Passive epicardial containment prevents ventricular remodeling in heart failure

Background. We examined the effects of passive containment of the cardiac v entricles with a surgically placed epicardial prosthetic wrap on indexes of left ventricular (LV) remodeling in dogs with heart failure. Methods. Heart failure (LV ejection fraction 30% to 40%) was produced in 12 dogs by intracoronary micro-embolization. Six dogs underwent mid-sternotom y and pericardiotomy with placement of a preformed-knitted polyester device (Acorn Cardiac Support Device [CSD], Acorn Cardiovascular, Inc, St. Paul, MN) snugly around the ventricles and anchored to the atrioventricular groov e. Six dogs did not undergo surgery and served as controls. Dogs were follo wed for 3 months prior to sacrifice. Results. In controls, LV end-diastolic volume increased after 3 months (67 +/- 12 versus 83 +/- 8 mi; p = 0.04), while in CSD-treated dogs, it decreas ed (68 +/- 10 versus 61 +/- 10 mi; p = 0.002). CSD-containment of LV size w as associated with increased LV systolic fractional area of shortening, whi le in controls, fractional area of shortening decreased. CSD-treated dogs a lso showed amelioration of myocyte hypertrophy and attenuation of interstit ial fibrosis compared to controls. Conclusions. In dogs with heart failure, passive epicardial containment of the ventricles with the Acorn CSD ameliorates LV remodeling and improves LV systolic function. (C) 2000 by The Society of Thoracic Surgeons.