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Eur J Cardiothorac Surg 2001;20:786-791
© 2001 Elsevier Science NL

Reshaping the remodelled left ventricle: a new concept

Clinic for Cardiovascular Surgery, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011 Lausanne, Switzerland

Received 26 March 2001; received in revised form 5 June 2001; accepted 6 June 2001.

Corresponding authorTel.: +41-21-314-22-80; fax: +41-21-314-22-78
e-mail: xavier.mueller{at}chuv.hospvd.ch

Objective: Based on the law of Laplace, transventricular tension members were designed to diminish wall stress by changing the left ventricle (LV) globular shape to a bilobular one, thus reducing the ventricular wall radius of curvature. This concept was tested in a model of congestive heart failure. Methods: Seven calves were used for the study (74.3±4.2 kg). Treatment efficacy was assessed with sonomicrometric wall motion analysis coupled with intraventricular pressure measurement. Preload increase was applied stepwise with tension members in released and tightened position. Results: Tightening of the tension members improved systolic function for CVP>10 mmHg (dP/dt: 828±122 vs. 895±112 mmHg/s, P=0.019, for baseline and 20% stress level reduction respectively; wall thickening: 11.6±1.5 vs. 13.3±1.7%, P<0.001) and diastolic function (LV end-diastolic pressure: 15.9±4.8 vs. 13.6±2.7 mmHg, P<0.001, for CVP>10 mmHg; peak rate of wall thinning: -12.2±2.2 vs. -14±2.3 cm²/s, P<0.001 and logistic time constant of isovolumic relaxation: 48.4 ±10.9 vs. 39.8±9.6ms, P<0.001, for CVP>5 mmHg). Conclusions: This less aggressive LV reduction method significantly improves contractility and relaxation parameters in this model of congestive heart failure.

Key Words: Heart failure • Congestive • Remodelling • Volume reduction

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