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Ventricular containment in the prophylaxis of experimental dilated cardiomyopathy

Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany

^* Corresponding author Tel.: +49-211-811-8879; fax +49-211-811-8333
peter.feindt{at}uni-duesseldorf.de

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 () an elastic net was placed around both ventricles before pacing was induced, whereas in group II () 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 l/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 (LVP_max: 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.

Key Words: Dilated cardiomyopathy; Ventricular containment; Cardioplasty; Elastic net; Girdling effect