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The Annals of Thoracic Surgery, Vol 56, 54-66, Copyright © 1993 by The Society of Thoracic Surgeons
MR Moon, LJ Castro, A DeAnda, Y Tomizawa, GT Daughters 2d, NB Ingels Jr and DC Miller
To determine the effects of left ventricular assist device (LVAD) support
on global right ventricular (RV) systolic mechanics, 8 closed- chest,
conscious, sedated dogs were studied after placement of an LVAD (left
ventricle to femoral artery bypass) and implantation of 27 tantalum markers
into the left ventricular and RV walls for computation of biventricular
volumes and geometry. Biplane cinefluoroscopic marker images and
hemodynamic parameters were recorded during transient vena caval occlusion
at various levels of LVAD support. Right ventricular contractility was
assessed using end-systolic elastance and preload recruitable stroke work,
and the myocardial (pump) efficiency of converting mechanical energy to
external work (stroke work/total pressure-volume area) was calculated. With
full LVAD support, RV end- diastolic volume increased from 60 +/- 15 to 62
+/- 17 mL (p < 0.002), pulmonary artery input impedance decreased from
940 +/- 636 to 587 +/- 347 dyne.s/cm5 (p < 0.007), and measurement of RV
and left ventricular septal-free wall dimensions demonstrated a significant
leftward septal shift (p < 0.0005). Global RV end-systolic elastance and
preload recruitable stroke work decreased from 2.4 +/- 1.0 to 1.7 +/- 0.7
mm Hg/mL (p < 0.004) and 14.1 +/- 3.3 to 12.1 +/- 3.9 mm Hg (p <
0.02), respectively; however, RV power output and myocardial efficiency did
not change significantly (p > 0.74 and p > 0.33, respectively).
Therefore, during LVAD support, global RV contractility is impaired with
leftward septal shifting, but RV myocardial efficiency and power output are
maintained through a decrease in RV afterload and an increase in RV
preload.
ARTICLES
Right ventricular dynamics during left ventricular assistance in closed- chest dogs
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305.
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