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  • Title: Right ventricular performance is impaired by full assist of left heart bypass. Analysis of right ventricular performance against change in afterload in heart failure models.
    Author: Park CH, Nishimura K, Kitano M, Okamoto Y, Ban T.
    Journal: ASAIO J; 1994; 40(3):M303-8. PubMed ID: 8555529.
    Abstract:
    The purpose of this study was to assess right ventricular (RV) performance during left heart bypass (LHB) and to determine the optimum LHB driving conditions to preserve RV performance. LHB was established with a centrifugal pump in eight mongrel dogs weighing 11-19 kg. Failing heart models were induced by normothermic aortic clamping for 20 min. RV volume was measured by a conductance catheter, and RV performance was evaluated by two parameters. One was the slope of the RV end-systolic pressure-volume relationship (ESPVR) as a load independent index, and the other was the peak RV pressure (PRVP)-RV stroke volume (RVSV) relationship as a "force-velocity relationship." These parameters were measured during varying assist ratios of LHB at 0% to 100% of pulmonary artery flow, and varying afterload as induced by bilateral intrapulmonary balloon inflation. In failing hearts, RV ESPVR showed an inverse correlation, with the assist ratio of LHB significantly decreasing from 4.23 +/- 1.35 (mmHg/ml) to 3.52 +/- 1.30 (mmHg/ml; P < 0.05) after 100% LHB assist. The correlation between PRVP and RVSV also was inversely linear, the slope of this correlation becoming significantly steeper after 100% LHB assist compared to that without LHB (-0.131 +/- 0.042 vs. -0.051 +/- 0.038, P < 0.005). These two slopes intersected, and this intersection was considered the critical point of afterload above which RVSV was decreased by LHB compared to that without LHB. In addition, reducing the assist ratio made the slope of the PRVP-RVSV correlation significantly more gentle (70%: -0.072 +/- 0.037 vs. 100%: -0.131 +/- 0.042, P < 0.05), with the intersection of the two slopes shifting rightward (i.e., higher afterload). Consequently, the critical level of afterload at 70% LHB assist was significantly higher than that at 100% LHB assist (70%: 38.1 +/- 6.9 vs. 100%: 29.2 +/- 6.8, P < 0.05). Therefore, RV performance against afterload was improved by reducing the assist ratio of LHB. This study demonstrates that RV performance is impaired by full LHB assist if the RV afterload is above the critical level, and that reducing the assist ratio may improve RV performance against afterload.
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