CARDIAC WALL TENSION RELIEF WITH CELL LOSS MANAGEMENT
Methods and apparatus are disclosed for treating congestive heart failure. The method includes relieving wall stress on a diseased heart by an amount to decrease a rate of myocardial cell loss. Further, the method includes pharmacologically encouraging a myocardial cell gain. Cell gain may be encouraged by cell replication, cell recruitment or inhibition of cell death. Further embodiments of the method include a passive cardiac constraint selected to reduce wall stress on the heart. An apparatus of the present invention includes a passive cardiac constraint and a pharmacological agent to encourage cell gain.
1 . An apparatus for treating a condition of a heart comprising:
a passive constraint sized to be placed on at least a portion of the heart of a patient and left in situ on the heart following placement; and
a scaffold or matrix placed between at least a portion of the heart and the constraint to promote reverse remodeling of the heart.
2 . An apparatus according to claim 1 wherein the scaffold or matrix is a resorbable or bioresorbable material.
3 . An apparatus according to claim 1 wherein the passive constraint is a jacket with the scaffold or matrix incorporated into a material of the jacket.
4 . An apparatus according to claim 1 wherein the scaffold or matrix incorporates a therapeutic agent.
5 . An apparatus according to claim 4 wherein the therapeutic agent incorporated into the scaffold or matrix comprises one or more pharmacological agents, cellular materials, or combinations thereof.
6 . An apparatus according to claim 5 wherein the pharmacological agent incorporated into the scaffold or matrix comprises cytokines, growth factors or transcription factors.
7 . An apparatus according to claim 1 wherein the scaffold or matrix incorporates a hydrogel.
8 . An apparatus according to claim 7 wherein the hydrogel comprises polycarboxylic acids, water-swollen cellulose derivatives, gelatin, polyvinylpyrrolidone, maleic anhydride polymers, polyamides, poly(vinyl alcohol), polyethylene oxides, poly(2-hydroxyethyl methacrylate), poly(ethylene oxide), or copolymers thereof.
9 . An apparatus according to claim 4 wherein the passive constraint is a jacket with the scaffold or matrix and therapeutic agent incorporated into a material of the jacket.
10 . An apparatus for treating a condition of a heart comprising:
a passive constraint sized to be placed on at least a portion of the heart of a patient and left in situ on the heart following placement; wherein the passive constraint is a jacket with an internal surface facing an epicardial surface of the heart and external surface;
a first scaffold or matrix on the internal surface of the jacket; and
a second scaffold or matrix on the external surface of the jacket.
11 . An apparatus according to claim 10 where in the scaffold or matrix is resorbable or bioresorbable.
12 . An apparatus according to claim 10 wherein the scaffold or matrix incorporates a therapeutic agent.
13 . An apparatus according to claim 12 wherein the therapeutic agent incorporated into the scaffold or matrix comprises one or more pharmacological agents, cellular materials, or combinations thereof.
14 . An apparatus according to claim 13 wherein the pharmacological agent incorporated into the scaffold or matrix comprises cytokines, growth factors or transcription factors.
15 . An apparatus according to claim 10 wherein the scaffold or matrix incorporates a hydrogel.
16 . An apparatus according to claim 15 wherein the hydrogel comprises polycarboxylic acids, water-swollen cellulose derivatives, gelatin, polyvinylpyrrolidone, maleic anhydride polymers, polyamides, poly(vinyl alcohol), polyethylene oxides, poly(2-hydroxyethyl methacrylate), poly(ethylene oxide), or copolymers thereof.
17 . An apparatus for treating a condition of a heart comprising:
a passive constraint sized to be placed on at least a portion of the heart of a patient and left in situ on the heart following placement; wherein the passive constraint is a jacket incorporating a scaffold or matrix; and
cellular materials associated with the jacket via a spacer arm.
18 . An apparatus according to claim 17 wherein the spacer arm comprises a string of methylene groups, natural peptides, or synthetic peptides.
19 . An apparatus according to claim 18 wherein the spacer arm terminates with an arginine-glycine-aspartic acid amino acid sequence.
20 . An apparatus according to claim 17 wherein the jacket has a surface facing an epicardial surface the of the heart and the cellular materials are attached to the surface of the jacket by the spacer arm.