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Ann Thorac Surg 1990;49:123-128
© 1990 The Society of Thoracic Surgeons

Articles

Effect of circulatory assist devices on stunned myocardium

Joseph E. Bavaria, MD*, Satoshi Furnlaw, MD, Gerhard Kreiner, MD, Kris B. Gupta, MSE, James Stretchcs, BSE, L.Henry Edmunds, Jr, MD

Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania USA

Accepted for publication September 28, 1989.

* Address reprint requests to Dr Bavaria, c/o L. Henry Edmunds, Jr, MD, Department of Surgery, 4 Silverstein, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.

We studied the effects of mechanical circulatory assist devices on left ventricular oxygen consumption, the integrals of systolic left venticular wall stress (SSI), and end-systolic elastance (Ees) in 8 sheep after 25 minutes of global ischemia. Extracorporeal membrane oxygenation at 35 mL/kg/min, intraaortic balloon counterpulsation, and an intraaortic double-balloon pump were studied alone or in combination. Left ventricular oxygen consumption, SSI, and Ees were measured before and during mechanical circulatory assistance. Left ventricular oxygen consumption was calculated from transit-time measurements of left main coronary artery blood flow and fiberoptic measurements of coronary sinus blood oxygen saturation. Three pairs of sonomicrometry crystals placed across three orthogonal ventricular axes were used to calculate instantaneous ventricular volumes and pressure-volume loops from which the SSI data were derived. The Ees was measured using a new single-beat aortic occlusive method. Extracorporeal membrane oxygenation alone increased SSI and did not change Ees in postischemic poorly contracting hearts. Intraaortic balloon counterpulsation alone significantly reduced SSI and increased Ees. The combination of extracorporeal membrane oxygenation and either the intraaortic balloon pump or the intraaortic double-balloon pump reduced SSI, increased Ees, and reduced left ventricular oxygen consumption. In postischemic dilated, poorly contracting hearts, the combination of extracorporeal membrane oxygenation and intraaortic balloon counterpulsation has important advantages over extracorporeal membrane oxygenation alone.




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