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J Thorac Cardiovasc Surg 2003;126:56-65
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Left ventricular systolic performance in failing heart improved acutely by left ventricular reshaping

Kun-lun He, MD, PhDa, Juichiro Shimizu, MD, PhDa, Geng-hua Yi, MDa, Anguo Gu, MD,a, M. Abul Kashem, MD, PhDb, Deborah L. Crabbe, MDb, Sulli Popilskis, DVMc, Ed X. Wu, PhDd, William P. Santamore, PhDb, David Melvin, MD, PhD,e,*, Jie Wang, MD, PhDd,a,*

a Division of Circulatory Physiology, Department of Medicine, Columbia University, New York, NY, USA
b Cardiology Section, Temple University, Philadelphia, Pa, USA
c Department of Comparative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
d Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
e Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Received for publication July 16, 2002; revisions received August 13, 2002; accepted for publication December 30, 2002.

* Address for reprints: Jie Wang, MD, PhD, The Heart Failure Center, Department of Medicine, Columbia University, MHB 5-435, 177 Ft Washington Ave, New York, NY 10032, USA
jw147{at}columbia.edu

OBJECTIVE: If the geometric distortion during dilated heart failure could be corrected, the tension on the myocytes would be decreased, thereby leading to an improvement in left ventricular systolic function. We tested the effects of the CardioClasp (CardioClasp Inc, Pine Brook, NJ), a left ventricular reshaping device, on the failing heart, and our empirical data were compared with computationally derived data.

METHODS: Heart failure was induced by 4-week rapid cardiac pacing. At the terminal experiment, an isolated failing heart preparation (isovolumic contraction, n = 5) or an intact failing heart in vivo (n = 7) was used. The effects of the reshaping device on left ventricular performance were assessed by the slopes (Ees) of the left ventricular end-systolic pressure-volume relations, hemodynamics, and echocardiograph before and after placing the CardioClasp on the heart. The change in Ees as the result of left ventricular reshaping was also estimated from computed theoretical analysis and compared with empirical data.

RESULTS: There was a significant change in left ventricular dimension after placing the CardioClasp on the heart. In isolated heart preparation, Ees significantly increased from 1.40 ± 0.44 mm Hg/mL to 2.42 ± 0.63 mm Hg/mL after placing the device on the heart but returned to the baseline level (1.46 ± 0.27 mm Hg) after removing it. Left ventricular developed pressure and left ventricular fractional area shortening were significantly increased as the result of left ventricular reshaping. Ees derived from computed theoretical analysis was highly correlated with confirming empirical data.

CONCLUSIONS: The CardioClasp can reshape the left ventricle and improve left ventricular systolic performance in failing hearts.






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