Adaptive cardiac binding: a new method for treatment of dilated cardiomyopathy.

Adaptive cardiac binding, a new surgical procedure for advanced heart failure, allows a gradual increase in compression on the dilated heart, with separate loads on the left and right ventricles. A canine model of biventricular heart failure (anastomosis between the carotid artery and jugular vein and doxorubicin administration) was created. Twenty-four dogs were divided into 4 groups: control, adynamic cardiomyoplasty, plastic cardiac binding, and adaptive cardiac binding. In the adaptive cardiac binding group, fluid was added (35, 15, and 10 mL) to each side of the pouch at weeks 1, 2, and 3. Left ventricular ejection fraction was 59%+/-4% before induction of heart failure and 27%+/-2% 6 weeks later. Immediately after the main operation, left ventricular ejection fractions were 35+/-3% (cardiomyoplasty), 34%+/-4% (plastic cardiac binding), and 35%+/-4% (adaptive cardiac binding). Four weeks later, left ventricular ejection fraction had not changed in the cardiomyoplasty (37%+/-3%) and plastic cardiac binding (32%+/-2%) groups, but significantly increased in the adaptive cardiac binding group (48%+/-5%); it had decreased to 23%+/-4% in controls. Adaptive cardiac binding is a promising new surgical approach for patients with end-stage heart failure.