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Journal article
Epicardial catheter-based ventricular reconstruction: a novel therapy for ischaemic heart failure with anteroapical aneurysm
Interactive cardiovascular and thoracic surgery, v 17(6), pp 915-922
01 Dec 2013
PMID: 23985410
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
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.
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Details
- Title
- Epicardial catheter-based ventricular reconstruction: a novel therapy for ischaemic heart failure with anteroapical aneurysm
- Creators
- Yanping Cheng - Cardiovascular Research FoundationMichael S. Aboodi - Cardiovascular Research FoundationAndrew S. Wechsler - Drexel UniversityGreg L. Kaluza - Cardiovascular Research FoundationJuan F. Granada - Cardiovascular Research FoundationKevin Van Bladel - cBioVentrix, San Ramon, CA, USALon S. Annest - cBioVentrix, San Ramon, CA, USAGeng-Hua Yi - Cardiovascular Research Foundation
- Publication Details
- Interactive cardiovascular and thoracic surgery, v 17(6), pp 915-922
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Grant note
- BioVentix (San Ramon, CA, USA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- [Retired Faculty]
- Web of Science ID
- WOS:000327456100001
- Scopus ID
- 2-s2.0-84903684858
- Other Identifier
- 991019168398604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery