Dynamic cardiomyoplasty: Its chronic and acute effects on the failing heart

H. J. Patel, Edward Lankford, D. J. Polidori, J. J. Pilla, T. Plappert, M. S.J. Sutton, M. A. Acker

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives: Dynamic cardiomyoplasty is an alternative therapy for end- stage heart failure. We investigated the mechanisms, both acute and chronic, by which a synchronously stimulated conditioned muscle wrap affects left ventricular function in a chronic canine model of dilated cardiomyopathy. Methods: Nineteen dogs underwent rapid ventricular pacing at a rate of 215 beats/min for 4 weeks to create a model of heart failure. Eight dogs were then randomly selected to undergo cardiomyoplasty, and all dogs received 6 additional weeks of rapid ventricular pacing. The cardiomyoplasty group also received a graded muscle conditioning protocol of synchronized burst stimulation to transform the muscle wrap. All dogs were studied with pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of rapid ventricular pacing. Data in the cardiomyoplasty group were analyzed with the stimulator off, with it augmenting every beat (1:1), and with it augmenting only every other beat/1:2). Results: Stimulator 'off' data at 10 weeks of rapid pacing demonstrated chronic effects by enhanced ventricular function fend-systolic elastance = 1.80 after myoplasty vs 1.17 for controls, p = 0.005) and a stabilization of volumes and composite end- systolic and end-diastolic pressure-volume relations in the cardiomyoplasty group when compared with controls. Myoplasty stimulation increased apparent contractility (preload recruitable stroke work = 31.3 for stimulator 'off' vs 40.6 for stimulator 1:2 assisted beats [p < 0.05] and vs 45.4 for stimulator 1:1 [p < 0.05]). Conclusions: Benefits from dynamic cardiomyoplasty are by at least two mechanisms: (1) the girdling effects of a conditioned muscle wrap, which halts the chronic remodeling of heart failure, and (2) active systolic assistance, which augments the apparent contractility of the failing heart.

Original languageEnglish (US)
Pages (from-to)169-178
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume114
Issue number2
DOIs
StatePublished - Jan 1 1997

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Cardiomyoplasty
Dogs
Muscles
Heart Failure
Myocardial Contraction
Ventricular Function
Dilated Cardiomyopathy
Complementary Therapies
Left Ventricular Function
Echocardiography
Canidae
Stroke
Blood Pressure
Pressure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Patel, H. J., Lankford, E., Polidori, D. J., Pilla, J. J., Plappert, T., Sutton, M. S. J., & Acker, M. A. (1997). Dynamic cardiomyoplasty: Its chronic and acute effects on the failing heart. Journal of Thoracic and Cardiovascular Surgery, 114(2), 169-178. https://doi.org/10.1016/S0022-5223(97)70141-7
Patel, H. J. ; Lankford, Edward ; Polidori, D. J. ; Pilla, J. J. ; Plappert, T. ; Sutton, M. S.J. ; Acker, M. A. / Dynamic cardiomyoplasty : Its chronic and acute effects on the failing heart. In: Journal of Thoracic and Cardiovascular Surgery. 1997 ; Vol. 114, No. 2. pp. 169-178.
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Dynamic cardiomyoplasty : Its chronic and acute effects on the failing heart. / Patel, H. J.; Lankford, Edward; Polidori, D. J.; Pilla, J. J.; Plappert, T.; Sutton, M. S.J.; Acker, M. A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 114, No. 2, 01.01.1997, p. 169-178.

Research output: Contribution to journalArticle

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T2 - Its chronic and acute effects on the failing heart

AU - Patel, H. J.

AU - Lankford, Edward

AU - Polidori, D. J.

AU - Pilla, J. J.

AU - Plappert, T.

AU - Sutton, M. S.J.

AU - Acker, M. A.

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N2 - Objectives: Dynamic cardiomyoplasty is an alternative therapy for end- stage heart failure. We investigated the mechanisms, both acute and chronic, by which a synchronously stimulated conditioned muscle wrap affects left ventricular function in a chronic canine model of dilated cardiomyopathy. Methods: Nineteen dogs underwent rapid ventricular pacing at a rate of 215 beats/min for 4 weeks to create a model of heart failure. Eight dogs were then randomly selected to undergo cardiomyoplasty, and all dogs received 6 additional weeks of rapid ventricular pacing. The cardiomyoplasty group also received a graded muscle conditioning protocol of synchronized burst stimulation to transform the muscle wrap. All dogs were studied with pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of rapid ventricular pacing. Data in the cardiomyoplasty group were analyzed with the stimulator off, with it augmenting every beat (1:1), and with it augmenting only every other beat/1:2). Results: Stimulator 'off' data at 10 weeks of rapid pacing demonstrated chronic effects by enhanced ventricular function fend-systolic elastance = 1.80 after myoplasty vs 1.17 for controls, p = 0.005) and a stabilization of volumes and composite end- systolic and end-diastolic pressure-volume relations in the cardiomyoplasty group when compared with controls. Myoplasty stimulation increased apparent contractility (preload recruitable stroke work = 31.3 for stimulator 'off' vs 40.6 for stimulator 1:2 assisted beats [p < 0.05] and vs 45.4 for stimulator 1:1 [p < 0.05]). Conclusions: Benefits from dynamic cardiomyoplasty are by at least two mechanisms: (1) the girdling effects of a conditioned muscle wrap, which halts the chronic remodeling of heart failure, and (2) active systolic assistance, which augments the apparent contractility of the failing heart.

AB - Objectives: Dynamic cardiomyoplasty is an alternative therapy for end- stage heart failure. We investigated the mechanisms, both acute and chronic, by which a synchronously stimulated conditioned muscle wrap affects left ventricular function in a chronic canine model of dilated cardiomyopathy. Methods: Nineteen dogs underwent rapid ventricular pacing at a rate of 215 beats/min for 4 weeks to create a model of heart failure. Eight dogs were then randomly selected to undergo cardiomyoplasty, and all dogs received 6 additional weeks of rapid ventricular pacing. The cardiomyoplasty group also received a graded muscle conditioning protocol of synchronized burst stimulation to transform the muscle wrap. All dogs were studied with pressure-volume analysis and echocardiography at baseline and after 4 and 10 weeks of rapid ventricular pacing. Data in the cardiomyoplasty group were analyzed with the stimulator off, with it augmenting every beat (1:1), and with it augmenting only every other beat/1:2). Results: Stimulator 'off' data at 10 weeks of rapid pacing demonstrated chronic effects by enhanced ventricular function fend-systolic elastance = 1.80 after myoplasty vs 1.17 for controls, p = 0.005) and a stabilization of volumes and composite end- systolic and end-diastolic pressure-volume relations in the cardiomyoplasty group when compared with controls. Myoplasty stimulation increased apparent contractility (preload recruitable stroke work = 31.3 for stimulator 'off' vs 40.6 for stimulator 1:2 assisted beats [p < 0.05] and vs 45.4 for stimulator 1:1 [p < 0.05]). Conclusions: Benefits from dynamic cardiomyoplasty are by at least two mechanisms: (1) the girdling effects of a conditioned muscle wrap, which halts the chronic remodeling of heart failure, and (2) active systolic assistance, which augments the apparent contractility of the failing heart.

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