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Cardiac Restraint and Support Following Myocardial Infarction

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Cardiovascular and Cardiac Therapeutic Devices

Part of the book series: Studies in Mechanobiology, Tissue Engineering and Biomaterials ((SMTEB,volume 15))

Abstract

Myocardial infarction occurs when blood supply to a region of the myocardium is interrupted or eliminated, leading within seconds to loss of active contraction in the affected region and within minutes to cardiomyocyte death. Unable to contract, the infarct stretches passively each time the heart generates pressure, creating an immediate mechanical disadvantage and, if the infarct is large, triggering a cascade of pathological ventricular remodeling that eventually leads to heart failure. Therefore, a variety of therapies have been explored to mechanically reinforce the infarcted heart in the hopes of improving cardiac function and limiting adverse remodeling. This chapter will discuss two major strategies for mechanical support post-MI: globally restraining one or both ventricles, or locally reinforcing only the infarct area. Several ventricular restraint devices and a variety of local reinforcement approaches are compared and evaluated for their ability to reduce left ventricular remodeling and improve cardiac function following myocardial infarction. A variety of metrics used to quantify cardiac function are discussed, including limitations of frequently used functional indices. Differences in efficacy between synthetic and cell-seeded or tissue engineered patches for local reinforcement are investigated, followed by a brief discussion of the importance of patch material properties. Finally, methods for optimizing the type and degree of reinforcement are presented, including both experimental and computational approaches.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, US

    Samantha A. Clarke, Gorav Ailawadi & Jeffrey W. Holmes

  2. Department of Surgery, University of Virginia, Charlottesville, VA, US

    Ravi K. Ghanta & Gorav Ailawadi

  3. Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, US

    Jeffrey W. Holmes

  4. Department of Medicine, University of Virginia, Health System, 800759, Charlottesville, VA, 22908, US

    Jeffrey W. Holmes

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  1. Samantha A. Clarke
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  2. Ravi K. Ghanta
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  3. Gorav Ailawadi
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  4. Jeffrey W. Holmes
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Correspondence to Jeffrey W. Holmes .

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  1. Faculty of Health Sciences and Research Office, University of Cape Town, Cape Town, South Africa

    Thomas Franz

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Clarke, S.A., Ghanta, R.K., Ailawadi, G., Holmes, J.W. (2013). Cardiac Restraint and Support Following Myocardial Infarction. In: Franz, T. (eds) Cardiovascular and Cardiac Therapeutic Devices. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 15. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2013_163

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