THE EFFECTS OF PROSTHETIC CARDIAC BINDING AND ADYNAMIC CARDIOMYOPLASTY IN A MODEL OF DILATED CARDIOMYOPATHY

Objective: Because adynamic cardiomyoplasty, or wrapping skeletal musc le around the heart, had been shown to provide a girdling effect and d elay progressive ventricular dilatation in heart failure, a similar gi rdling effect by the much simpler procedure of cardiac binding, using a prosthetic membrane to wrap the heart, was studied and compared with that of adynamic cardiomyoplasty. Methods: Twenty-one dogs were divid ed into control, adynamic cardiomyoplasty;, and cardiac binding groups . Cardiac dimension and hemodynamic studies were carried out before an d 4 weeks after rapid pacing at 250 beats/min. For adynamic cardiomyop lasty, the left latissimus dorsi muscle was used for the cardiac wrap; for cardiac binding, a Marlex sheet (C. R. Bard, Inc., Murray Hill, N .J.) was used. Serial two-dimensional echocardiography, right heart ca theterization, and in the cardiac binding group, left heart catheteriz ation were performed. Results: Four weeks of rapid pacing induced seve re heart failure and cardiac dilatation. The magnitude of ventricular dilatation at the end of rapid pacing was less in the cardiac binding group than in the control group and least in the adynamic cardiomyopla sty group. Left ventricular end-diastolic volume, end-systolic volume, and ejection fraction were 82.1 +/- 21.1 nl, 67.1 +/- 16.0 ml, and 17 .5% +/- 5.8%, respectively, in the control group; 61.9. +/- 8.1 ml, 44 .1 +/- 7.8 ml, and 30.1% +/- 3.6%, respectively, in the cardiac bindin g group; and 51.8 +/- 5.7 mI, 30.3 +/- 10.4 ml, and 27.0% +/- 4.0%, re spectively; in the adynamic cardiomyoplasty group. Conclusions: Both a dynamic cardiomyoplasty and cardiac binding reduced cardiac enlargemen t and functional deterioration after rapid pacing, with adynamic cardi omyoplasty appearing to be more effective, perhaps because of the adap tive capabilities of the skeletal muscle wrap, However, cardiac bindin g is a simpler and less invasive procedure, which may be useful as an adjunct to prevent or delay progressive ventricular dilatation in hear t failure.