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J Thorac Cardiovasc Surg 1994;107:1503-1511
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Left ventricular mechanics during synchronous left atrial–aortic bypass

Hershey, Pa., and St. Louis, Mo.

From the Department of Surgery, Division of Cardiothoracic Surgery, The Pennsylvania State University, College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pa., and the Department of Surgery, Jewish Hospital, St. Louis, Mo.

Received for publication March 24, 1993. Accepted for publication Oct. 25, 1993. Address for reprints: William S. Pierce, MD, P.O. Box 850, Department of Surgery, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA 17033.

Abstract

The purpose of this study was to analyze left ventricular mechanics during asynchronous, pulsatile left atrial–aortic bypass before and after microsphere injection with the pressure-volume relationship. In 14 anesthetized Holstein calves, left ventricular pressure was measured with a micromanometer and ultrasonic dimension transducers measured left ventricular orthogonal diameters. Ellipsoidal geometry was used to calculate simultaneous left ventricular volume. Contractility index, pressure-volume area, external work, and potential energy were calculated during steady-state contractions. These measurements were repeated during pulsatile left atrial–aortic bypass. To induce heart failure, we injected microspheres into the left main coronary artery, and the protocol for baseline and pulsatile left atrial–aortic bypass was repeated. Despite the significant differences in the baseline contractility index (7.4 ± 0.7 mm Hg/ml versus 4.7 ± 0.5 mm Hg/ml), contractility index remained the same during pulsatile left atrial–aortic bypass in control and heart failure modes, respectively. Pulsatile left atrial–aortic bypass significantly decreased end-diastolic volume (22% and 17%), pressure-volume area (58% and 48%) and external work (74% and 69%, all p < 0.05) during control and heart failure measurements, respectively. However, it did not change end-systolic volume or potential energy. In conclusion, asynchronous pulsatile left atrial–aortic bypass did not affect left ventricular contractile state in either the normal or failing heart. Although decreased pressure-volume area accounts for the reduction in myocardial oxygen consumption, unchanged potential energy suggested a limited unloading of the ventricle. (J T HORAC C ARDIOVASC S URG 1994;107:1503-11)

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