Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 7 Issue 6

The Akor® Extracardiac Mesh Implantation in Dilated Cardiomyopathy Management

Alexey Koroteev*

Professor, Moscow Sechenov Medical University, Russia

*Corresponding Author: Alexey Koroteev, Professor, Moscow Sechenov Medical University, Russia.

Received: April 03, 2023; Published: May 17, 2023

Abstract

Objective: The aim of the study was to assess the long-term effects of the AKOR® extracardiac mesh implantation alone or in combination with mitral valve replacement (MVR) on left ventricular (LV) structure and function in patients with idiopathic dilated cardiomyopathy (IDCM) and heart failure, evaluate the safety and efficacy of this procedure.

Background: Dilated cardiomyopathy progression depends on ventricular remodeling. Changes in myocardial stroma based on collagen type I/type III ratio, affect cardiac compliance and lead to further LV dilation. The originally designed “AKOR®” extracardiac mesh was implemented in the trial. It was different from the ACORN CorCap CSD, that was used in previous trials. The trial was aimed to check, whether its implantation (alone or in combination with MVR) may compensate negative changes in myocardial stroma and prevent remodeling development.

Methods: A total of 36 patients with IDCM, severe LV dysfunction and advanced heart failure (NYHA class III-IV) were enrolled in the trial. All patients underwent extracardiac mesh of original design implantation either alone (Group I; n = 16) or in combination with MVR (Group II; n = 20). Long-term results were followed up to 4 years postop. Echocardiograms were obtained annually until the last patient was followed for 4 years. Standard measurements of LV volumes and dimensions, ejection fraction were made. The NYHA functional class, 6-min walking distance, working capacity were evaluated at annual checkups.

Results: The total LV EDD preoperatively was 7,2 ± 0,8 cm; LV EDV 258,5 ± 76,3 ml; LV ejection fraction 24,7 ± 6,7%. There were no cases of intraoperative mortality in both groups. The total 4 years’ actuarial survival in total group was 79,6 ± 7,4% (p < 0,05). The 4 years’ actuarial survival in Group I (AKOR mesh alone) was 92,7 ± 7,0% (p < 0.05). The 4 years’ actuarial survival in Group II (AKOR mesh +MVR) was 70,0 ± 2,5% (p < 0.05). The LV EDD diameter decreased in total group by 13% (from 7,2 ± 0,8 cm to 6,1 ± 0,5 cm; p < 0.05). The LV EDV decreased by 38% (from 258,5 ± 76,3 ml to 160,8 ± 19,7ml; p < 0.05). There were no cases of LV EDD or LV EDV increase after AKOR mesh implantation. LV EF increased from 24,7 ± 6,7% to 38,5 ± 5,6%. The number of annual hospitalizations decreased 3 times. NYHA mean class changed from 3,3 ± 0,7 to 2,0 ± 0,5 (p < 0,05). 19 (52,7%) patients restored working capacity. In 7 (19,4%) patients the AKOR® mesh implantation stimulated the trend for reverse LV remodeling and NYHA class improvement.

Conclusions: The AKOR® extracardiac mesh implantation (alone or in combination with MVR) stopped remodeling progression in IDCM patients, improved cardiac structure and functional status. When implemented in the adaptive stage of LV remodeling it may stimulate reverse heart remodeling. No signs of cardiac constriction were noted. Randomized controlled trials are needed to further evaluate the efficacy of this medical technology.

 Keywords: Dilated Cardiomyopathy; Extracardiac Mesh

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Citation

Citation: Alexey Koroteev. “The Akor® Extracardiac Mesh Implantation in Dilated Cardiomyopathy Management”.Acta Scientific Medical Sciences 7.6 (2023): 62-69.

Copyright

Copyright: © 2023 Alexey Koroteev. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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