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The mid-term results of ventricular containment (ACORN WRAP) for end-stage ischemic cardiomyopathy
1Department of Cardiac Surgery, Austin & Repatriation Medical Centre, University of Melbourne, Australia.
Insights
The Acorn Cardiac Support Device (ACSD) shows promise in treating heart failure by preventing cardiac dilation. This surgical intervention improved key heart function metrics in patients with ischemic cardiomyopathy over 12 months.
Area of Science:
- Cardiology
- Biomedical Engineering
- Surgical Innovation
Background:
- Heart failure, particularly due to ischemic cardiomyopathy, often leads to progressive cardiac dilation.
- Existing treatments may not fully address the mechanical aspects of cardiac remodeling.
- The Acorn Cardiac Support Device (ACSD) aims to provide external support to the failing heart.
Purpose of the Study:
- To evaluate the mid-term efficacy of the Acorn Cardiac Support Device (ACSD) in patients with symptomatic heart failure.
- To assess the impact of ACSD on cardiac dimensions, function, and clinical status in ischemic cardiomyopathy.
- To determine the safety and feasibility of ACSD implantation alongside other cardiac procedures.
Main Methods:
- Surgical implantation of the ACSD in six patients with symptomatic heart failure.
- Concomitant procedures included coronary artery bypass grafting and ventricular reconstruction in most patients.
- Postoperative monitoring for 12 months included echocardiographic measurements (LVEDD, LVESD, LVEF), mitral regurgitation assessment, and NYHA functional classification.
Main Results:
- Significant reductions in left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were observed one month post-surgery.
- NYHA functional class improved significantly from a mean of 3 to 1.4 at 12 months.
- While mitral regurgitation and LVEF showed improvement, these changes did not reach statistical significance. No late deaths or heart failure readmissions occurred.
Conclusions:
- Ventricular containment using the ACSD appears beneficial in preventing cardiac dilation in patients with ischemic cardiomyopathy.
- Mid-term results suggest ACSD is a feasible and potentially effective adjunctive therapy for heart failure.
- Further randomized, long-term studies are warranted to establish the definitive role of ACSD in heart failure management.
Abstract:
The acorn cardiac support device (ACSD) is a device designed to treat heart failure by containing the heart to prevent further dilation. Six patients with symptomatic heart failure due to ischemic cardiomyopathy were treated surgically with ACSD. All patients simultaneously underwent coronary artery bypass grafting. Ventricular reconstruction was also performed in 5 of the 6 patients. We followed up the patients for 12 months postoperatively, monitoring the left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), mitral regurgitation, and NYHA classification. Both the LVEDD and LVESD were significantly improved one month postoperatively (from 63.2 to 50.6 mm, p=0.004, and from 51.6 to 39.5 mm, p=0.025, respectively). These dimensions did not change significantly over the next 11 months. NYHA functional class improved significantly from a mean of 3 to 1.4 at 12 months (p=0.012). Mitral regurgitation improved from a mean of 2.7 preoperatively to 1.4 at 12 months and the average LVEF also improved from 27% preoperatively to 35.9% at 12 months after surgery. However these latter two results were not statistically significant. There were no late deaths and no readmissions for heart failure. Repeat coronary angiography at 6 months revealed patent grafts in all patients. The mid-term results of ACSD for patients with symptomatic heart failure suggest that ventricular containment may be useful for preventing further cardiac dilation in patients with ischemic cardiomyopathy. Randomized, long-term studies are needed to assess the efficacy and possible role of ASCD in the future management of heart failure.