Efficacy trends of the acorn cardiac support device in patients with heart failure: a one year follow-up

The Acorn Cardiac Support Device (CSD), a preformed-knitted polyester device surgically placed around the cardiac ventricles was shown to prevent LV remodeling and improve LV ejection fraction (EF) in dogs with chronic heart failure (HF). In a previously reported cohort of patients with HF, the CSD was also shown to improve LV EF and to prevent progressive LV dilation at 3 months following implantation. In this study, we examined the efficacy trends of the CSD in 10 patients with HF in whom the CSD was implanted for one year. Five patients had concomitant mitral valve repair along with CSD implantation and 5 received only the CSD. A 2% to 10% reduction of LV end-diastolic dimension (LVEDD) was allowed at the time of surgical fitting of the CSD. LVEDD, end-systolic dimension (LVESD) and EF were measured with 2-D echocardiography before and one year after CSD implantation. The presence and severity of functional mitral regurgitation (MR) were assessed qualitatively from color flow Doppler and graded on a scale of 0 (no MR) to 41 (severe MR). NYHA classification was also determined before and after one year of CSD implantation. After one year of follow-up, CSD therapy was associated with a significant (*p,0.05) reduction of LVEDD and LVESD and with a significant increase of LV EF (Table). This was accompanied by a significant reduction in the severity of MR and with improvement of NYHA classification (Table). We conclude that the early improvements in LV systolic function and remodeling seen in dogs with HF and in patients with HF treated with the CSD for 3 months are sustained for at least one year. The one year findings of reduced functional MR and HF symptoms with CSD therapy are also consistent with the improvement in these endpoints observed following the first 3 months of therapy in patients with HF.