Ventricular containment in the prophylaxis of experimental dilated cardiomyopathy

摘要

End-stage heart failure is an increasing clinical problem with only a few satisfactory therapeutic options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanical containment of the dilating heart. In 16 pigs (50 ± 7 kg) DCM with congestive heart failure was initiated by rapid ventricular pacing (220 beats/m) for at least 4 weeks. In group I (n = 8) an elastic net was placed around both ventricles before pacing was induced, whereas in group II (n - 8) only the catheters for hemodynamic measurements were implanted, Comparing hemodynamic data the decrease of cardiac output (CO) and dp/dt_(max) during the period of stimulation was significantly lower in group I than in group II (CO: gr. I: - 1.4 1/min; gr. 2: -4.1 l/min/dp/dt_(max): gr. II: +288 mmHg/s; gr. 2: - 1350 mmHg/s), This observation could also be made concerning the maximal left ventricular pressure (LVPmax: gr. I: + 8.6 mmHg; gr. II: - 39.4 mmHg). Ventricular containment with an elastic net seems to be a prophylactic option in cardiac insufficiency caused by ventricular dilation. This 'cardioplasty' is able to reduce the development of such a dilation with concomitant heart failure.