OBJECTIVES: Surgical ventricular reconstruction has been used to treat ischaemic cardiomyopathy with large akinetic or dyskinetic areas. However, application of this approach requires a sternotomy, cardiopulmonary bypass and a left ventriculotomy. This study assessed the feasibility and efficacy of minimally invasive, off-pump, epicardial catheter-based ventricular reconstruction (ECVR) in an anteroapical aneurysm ovine model. METHODS: Left ventricular (LV) anteroapical myocardial infarction was induced percutaneously by coil embolization of the left anterior descending coronary artery. Eight weeks after infarction, via mini left thoracotomy and without cardiopulmonary bypass, ECVR was performed in six sheep. The scar was excluded by placing anchor pairs on the LV epicardial anterior wall and the right ventricular side of the interventricular septum under fluoroscopic guidance. LV performance was evaluated before, immediately after device implantation and after 6 weeks by echocardiography. Terminal histopathology was performed. RESULTS: ECVR was completed expeditiously in all animals without complications. Parameters obtained 6 weeks after device implantation were compared with baseline (pre-device). End-systolic volume was decreased by 38% (25.6 ± 6.1 ml vs baseline 41.2 ± 7.2 ml, P = 0.02) with preservation of stroke volume. Ejection fraction was significantly increased by 13% (48.5 ± 7% vs baseline 35.8 ± 7%, P = 0.02). The circumferential strain in the anterior septum (-7.67 ± 5.12% vs baseline -0.96 ± 2.22%, P = 0.03) and anterior wall (-9.01 ± 3.51% vs baseline -4.15 ± 1.36%, P = 0.01) were significantly improved. The longitudinal strain in apex was reversed (-3.08 ± 1.53% vs baseline 3.09 ± 3.39%, P = 0.01). Histopathology showed full endocardial healing over the anchors with appreciable reduction of the chronic infarct in the LV. CONCLUSIONS: ECVR without cardiopulmonary bypass is a less invasive alternative to current standard therapies, reverses LV remodelling and improves cardiac performance in an ovine model of anteroapical aneurysm.
OBJECTIVES: Surgical ventricular reconstruction has been used to treat ischaemic cardiomyopathy with large akinetic or dyskinetic areas. However, application of this approach requires a sternotomy, cardiopulmonary bypass and a left ventriculotomy. This study assessed the feasibility and efficacy of minimally invasive, off-pump, epicardial catheter-based ventricular reconstruction (ECVR) in an anteroapical aneurysm ovine model. METHODS: Left ventricular (LV) anteroapical myocardial infarction was induced percutaneously by coil embolization of the left anterior descending coronary artery. Eight weeks after infarction, via mini left thoracotomy and without cardiopulmonary bypass, ECVR was performed in six sheep. The scar was excluded by placing anchor pairs on the LV epicardial anterior wall and the right ventricular side of the interventricular septum under fluoroscopic guidance. LV performance was evaluated before, immediately after device implantation and after 6 weeks by echocardiography. Terminal histopathology was performed. RESULTS: ECVR was completed expeditiously in all animals without complications. Parameters obtained 6 weeks after device implantation were compared with baseline (pre-device). End-systolic volume was decreased by 38% (25.6 ± 6.1 ml vs baseline 41.2 ± 7.2 ml, P = 0.02) with preservation of stroke volume. Ejection fraction was significantly increased by 13% (48.5 ± 7% vs baseline 35.8 ± 7%, P = 0.02). The circumferential strain in the anterior septum (-7.67 ± 5.12% vs baseline -0.96 ± 2.22%, P = 0.03) and anterior wall (-9.01 ± 3.51% vs baseline -4.15 ± 1.36%, P = 0.01) were significantly improved. The longitudinal strain in apex was reversed (-3.08 ± 1.53% vs baseline 3.09 ± 3.39%, P = 0.01). Histopathology showed full endocardial healing over the anchors with appreciable reduction of the chronic infarct in the LV. CONCLUSIONS: ECVR without cardiopulmonary bypass is a less invasive alternative to current standard therapies, reverses LV remodelling and improves cardiac performance in an ovine model of anteroapical aneurysm.
Authors: Peng Zhang; Julius M Guccione; Susan I Nicholas; Joseph C Walker; Philip C Crawford; Amin Shamal; Gabriel Acevedo-Bolton; Michael A Guttman; Cengizhan Ozturk; Elliot R McVeigh; David A Saloner; Arthur W Wallace; Mark B Ratcliffe Journal: J Thorac Cardiovasc Surg Date: 2007-10 Impact factor: 5.209
Authors: L Menicanti; M DiDonato; S Castelvecchio; C Santambrogio; V Montericcio; A Frigiola; G Buckberg Journal: Heart Fail Rev Date: 2004-10 Impact factor: 4.214
Authors: Constantine L Athanasuleas; Gerald D Buckberg; Alfred W H Stanley; William Siler; Vincent Dor; Marisa DiDonato; Lorenzo Menicanti; Sergio Almeida de Oliveira; Friedhelm Beyersdorf; Irving L Kron; Hisayoshi Suma; Nicholas T Kouchoukos; Wistar Moore; Patrick M McCarthy; Mehmet C Oz; Francis Fontan; Meredith L Scott; Kevin A Accola Journal: Heart Fail Rev Date: 2004-10 Impact factor: 4.214
Authors: Marco A Costa; Michael Pencina; Serjan Nikolic; Thomas Engels; Barry Templin; William T Abraham Journal: Am Heart J Date: 2013-02-19 Impact factor: 4.749
Authors: Lorenzo Menicanti; Serenella Castelvecchio; Marco Ranucci; Alessandro Frigiola; Carlo Santambrogio; Carlo de Vincentiis; Jelena Brankovic; Marisa Di Donato Journal: J Thorac Cardiovasc Surg Date: 2007-06-18 Impact factor: 5.209
Authors: Stefan D Anker; Andrew J S Coats; Gabriel Cristian; Dinu Dragomir; Enrico Pusineri; Massimo Piredda; Luca Bettari; Robert Dowling; Maurizio Volterrani; Bridget-Anne Kirwan; Gerasimos Filippatos; Jean-Louis Mas; Nicolas Danchin; Scott D Solomon; Randall J Lee; Frank Ahmann; Andy Hinson; Hani N Sabbah; Douglas L Mann Journal: Eur Heart J Date: 2015-06-16 Impact factor: 29.983
Authors: Tom Hendriks; Remco A J Schurer; Lawien Al Ali; Ad F M van den Heuvel; Pim van der Harst Journal: Heart Fail Rev Date: 2018-11 Impact factor: 4.214