title: Epicardial catheter-based ventricular reconstruction: a novel therapy for ischaemic heart failure with anteroapical aneurysm.
abstract: OBJECTIVE
  Surgical ventricular reconstruction has been used to treat ischaemic cardiomyopathy with large akinetic or dyskinetic areas. However, application of this approach requires a sternotomy, cardiopulmonary bypass and a left ventriculotomy. This study assessed the feasibility and efficacy of minimally invasive, off-pump, epicardial catheter-based ventricular reconstruction (ECVR) in an anteroapical aneurysm ovine model.
  
  
  METHODS
  Left ventricular (LV) anteroapical myocardial infarction was induced percutaneously by coil embolization of the left anterior descending coronary artery. Eight weeks after infarction, via mini left thoracotomy and without cardiopulmonary bypass, ECVR was performed in six sheep. The scar was excluded by placing anchor pairs on the LV epicardial anterior wall and the right ventricular side of the interventricular septum under fluoroscopic guidance. LV performance was evaluated before, immediately after device implantation and after 6 weeks by echocardiography. Terminal histopathology was performed.
  
  
  RESULTS
  ECVR was completed expeditiously in all animals without complications. Parameters obtained 6 weeks after device implantation were compared with baseline (pre-device). End-systolic volume was decreased by 38% (25.6 ± 6.1 ml vs baseline 41.2 ± 7.2 ml, P = 0.02) with preservation of stroke volume. Ejection fraction was significantly increased by 13% (48.5 ± 7% vs baseline 35.8 ± 7%, P = 0.02). The circumferential strain in the anterior septum (-7.67 ± 5.12% vs baseline -0.96 ± 2.22%, P = 0.03) and anterior wall (-9.01 ± 3.51% vs baseline -4.15 ± 1.36%, P = 0.01) were significantly improved. The longitudinal strain in apex was reversed (-3.08 ± 1.53% vs baseline 3.09 ± 3.39%, P = 0.01). Histopathology showed full endocardial healing over the anchors with appreciable reduction of the chronic infarct in the LV.
  
  
  CONCLUSIONS
  ECVR without cardiopulmonary bypass is a less invasive alternative to current standard therapies, reverses LV remodelling and improves cardiac performance in an ovine model of anteroapical aneurysm.
authors.affiliation: The Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Cheng
authors.forename: Michael S
authors.initials: MS
authors.lastname: Aboodi
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wechsler
authors.forename: Greg L
authors.initials: GL
authors.lastname: Kaluza
authors.forename: Juan F
authors.initials: JF
authors.lastname: Granada
authors.forename: Kevin
authors.initials: K
authors.lastname: Van Bladel
authors.forename: Lon S
authors.initials: LS
authors.lastname: Annest
authors.forename: Geng-Hua
authors.initials: GH
authors.lastname: Yi
mesh_terms: D000818:Animals; D056988:Anterior Wall Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D004195:Disease Models, Animal; D004867:Equipment Design; D005240:Feasibility Studies; D006322:Heart Aneurysm / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012756:Sheep; D013908:Thoracotomy; D013997:Time Factors; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Congestive heart failure; Off-pump surgery; Ventricular reshaping