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Mitral Valve Repair: What the ACORN Trial Taught Us

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Abstract

Progressive left ventricular remodeling is characterized by dilation of the left ventricle with a change in the heart from an elliptical shape to a more spherical shape. This change is part of the unfavorable natural history in patients with heart failure. The CorCap Cardiac Support Device (Acorn Cardiovascular, St. Paul, MN) is a mesh device that is implanted around the heart to reduce wall stress and the first therapy specifically designed to address left ventricular remodeling. The CorCap was studied in a large, prospective, randomized, multicentered trial. This study demonstrated safety and effectiveness of the CorCap in patients with advanced heart failure and remodeled ventricles. Moreover, it provided interesting insights into mitral valve surgery in patients with heart failure. These insights and a review of the ACORN (Assessment of a Cardiac Support Device [CSD] in Patients With Heart Failure) trial are discussed in this article.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Baig MK, Mahon N, McKenna WJ, et al.: The pathophysiology of advanced heart failure. Heart Lung 1999, 28:87–101.

    Article  CAS  PubMed  Google Scholar 

  2. Chien KR: Stress pathways and heart failure. Cell 1999, 98:555–558.

    Article  CAS  PubMed  Google Scholar 

  3. Oz MC, Konertz WF, Kleber FX, et al.: Global surgical experience with the Acorn cardiac support device. J Thorac Cardiovasc Surg 2003, 126:983–991.

    Article  PubMed  Google Scholar 

  4. Goldstein S, Ali AS, Sabbah H: Ventricular remodeling. Cardiol Clin 1998, 16:623–632.

    Article  CAS  PubMed  Google Scholar 

  5. Florea VG, Mareyev VY, Samko AN, et al.: Left ventricular remodeling: common process in patients with different primary myocardial disorders. Int J Cardiol 1999, 68:281–287.

    Article  CAS  PubMed  Google Scholar 

  6. Vasan RS, Larson MG, Benjamin EJ, et al.: Left ventricular dilation and the risk of congestive heart failure in people without myocardial infarction. N Engl J Med 1997, 336:1350–1355.

    Article  CAS  PubMed  Google Scholar 

  7. Kass DA, Baughman KL, Pak PH, et al.: Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation 1995, 91:2314–2318.

    CAS  PubMed  Google Scholar 

  8. Batista R: Partial left ventriculectomy—the Batista procedure. Eur J Cardiothorac Surg 1999, 15(Suppl I):S12–S19.

    Article  PubMed  Google Scholar 

  9. Dor V, Saab M, Coste P, et al.: Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg 1989, 37:11–19.

    Article  CAS  PubMed  Google Scholar 

  10. Sarling RC: Cardiac surgery for heart failure. Semin Thorac Cardiovasc Surg 2002, 14:122–124.

    Article  Google Scholar 

  11. Voss B, Lange R: Dynamic cardiomyoplasty: evaluation of an alternative procedure in the treatment of terminal heart failure. Z Kardiol 2001, 90(Suppl 1):22–27.

    Article  PubMed  Google Scholar 

  12. Gummert JF, Rahmel A, Bossert T, et al.: Socks for the dilated heart. Does passive cardiomyoplasty have a role in long-term care for heart failure patients? Z Kardiol 2004, 93:849–854.

    Article  CAS  PubMed  Google Scholar 

  13. Patel HJ, Polidori DJ, Pilla JJ, et al.: Stabilization of chronic remodeling by asynchronous cardiomyoplasty in dilated cardiomyopathy: effects of a conditioned muscle wrap. Circulation 1997, 96:3665–3671.

    CAS  PubMed  Google Scholar 

  14. Capouya ER, Gerber RS, Drinkwater DC Jr, et al.: Girdling effect of nonstimulated cardiomyoplasty on left ventricular function. Ann Thorac Surg 1993, 56:867–870.

    CAS  PubMed  Google Scholar 

  15. Sabbah HN, Chaudhry PA, Paone G, et al.: Passive ventricular constraint with the Acorn prosthetic jacket prevents progressive left ventricular dilation and improves ejection fraction in dogs with moderate heart failure. J Am Coll Cardiol 1999, 33:207A.

    Google Scholar 

  16. Sabbah HN, Maltsev VA, Chaudhry PA, et al.: Contractile function of cardiomyocytes isolated from dogs with heart failure is enhanced after chronic therapy with passive ventricular constraint using the acorn cardiac support device. Circulation 1999, 100:2314.

    Google Scholar 

  17. Power JM, Raman J, Byrne MJ, et al.: Passive ventricular constraint is a trigger for a significant degree of reverse remodeling in an experimental model of degenerative heart failure and dilated cardiomyopathy. Circulation 2000, 102:2442.

    Google Scholar 

  18. Saavedra WF, Tunin RS, Paolocci N, et al.: Reverse remodeling and enhanced adrenergic reserve from passive external support in experimental dilated heart failure. J Am Coll Cardiol 2002, 39:2069–2076.

    Article  CAS  PubMed  Google Scholar 

  19. Pilla JJ, Blom AS, Brockman DJ: Passive ventricular constraint improves left ventricular function and mechanics in a model of heart failure secondary to acute myocardial infarction. Circulation 2002, 106(Suppl I):I207–I211.

    PubMed  Google Scholar 

  20. Chaudhry PA, Mishima T, Sharov VG, et al.: Passive epicardial containment prevents ventricular remodeling in heart failure. Ann Thorac Surg 2000, 70:1275–1280.

    Article  CAS  PubMed  Google Scholar 

  21. Sabbah HN, Sharov VG, Gupta RC, et al.: Reversal of chronic molecular and cellular abnormalities due to heart failure by passive mechanical ventricular containment. Circ Res 2003, 93:1095–1101.

    Article  CAS  PubMed  Google Scholar 

  22. Mann DL, Acker MA, Jessup M, et al.: Rationale, design and methods for a pivotal randomized clinical trial for the assessment of a cardiac support device in patients with New York Heart Association Class III–IV heart failure. J Card Fail 2004, 10:185–192.

    Article  PubMed  Google Scholar 

  23. Sabbah HN, Sharov VG, Chaudhry PA, et al.: Chronic therapy with the Acorn cardiac support device in dogs with chronic heart failure: three and six months hemodynamic, histologic and ultrastructural findings. J Heart Lung Transplant 2001, 20:189.

    Article  PubMed  Google Scholar 

  24. Ranous NH, Paone G, Morita H, et al.: Reverse left ventricular remodeling with the Acorn cardiac support device in dogs with advanced heart failure: randomized, placebo controlled study. Circulation 2002, 106(Suppl II):II–550.

    Google Scholar 

  25. Rastogi S, Gupta RC, Mishra S, et al.: Long-term therapy with the Acorn cardiac support device normalizes gene expression as alpha-myosin heavy chain in dogs with chronic heart failure. Circulation 2002, 106(Suppl II):II–384.

    Google Scholar 

  26. Konertz WF, Kleber FX, Dushe S, et al.: Efficacy trends with the Acorn cardiac support device: two years follow-up. J Am Coll Cardiol 2002, 39(Suppl A):142A.

    Article  Google Scholar 

  27. Raman JS, Power JM, Buxton BF, et al.: Ventricular containment as an adjunctive procedure in ischemic cardiomyopathy: early results. Ann Thorac Surg 2001, 70:1124–1126.

    Article  Google Scholar 

  28. Acker MA: Clinical results with the Acorn cardiac restraint device with and without mitral valve surgery. Semin Thorac Cardiovasc Surg 2005, 17:361–363.

    Article  PubMed  Google Scholar 

  29. •• Mann, DL, Acker, MA, Jessup M, et al.: Clinical evaluation of the CorCap cardiac support device in patients with dilated cardiomyopathy. Ann Thorac Surg 2007, 84:1226–1235. This is the original article describing the ACORN trial results.

    Article  PubMed  Google Scholar 

  30. •• Starling RC, Jessup M, Oh JK, et al.: Sustained benefits of the CorCap cardiac support device on left ventricular remodeling: three-year follow-up results from the Acorn clinical trial. Ann Thorac Surg 2007, 84:1236–1242. This paper provides the long-term results of the ACORN trial.

    Article  PubMed  Google Scholar 

  31. Otto CM: Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001, 345:740–746.

    Article  CAS  PubMed  Google Scholar 

  32. Koelling TM, Aaronson KD, Cody RJ, et al.: Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002, 144:524–529.

    Article  PubMed  Google Scholar 

  33. Trichon BH, Felker GM, Shaw LK, et al.: Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003, 91:538–543.

    Article  PubMed  Google Scholar 

  34. Robbins JD, Maniar PB, Cotts AW, et al.: Prevalence and severity of mitral regurgitation in chronic systolic heart failure. Am J. Cardiol 2003, 91:360–362.

    Article  PubMed  Google Scholar 

  35. Kono T, Sabbah HN, Rosman H, et al.: Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol 1992, 20:1594–1598.

    Article  CAS  PubMed  Google Scholar 

  36. Yiu SF, Enriquez-Sarano M, Tribouilloy C, et al.: Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation 2000, 102:1400–1406.

    CAS  PubMed  Google Scholar 

  37. Bolling SF, Pagani FD, Deeb GM, et al.: Intermediate-term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998, 115:381–386.

    Article  CAS  PubMed  Google Scholar 

  38. Bach DS, Bolling SF: Improvement following correction of secondary mitral regurgitation in end-stage cardiomyopathy with mitral annuloplasty. Am J Cardiol 1996, 78:966–969.

    Article  CAS  PubMed  Google Scholar 

  39. Badhwar V, Bolling SF: Mitral valve surgery in the patient with LV dysfunction. Semin Thorac Cardiovasc Surg 2002, 14:133.

    Article  PubMed  Google Scholar 

  40. Romano MA, Bolling SF: Update on mitral repair in dilated cardiomyopathy. J Card Surg 2004, 19:396–400.

    Article  PubMed  Google Scholar 

  41. Acker MA, Bolling SF, Shemin R, et al.: Mitral valve surgery in heart failure: insights from the Acorn clinical trial. J Thorac Cardiovasc Surg 2006, 132:568–577.

    Article  PubMed  Google Scholar 

  42. Grossi EA, Crooke GA: Mitral valve surgery in heart failure: insights from the Acorn clinical trial. J Thorac Cardiovasc Surg 2006, 132:455–456.

    Article  PubMed  Google Scholar 

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Correspondence to Steven F. Bolling.

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Ali, M.W., Bolling, S.F. Mitral Valve Repair: What the ACORN Trial Taught Us. Curr Cardiol Rep 12, 116–121 (2010). https://doi.org/10.1007/s11886-010-0088-7

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