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J Thorac Cardiovasc Surg 2005;130:1107
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Ventricular constraint in dilated cardiomyopathy: A new, compliant textile mesh exerts prophylactic and therapeutic properties

Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital Duesseldorf, Germany

Received for publication December 8, 2004; revisions received March 4, 2005; accepted for publication March 23, 2005.

^_* Address for reprints: Jochen D. Schipke, PhD, FESC, Research Group Experimental Surgery, Department of Thoracic and Cardiovascular Surgery, University Hospital Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany (Email: schipke{at}med.uni-duesseldorf.de).

BACKGROUND: Dilated cardiomyopathy is associated with a progressive decrease in cardiac function, leading to end-stage heart failure. We aimed to stop this process by mechanically constraining the heart with a new, compliant textile mesh.

METHODS: In 16 male Munich minipigs (50 ± 7 kg), dilated cardiomyopathy with congestive heart failure was induced through 4 weeks of rapid ventricular pacing (220 beats/min). In the early-mesh group (n = 8), a polyvinylidene fluoride mesh was positioned around both ventricles before pacing was started. In the other group (n = 8), experimental dilated cardiomyopathy through rapid pacing was induced (no mesh). After mesh grafting, rapid pacing was continued (late mesh).

RESULTS: Rapid pacing in the no-mesh group (control group) significantly decreased both systolic (cardiac output, peak systolic pressure, and the derivative of pressure increase [dP/dt_max]) and diastolic (minimum rate of pressure rise [dP/dt_min] and left ventricular end-diastolic pressure) variables, whereas these variables remained almost unchanged in the early-mesh group. In the late-mesh group the passive-elastic constraint not only prevented further deterioration but even exerted reverse remodeling to some extent (dP/dt_max and left ventricular end-diastolic pressure, P < .05).

CONCLUSIONS: Ventricular constraint with the new mesh seems to be a prophylactic and therapeutic option in cardiac insufficiency caused by ventricular dilation. This passive-elastic cardioplasty induced reverse remodeling of dilated hearts and significantly improved diastolic and systolic ventricular function.