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Masashi Komeda
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Ann Thorac Surg 1997;64:1250-1255
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Complete Unloading Alone May Not Adequately Protect the Left Ventricle

Masashi Komeda, MD, PhD, Abe DeAnda, Jr, MD, Julie R. Glasson, MD, Ann F. Bolger, MD, George T. Daughters, II, MS, Neil B. Ingels, Jr, PhD, D. Craig Miller, MD

Department of Cardiovascular and Thoracic Surgery and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Palo Alto Veterans Affairs Medical Center, and Department of Cardiovascular Physiology and Biophysics, Research Institute, Palo Alto Medical Foundation, Palo Alto, California

Background. The benefit of left ventricular (LV) unloading for preserving LV function is commonly accepted, but its efficacy remains incompletely defined.

Methods. We studied the influence of complete LV unloading on LV systolic and diastolic mechanics using an in situ isovolumic preparation with two different coronary perfusion pressures (CPPs) in 12 dogs during prolonged normothermic cardiopulmonary bypass.

Results. Multivariate analysis of covariance with time as a covariate revealed that a high CPP (143 ± 36 mm Hg; n = 6) was associated with better preservation of systolic LV function over time as assessed by LV end-systolic elastance (p < 0.001) and the end-systolic pressure-volume relation physiologic intercept (p < 0.001) compared with a moderate CPP (107 ± 18 mm Hg; p < 0.005 versus a high CPP by t-test; n = 6). Dobutamine (2 µg • kg-1 • min-1) improved LV end-systolic elastance (p < 0.005) and LV physiologic intercept (p < 0.01) only in the high-CPP group. Conversely, impaired LV diastolic function (as measured by LV stiffness) was observed (p < 0.001) with a high CPP, but did not change with a moderate CPP.

Conclusions. These observations in canine hearts suggest that complete LV unloading may not preserve LV systolic function adequately over time when CPP is maintained in the accepted clinical range. A higher CPP is required to prevent deterioration over prolonged cardiopulmonary bypass times, but diastolic dysfunction still occurs.




This article has been cited by other articles:


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 J. Thorac. Cardiovasc. Surg.Home page
A. C. Nicolosi, J. G. Markley, and G. N. Olinger
EFFECTS OF POSTISCHEMIC LEFT VENTRICULAR PRESSURE-VOLUME UNLOADINGON CONTRACTILE RECOVERY AND MYOCARDIAL BLOOD FLOW IN THE REGIONALLY STUNNEDCANINE HEART
J. Thorac. Cardiovasc. Surg., July 1, 1999; 118(1): 181 - 188.
[Abstract] [Full Text] [PDF]


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