3) and without (nϭ3) restraint over 2 months. Optimized ventricular restraint prevented and reversed pathological LV dilatation (130Ϯ22 mL to 91Ϯ18 mL) and improved LV ejection fraction (27Ϯ3% to 43Ϯ5%). Measured restraint level decreased over time as the LV became smaller, and reverse remodeling slowed. Conclusions-Ventricular restraint level affects the degree of decrease in P tm , the degree of decrease in MV O 2 , and the rate of LV reverse remodeling. Periodic physiological adjustments of restraint level may be required for optimal restraint therapy efficacy.

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Section: Discussionmentioning

confidence: 99%

“…1,2 The intent is to provide passive end-diastolic support to constrain ventricular size without pathological diastolic restriction. Numerous studies have demonstrated that passive ventricular restraint may prevent or reverse left ventricular (LV) dilation and remodeling in HF.…”

mentioning

confidence: 99%

Adjustable, Physiological Ventricular Restraint Improves Left Ventricular Mechanics and Reduces Dilatation in an Ovine Model of Chronic Heart Failure

et al. 2007

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“…Initial reports of passive containment devices for treating heart failure, such as the Acorn device extending around both ventricles to the atrioventricular groove, suggest they are well tolerated by patients without clinical evidence of constriction. 30,31 Patch placement may in fact provide additional benefits by limiting ventricular remodeling. Localized patching of anterior infarcts that do not generate MR has been shown to limit the global dilatation and dysfunction that occur in remodeling; decreasing MR would compound this benefit.…”

Section: Limitations and Additional Directionsmentioning

confidence: 99%

Reverse Ventricular Remodeling Reduces Ischemic Mitral Regurgitation

et al. 2002

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Background-In ischemic mitral regurgitation (MR), mitral leaflet closure is restricted by ventricular remodeling with displacement of the papillary muscles (PMs). Therapy is uncertain because ring annuloplasty does not alleviate PM displacement. We tested the hypothesis that echo-guided PM repositioning using an external device can reduce MR without compromising left ventricular (LV) function. Methods and Results-We studied 10 sheep with ischemic MR produced by circumflex ligation with inferior infarction, 6 acutely and 4 eight weeks after myocardial infarction (MI). A Dacron patch containing an inflatable balloon was placed over the PMs and adjusted under echo guidance to reverse LV remodeling and reposition the infarcted PM. 3D echo assessed mitral valve geometric changes. In 7 sheep, sonomicrometry and Millar catheters assessed changes in end-systolic and end-diastolic pressure-volume relationships, and microspheres were injected to assess coronary flow. Moderate MR after MI resolved with patch application alone (nϭ3) or echo-guided balloon inflation, which repositioned the infarcted PM, decreasing the PM tethering distance from 31.1Ϯ2.5 mm after MI to 26.8Ϯ1.8 with patch (PϽ0.01; baselineϭ25.5Ϯ1.5). LV contractility was unchanged (end-systolic slopeϭ3.4Ϯ1.6 mm Hg/mL with patch versus 2.8Ϯ1.6 after MI). Although there was a nonsignificant trend for a mild increase in stiffness constant (0.07Ϯ0.05 mL

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“…[29,30] Atlas stitch is the basic structure and the material is multi-filamentous yarn to provide high-strength and fatigueresistant characteristics, while maintaining flexibility. [31] The fabric with warp-knitted atlas stitch is glossy and it is easy to slide on the surface of heart to provide acute wall support.…”

Section: Cardiac Support Devicementioning

confidence: 99%

Application of Knitting Structure Textiles in Medical Areas

Zhang

2018

Autex Research Journal

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There are many kinds of medical textiles, such as woven textiles, non-woven textiles, braided textiles and knitted textiles. Non-woven medical textiles constitute more than 60% of the total medical textiles used, but are almost disposable ordinary medical textiles. While knitted fabrics forms a small part of the medical textiles, but are greatly applied in high-tech medical textiles, containing artificial blood vessels, hernia patches, cardiac support devices, knitted medical expandable metallic stents and tendon scaffolds. Knitting structures, including weft knitting structure and warp knitting structure. The knitted textiles are popular for their loose structure, greater flexibility, higher porosity, more flexible structure and better forming technology. The present article will introduce some knitting structures and materials applied in the medical textiles in accordance with non-implantable, implantable, extra-corporeal textiles and healthcare and hygiene products.

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Passive Containment and Reverse Remodeling by a Novel Textile Cardiac Support Device

Cited by 98 publications

References 15 publications

Adjustable, Physiological Ventricular Restraint Improves Left Ventricular Mechanics and Reduces Dilatation in an Ovine Model of Chronic Heart Failure

Adjustable, Physiological Ventricular Restraint Improves Left Ventricular Mechanics and Reduces Dilatation in an Ovine Model of Chronic Heart Failure

Reverse Ventricular Remodeling Reduces Ischemic Mitral Regurgitation

Application of Knitting Structure Textiles in Medical Areas

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