VENTRICULAR
CONTAINMENT AS AN ADJUNCTIVE PRODEDUREIN ISCHAEMIC CARDIMOYOPATHY - RESULTS OF
THE PHASE I STUDY. J. Raman, S
Seevanayagam, J.M. Power, D. L Hare, B.F. Buxton, C.Alferness* Department of
Cardiac Surgery, Austin & Repatriation Medical Centre, Heidelberg,
Victoria, Acorn Cardiovascular Inc., St Paul Minnesota, U.S.A. Background:
Ventricular containment (VC) with custom made polyester mesh (CPM) (Acorn
Cardiovascular Inc. St. Paul, MN) is an evolving technique that that
extensively been studied in experimental animals with heart failure with good
results. Method: Five patients with symptomatic heart failure and dilated
ischaemic cardiomyopathy were enrolled in a Phase 1 study. All patients
underwent VC with the Acorn Cardiac Support Device which is CPM, along with
coronary artery bypass graft surgery (CABGS). Four patients had geometric left
ventricular aneurysm (LVA) repairs in addition. All study patients underwent
pre-operative and post-operative radionuclide ventriculography, echocardiography
and angiography. Results: All
patients were in HYHA functional class III at the time of their surgery. Mean
pre-operative Ejection Fraction (EF) was 25± 6.4%. There were no deaths. Mean post-operative EF was
56.6 ± 6.25% (p<0.001). Left ventricular end-diastolic
diameter fells from 63. ± 2
1.6mm pre-operatively to 50.6 + 5mm, post-operatively (p=0.0040). There was no
evidence of significant diastolic dysfunction pericardial constriction on
intro-or post-operative echocardiography. At a mean follow-up of 180 days all
patients were in NYHA Class 1. There were no re-admissions for heart failure.
Repeat coronary angiography at 6 months revealed patent grafts in all patients Conclusions:
Ventricular containment with the Acorn cardiac support device may be safely
performed as an adjunct to conventional cardiac surgery in patients with
symptomatic heart failure. Longer follow-up with expansion of the study will
help delineate the long term effects of this therapy.
