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Ann Thorac Surg 2002;73:849-854
© 2002 The Society of Thoracic Surgeons
a Cardiac Technology Centre, Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
b Department of Cardiothoracic Surgery, Nagoya University of Medicine, Nagoya, Japan
c Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
Accepted for publication October 25, 2001.
* Address reprint requests to Dr Shirota, c/o Dr Hunyor, Cardiac Technology Centre, Block 4, Level 3, Royal North Shore Hospital, St. Leonards, Sydney, New South Wales 2065, Australia
e-mail: stephenh{at}med.usyd.edu.au
Background. Dynamic cardiomyoplasty (d-CMP) encourages reverse remodeling and improved contractility and stroke work (SW) efficiency of the failing native heart. This contrasts with passive cardiomyoplasty (p-CMP), which provides "passive girdling." To further evaluate pump recovery we assessed native left ventricular performance (without assist) 6 months after dynamic and passive CMP in sheep with heart failure with acute volume loading.
Methods. Heart failure (left ventricular ejection fraction 26% ± 8%) induced by coronary microembolization was followed by CMP in 11 sheep. After 8 weeks of muscle "training," paced cardiac assist was undertaken in the d-CMP group (n = 6). Five sheep with heart failure served as controls. Six months later the pressure-volume relationship was derived before and after volume loading by colloid solution. Latissimus dorsi muscle pacing was previously ceased in the d-CMP group.
Results. Volume loading increased left ventricular end-diastolic volume and pressure in all groups. After volume loading in d-CMP, the SW and pressure-volume area were increased, and SW efficiency remained unchanged. In p-CMP neither variable changed, whereas in control heart failure SW efficiency decreased due to a rise in pressure-volume area with stable SW.
Conclusions. Based on response to volume loading, the failing native heart after 6 months of d-CMP showed functional recovery from "active girdling," whereas p-CMP prevented functional deterioration through passive girdling. The failing control heart progressively deteriorated.
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