Girdling effect of nonstimulated cardiomyoplasty on left ventricular function

Capouya, Eli R.; Gerber, R.; Drinkwater, Davis C.; Pearl, Jeffrey M.; Sack, Jeffrey B.; Aharon, Alon S.; Barthel, Steven W.; Kaczer, Elias; Chang, Paul; Laks, Hillel

doi:10.1016/0003-4975(93)90345-i

Cited by 95 publications

(28 citation statements)

References 15 publications

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“…Even though the procedure involved extensive surgery and was plagued with technical difficulties, patients showed symptomatic improvement. 24,25 However, several experimental 26,27 and clinical 28 studies have suggested that the improvement was derived primarily from the passive girdling of the heart and not from active contraction of the skeletal muscle. Several studies in various animal models of HF have shown that progressive LV dilation can be prevented or attenuated by wrapping synthetic materials around the cardiac ventricles to elicit containment.…”

Section: Discussionmentioning

confidence: 99%

Reversal of Chronic Molecular and Cellular Abnormalities Due to Heart Failure by Passive Mechanical Ventricular Containment

Sabbah¹,

Sharov²,

Gupta³

et al. 2003

Circulation Research

102

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Abstract-Passive mechanical containment of failing left ventricle (LV) with the Acorn Cardiac Support Device (CSD) was shown to prevent progressive LV dilation in dogs with heart failure (HF) and increase ejection fraction. To examine possible mechanisms for improved LV function with the CSD, we examined the effect of CSD therapy on the expression of cardiac stretch response proteins, myocyte hypertrophy, sarcoplasmic reticulum Ca 2ϩ -ATPase activity and uptake, and mRNA gene expression for myosin heavy chain (MHC) isoforms. HF was produced in 12 dogs by intracoronary microembolization. Six dogs were implanted with the CSD and 6 served as concurrent controls. LV tissue from 6 normal dogs was used for comparison. Compared with normal dogs, untreated HF dogs showed reduced cardiomyocyte contraction and relaxation, upregulation of stretch response proteins (p21ras, c-fos, and p38 ␣/␤ mitogen-activated protein kinase), increased myocyte hypertrophy, reduced SERCA2a activity with unchanged affinity for calcium, reduced proportion of mRNA gene expression for ␣-MHC, and increased proportion of ␤-MHC. Therapy with the CSD was associated with improved cardiomyocyte contraction and relaxation, downregulation of stretch response proteins, attenuation of cardiomyocyte hypertrophy, increased affinity of the pump for calcium, and restoration of ␣-and ␤-MHC isoforms ratio. The results suggest that preventing LV dilation and stretch with the CSD promotes downregulation of stretch response proteins, attenuates myocyte hypertrophy and improves SR calcium cycling. These data offer possible mechanisms for improvement of LV function after CSD therapy. Key Words: heart failure Ⅲ myocyte hypertrophy Ⅲ sarcoplasmic reticulum Ⅲ myosin heavy chain H eart failure (HF) is a progressive disorder mediated through multiple signaling pathways. Once initiated, HF is characterized by increased neurohumoral activation and ventricular dilation. Although such compensatory changes are initially beneficial, over the long-term they cause adverse structural and functional changes collectively referred to as ventricular remodeling. Ventricular dilation also causes increased mechanical stress and myocardial stretch. Upregulation of stretch response proteins, such as p21ras, 1 c-fos, 2,3 and p38 ␣/␤ mitogen-activated protein kinase (MAPK), 4 have been shown to induce cardiomyocyte hypertrophy.The Acorn Cardiac Support Device (CSD) has been shown to halt progressive left ventricular (LV) dilation and improve ejection fraction. [5][6][7] However, the mechanism(s) underlying the improved cardiac function has not been elucidated. In the present study, we tested the hypothesis that improvement in LV systolic function in dogs with HF after long-term therapy with the CSD results, in part, from downregulation of stretch response proteins, attenuation of cardiomyocyte hypertrophy, 1-4 and improvement of sarcoplasmic reticulum (SR) calcium cycling. To further understand the mechanisms for the improvement in LV systolic function, we also explored the influence of ...

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Section: Discussionmentioning

confidence: 99%

Reversal of Chronic Molecular and Cellular Abnormalities Due to Heart Failure by Passive Mechanical Ventricular Containment

Sabbah¹,

Sharov²,

Gupta³

et al. 2003

Circulation Research

102

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“…Animal [17][18][19][20] and clinical [21,22] studies of cardiomyoplasty support a conclusion that passive external constraint by the muscle wrap may halt or even reverse remodeling of the dilated ailing heart. It has been postulated that the constraining effect of cardiomyoplasty on the left ventricle E-mail: rwalsh@acorncv.com stabilizes cardiac function by limiting left ventricular volume, thus reducing chronic dilation and decreasing diastolic strain [23].…”

Section: Introductionmentioning

confidence: 77%

“…This prompted reevaluation of the mechanism of dynamic cardiomyoplasty, with the proposal that passive mechanical constraint was an important contributor of cardiomyoplasty success. The skeletal muscle was believed to supply an external constraint against cardiac dilatation, while reducing ventricular wall tension [12].…”

Section: Introductionmentioning

confidence: 99%

Design and Features of the Acorn CorCapTM Cardiac Support Device: The Concept of Passive Mechanical Diastolic Support

Walsh

2005

Heart Fail Rev

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The Laplace equation points to the importance of ventricular wall stress as a factor in heart failure development and progression. Based on animal and clinical experience with active and passive cardiomyoplasty, a synthetic passive constraint was proposed as a means of reducing excessive wall stress, and thus assuaging disease progression. The Acorn CorCap CSD Cardiac Support Device was designed to provide passive diastolic support and serve as a constraint against chronic cardiac dilation in heart failure. Basic and uncomplicated in appearance, the device nevertheless incorporates numerous sophisticated structural and functional features intended maximize therapeutic value. The device is fabricated from medical grade multifilament polyester yarn, in a specific knit construction chosen to provide structural integrity, low physical profile, pliability for intimate contact with the epicardial surface, ease of manipulation during implantation, and anisotropic compliance characteristics to encourage beneficial reverse remodeling.

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“…However, observations in some of these patients revealed that even nonstimulated or fibrotic transformed latissimus dorsi wraps led to an improvement of heart failure symptoms [7,12,13]. In a canine model of heart failure, Capouya et al [14] demonstrated that simple wrapping of the heart with a nonstimulated latissimus dorsi muscle preserved cardiovascular function compared with untreated controls. This mechanism was described as a "girdling" effect [12,14].…”

Section: Introductionmentioning

confidence: 97%

Mitral Valve Repair: What the ACORN Trial Taught Us

Ali

Bolling

2010

Curr Cardiol Rep

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Progressive left ventricular remodeling is characterized by dilation of the left ventricle with a change in the heart from an elliptical shape to a more spherical shape. This change is part of the unfavorable natural history in patients with heart failure. The CorCap Cardiac Support Device (Acorn Cardiovascular, St. Paul, MN) is a mesh device that is implanted around the heart to reduce wall stress and the first therapy specifically designed to address left ventricular remodeling. The CorCap was studied in a large, prospective, randomized, multicentered trial. This study demonstrated safety and effectiveness of the CorCap in patients with advanced heart failure and remodeled ventricles. Moreover, it provided interesting insights into mitral valve surgery in patients with heart failure. These insights and a review of the ACORN (Assessment of a Cardiac Support Device [CSD] in Patients With Heart Failure) trial are discussed in this article.

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Girdling effect of nonstimulated cardiomyoplasty on left ventricular function

Cited by 95 publications

References 15 publications

Reversal of Chronic Molecular and Cellular Abnormalities Due to Heart Failure by Passive Mechanical Ventricular Containment

Reversal of Chronic Molecular and Cellular Abnormalities Due to Heart Failure by Passive Mechanical Ventricular Containment

Design and Features of the Acorn CorCapTM Cardiac Support Device: The Concept of Passive Mechanical Diastolic Support

Mitral Valve Repair: What the ACORN Trial Taught Us

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