Abstract
Natural history studies have shown that progressive left ventricular (LV) remodeling is directly related to future deterioration in LV performance and a less favorable clinical course in patients with heart failure.1,2 These studies have led to the hypothesis that the mechanical burdens engendered by left ventricular remodeling - increased wall stress, decreased cardiac output, increased mitral regurgitation with increased hemodynamic overloading - may contribute to disease progression independently of the patient's neurohormonal status (reviewed in 3). Accordingly, several innovative approaches have been evaluated to address LV remodeling, including cardiomyoplasty, partial left ventriculectomy ("Batista procedure") and the endoventricular circular patch plasty (the "Dor procedure").4-7 The suggestion that passive containment of the ventricle might prevent and/or reverse LV remodeling arose from studies in patients who underwent the cardiomyoplasty procedure and found the external girdling provided by the skeletal muscle wrap more beneficial than the systolic assistance provided by the skeletal muscle contraction.4 This review examines the role of cardiac support devices (CSD), specifically the CorCap™ CSD (Acorn Cardiovascular, Inc.™, St. Paul, MN) currently being evaluated in clinical trials.