Reverse remodeling by net cardioplasty in a model of dilated cardiomyopathy: results of an animal study.
OBJECTIVE
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 11-animals, the decrease of CO and dp/dt(max) 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%).


CONCLUSIONS
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.
Feindt
P
P
Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University, Düsseldorf - Germany.
Litmathe
J
J
Boeken
U
U
Gams
E
E
D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004195:Disease Models, Animal; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D011091:Polyesters; D013526:Surgical Mesh; D013552:Swine; D020257:Ventricular Remodeling / Q000502:physiology*
D011091:Polyesters