Related Experiment Videos
The potential role of ventricular compressive therapy
Robert C Gorman1, Benjamin M Jackson, Joseph H Gorman
1University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. gormanr@uphs.upenn.edu
The Surgical Clinics of North America
|April 1, 2004
Summary
Early infarct expansion worsens heart failure. Ventricular compressive therapy, especially early intervention to prevent expansion, shows promise in animal models for improving cardiac remodeling and long-term outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
- Pathophysiology
Background:
- Early infarct expansion contributes to ventricular dilatation, contractile dysfunction, and poor prognosis in heart failure.
- Ventricular remodeling leading to congestive heart failure (CHF) is hypothesized to initiate with infarct expansion, increasing myocardial stress.
- Increased stress in border zone myocardium triggers cytokine and reactive oxygen species (ROS) production, leading to myocyte apoptosis, extracellular matrix (ECM) disruption, and fibrosis.
Purpose of the Study:
- To evaluate the unclear value of ventricular compressive therapy in established CHF using the Acorn Cardiac Support Device (CSD).
- To assess the potential of early ventricular compressive therapy (ventricular restraint) as a prophylactic measure against infarct expansion and subsequent remodeling.
Main Methods:
- Review of early clinical and laboratory studies on Acorn CSD safety and efficacy in established CHF.
- Experimental demonstration of early ventricular restraint's effect on cardiac remodeling.
Main Results:
- Acorn CSD placement is safe with standard surgical techniques; constrictive physiology is rare.
- Clinical benefit from Acorn CSD in established CHF has not been dramatic in limited patient cases.
- Experimental studies show early ventricular restraint dramatically ameliorates remodeling.
Conclusions:
- A definitive assessment of Acorn CSD in established CHF requires a clinical trial comparing it with optimal medical management.
- Early ventricular compressive therapy (prophylactic prevention of infarct expansion) is a promising strategy demonstrated experimentally.
- Further research is needed to determine the optimal timing for early ventricular compressive therapy interventions.