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PRECLINICAL STUDIES

Implantation of an Elastic Ring at Equator of the Left Ventricle Influences Cardiac Mechanics in Experimental Acute Ventricular Dysfunction

Paolo Ferrazzi, MD^_*,_*, Michele Senni, MD^_*, Maria R. Iascone, BSc, PhD, Maurizio Merlo, MD^_*, Michele Triggiani, MD^_*, Roberto Lorusso, MD, Paul Herijgers, MD, Jan J. Schreuder, MD^||, Samuele Pentiricci, MD^_*, Attilio Iacovoni, MD^_* and Eugenio Quaini, MD^#

^_* Dipartimento Cardiovascolare Clinico e di Ricerca, Bergamo, Italy
Dipartimento Patologia Clinica, Ospedali Riuniti, Bergamo, Italy
Laboratorio di Cardiochirurgia Sperimentale, Dipartimento Cardio-Toracico, Azienda Spedali Civili, Brescia, Italy
Laboratory for Experimental Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
^|| Dipartimento Chirurgia Cardiaca, Ospedale S. Raffaele, Milano, Italy
^# Fondazione Poliambulanza, Dipartimento Cardiovascolare, Brescia, Italy

Manuscript received April 23, 2007; revised manuscript received June 25, 2007, accepted July 30, 2007.

^_* Reprint requests and correspondence: Dr. Paolo Ferrazzi, Dipartimento Cardiovascolare Clinico e di Ricerca, Ospedali Riuniti, Largo Barozzi, 1-24128 Bergamo, Italy. (Email: pferrazzi{at}ospedaliriuniti.bergamo.it).

Objectives: We hypothesize that the implantation of an endoventricular elastic ring at the left ventricle (LV) equatorial site will positively affect the cardiac mechanics in an experimental model of acute LV dysfunction.

Background: Changes in the elastic properties of LV occur in the dilated and failing heart, contributing to overall cardiac mechanical dysfunction. No interventions are as yet specifically designed to improve LV elasticity in failing hearts.

Methods: Acute LV enlargement and dysfunction was induced in 13 healthy sheep via the insertion of a large Dacron patch into the lateral wall. In 6 of these sheep, a customized elastic ring was implanted at the inner surface of the LV equator (ring group), and the remaining 7 served as control subjects (dysfunction group). Systolic and diastolic function was evaluated using echocardiography and pressure–volume (P–V) analysis.

Results: In the ring group, both the maximum rate of pressure increase and the slope of end-systolic P–V relationship were significantly different from those without ring (1,718 ± 726 vs. 1,049 ± 269 and 1.25 ± 0.30 vs. 0.88 ± 0.19; both p < 0.05). Preload recruitable stroke work changed even more prominently (33 ± 11 vs. 17 ± 5; p = 0.005), along with stroke volume, ejection fraction, and stroke work. Although ring implantation had no effect on end-diastolic P–V relationship, it positively affected the active component of diastole: the maximum rate of pressure decrease declined significantly (p = 0.037). The time constant of relaxation tended to decrease (37 ± 8 vs. 44 ± 6; p = 0.088).

Conclusions: Improving the elastic component of the LV at its equatorial site substantially augments contractility and early relaxation in acute systodiastolic LV dysfunction.

Abbreviations and Acronyms   CPB = cardiopulmonary bypass   devP = developed pressure   dP/dtmax = maximum rate of pressure increase   dP/dtmin = maximum rate of pressure decrease   EDP = end-diastolic pressure   EDPVR = end-diastolic pressure–volume relationship   EDV = end-diastolic volume   EF = ejection fraction   ESP = end-systolic pressure   ESPVR = end-systolic pressure–volume relationship   ESV = end-systolic volume   HF = heart failure   LV = left ventricular/ventricle   PRSW = preload recruitable stroke work   P–V = pressure–volume   SV = stroke volume   SW = stroke work

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