title: Algisyl-LVR™ with coronary artery bypass grafting reduces left ventricular wall stress and improves function in the failing human heart.
abstract: BACKGROUND
  Left ventricular (LV) wall stress reduction is a cornerstone in treating heart failure. Large animal models and computer simulations indicate that adding non-contractile material to the damaged LV wall can potentially reduce myofiber stress. We sought to quantify the effects of a novel implantable hydrogel (Algisyl-LVR™) treatment in combination with coronary artery bypass grafting (i.e. Algisyl-LVR™+CABG) on both LV function and wall stress in heart failure patients.
  
  
  RESULTS
  Magnetic resonance images obtained before treatment (n=3), and at 3 months (n=3) and 6 months (n=2) afterwards were used to reconstruct the LV geometry. Cardiac function was quantified using end-diastolic volume (EDV), end-systolic volume (ESV), regional wall thickness, sphericity index and regional myofiber stress computed using validated mathematical modeling. The LV became more ellipsoidal after treatment, and both EDV and ESV decreased substantially 3 months after treatment in all patients; EDV decreased from 264 ± 91 ml to 146 ± 86 ml and ESV decreased from 184 ± 85 ml to 86 ± 76 ml. Ejection fraction increased from 32 ± 8% to 47 ± 18% during that period. Volumetric-averaged wall thickness increased in all patients, from 1.06 ± 0.21 cm (baseline) to 1.3 ± 0.26 cm (3 months). These changes were accompanied by about a 35% decrease in myofiber stress at end-of-diastole and at end-of-systole. Post-treatment myofiber stress became more uniform in the LV.
  
  
  CONCLUSIONS
  These results support the novel concept that Algisyl-LVR™+CABG treatment leads to decreased myofiber stress, restored LV geometry and improved function.
authors: Department of Surgery, University of California, San Francisco, CA, USA; Department of Bioengineering, University of California, San Francisco, CA, USA.
authors: Lik Chuan
authors: LC
authors: Lee
authors: Samuel T
authors: ST
authors: Wall
authors: Doron
authors: D
authors: Klepach
authors: Liang
authors: L
authors: Ge
authors: Zhihong
authors: Z
authors: Zhang
authors: Randall J
authors: RJ
authors: Lee
authors: Andy
authors: A
authors: Hinson
authors: Joseph H
authors: JH
authors: Gorman
authors: Robert C
authors: RC
authors: Gorman
authors: Julius M
authors: JM
authors: Guccione
mesh_terms: D000328:Adult; D000368:Aged; D000464:Alginates / Q000494:pharmacology*; D001672:Biocompatible Materials / Q000494:pharmacology; D001026:Coronary Artery Bypass / Q000379:methods*; D003760:Dental Impression Materials; D005260:Female; D005500:Follow-Up Studies; D020723:Glucuronic Acid / Q000494:pharmacology; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006603:Hexuronic Acids / Q000494:pharmacology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009200:Myocardial Contraction; D019919:Prosthesis Implantation / Q000379:methods*; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000464:Alginates; D001672:Biocompatible Materials; D003760:Dental Impression Materials; D006603:Hexuronic Acids; D020723:Glucuronic Acid
keywords: Congestive heart failure; Coronary artery bypass grafting; Dilated cardiomyopathy; Left ventricular wall stress; Magnetic resonance imaging; Mathematical modeling
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