HEART CARE ASSOCIATES, MILWAUKEE HEART INSTITUTE AT AURORA SINAI MEDICAL CENTER, MILWAUKEE, WISCONSIN, USA
Background- We propose a new surgical procedure for advanced heart failure – adaptive cardiac binding - which allows for a gradual increase in compression on the dilated heart with separate loads on the left and right ventricles.
Method- A canine model of biventricular heart failure (arteriovenous anastomosis - AVA, and doxorubicin administration) was created. Twenty-four dogs were divided into four groups: control, adynamic cardiomyoplasty (CMP), usual plastic cardiac binding (PCB), and adaptive cardiac binding (ACB). Systolic and diastolic area and volume and LVEF were measured before creation of heart failure, six weeks after, immediately after main operation, and 4 weeks later. In the animal group with ACB, liquid was added incrementally (35ml, I5ml, and finally 10ml) to each side of the pouch at weeks 1, 2, and 3.
Results- LVEF was 59±4% before AVA and doxorubicin administration and dropped to 27±2% six weeks later. Immediately after the main operation, LVEF was 35±3% (CMP), 34±4% (PCB), and 35±4 (ACB) (p>0.05 between groups). Four weeks later, LVEF had not changed in the CMP (37±3%) and PCB (32±2%) groups but had significantly increased in the ACB group (48±5%, p<0.05). LVEF was 23±4% in the controls (p<0.05 vs. all groups).
Conclusion- Adaptive cardiac binding that gradually adapts to the heart's natural variations in tension and contractile strength is a promising new surgical approach for patients who have end-stage heart failure.