Ventricular restraint therapy for heart failure: A review, summary of state of the art, and future directions

Congestive heart failure is a leading cause of death in developed countries, and its incidence is expected to increase in parallel with the aging population. Most current therapies for congestive heart failure lead to modest symptom relief but are unable to significantly improve long-term survival outcomes. Indeed, there is no effective treatment except cardiac transplantation, which remains epidemiologically insignificant because of donor pool limitations. New strategies for treating congestive heart failure are needed. Ventricular restraint is a promising, nontransplant surgical therapy in which the overall goal is to wrap the dilated, failing heart with prosthetic material to mechanically constrain the heart at end-diastole, prevent further remodeling, and thereby ultimately improve ventricular function, patient symptoms, and survival. In this review, the principles of cardiac restraint therapy will be discussed. An overview of 3 restraint devices, along with their specific advantages and disadvantages, will be presented. The existing peer-reviewed literature from both animal and human trials will be summarized with an emphasis on understanding the mechanism of restraint therapy and how this knowledge can be used to optimize and improve its efficacy.