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Marc R. Moon
Luis J. Castro
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Neil B. Ingels, Jr
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Ann Thorac Surg 1993;56:54-67
© 1993 The Society of Thoracic Surgeons

Articles

Right ventricular dynamics during left ventricular assistance in closed-chest dogs

Marc R. Moon, MDa,b,c,1, Luis J. Castro, MDa,b,c, Abe DeAnda, MDa,b,c, Yasuko Tomizawa, MD, PhDa,b,c, George T. Daughters, II, MSa,b,c, Neil B. Ingels, Jr, PhDa,b,c, D.Craig Miller, MD*,a,b,c

a Department of Cardiovascular and Thoracic Surgery, Starford University School of Medicine, Stanford, California USA
b Department of Cardiac Surgery Section, Department of Veterans Affairs Medical Center, Palo Alto, California USA
c Research Institute of the Palo Alto Medical Foundation, Palo Alto, California USA

* Address reprint requests to Dr Miller, Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305.

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 myocardiol efficiency and power output are maintained through a decrease in RV afterload and an increase in RV preload.




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