Passive volume reduction heart surgery using the Acorn CorCap cardiac support device

Sammanfattning: Heart failure is a growing health problem, affecting an increasing number of patients with rapidly increasing costs for the health care system. In spite of recent improvements in pharmacological, non-pharmacological and surgical treatments the prognosis for patients with severe heart failure is still poor. Heart failure is associated with numerous processes and changes in left ventricular structure and function often referred to as left ventricular remodelling. The Acorn CorCap Cardiac Support Device is a mesh-like polyester device designed to arrest and reverse these processes thereby facilitating left ventricular reversed remodelling in heart failure. We have explored the effect of passive containment surgery using the Acorn CorCap Cardiac Support Device in heart failure patients with ischemic or idiopathic dilated cardiomyopathy. Following application of the Acorn CorCap Cardiac Support Device reduced cardiac dimensions, increased functional capacity, decreased levels of circulating plasma levels of Endothelin- I and improved quality of life was demonstrated. Furthermore, the possible beneficial effect on reduction on left ventricular dilatation with application of the Acorn CorCap Cardiac Support Device concomitant with aortic valve replacement in patients with longstanding aortic regurgitation and left ventricular dilatation was evaluated. No additive beneficial effects of application of the Acorn CorCap Cardiac Support Device were found in these patients when compared to patients with chronic aortic regurgitation and left ventricular dilatation undergoing aortic valve replacement as the sole procedure. The acute effects of application of the Acorn CorCap Cardiac Support Device in experimental porcine myocardial infarction were investigated. No acute effect on hemodynamics, coronary vasomotor function, Endothelin- I levels or infarction size was demonstrated following application of the Acorn CorCap Cardiac Support Device at induction of acute experimental myocardial infarction. Based on the findings in these studies it is concluded that application of the Acorn CorCap Cardiac Support Device is safe, simple and without apparent negative effects. In heart failure patients with ventricular dilatation the Acorn CorCap Cardiac Support Device represents a novel and interesting amendment to current surgical treatment options with likely beneficial effects.