Reverse remodeling by net cardioplasty in a model of dilated cardiomyopathy: results of an animal study.

AIM

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%).

CONCLUSION

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.