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J Thorac Cardiovasc Surg 1996;112:484-493
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

EFFECTS OF FAILURE OF THE RIGHT SIDE OF THE HEART AND INCREASED PULMONARY RESISTANCE ON MECHANICAL CIRCULATORY SUPPORT WITH USE OF THE MINIATURIZED HIA-VAD DISPLACEMENT PUMP SYSTEM

From the Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.

Received for publication June 7, 1995 Revisions requested August 8, 1995; revisions received Oct. 25, 1995 Accepted for publication Oct. 30, 1995. Address for reprints: W. Flameng, MD, PhD, C.E.H.A., Provisorium I, Minderbroedersstraat 17, B-3000 Leuven, Belgium.

Abstract

This experimental study was designed to assess the influence of failure of the right side of the heart or pulmonary hypertension, or both, on the performance of a novel miniaturized left ventricular assist device. In small-sized dogs (n = 50) ischemic global left ventricular failure was induced and support was provided by the HIA-VAD displacement pump (stroke volume 10 or 25 ml) installed as a left ventricular assist device. In three groups of animals (n = 10 each) pulmonary hypertension was created before induction of global left ventricular failure. During left ventricular assist device support temporary ischemic failure of the right side of the heart was induced in four groups of animals (n = 10 each). In the group subjected to left ventricular failure, support with the left ventricular assist device, and right ventricular failure during left ventricular assist, left atrial pressure and cardiac index were significantly lower than in the group subjected to left ventricular failure and left ventricular assist alone (2 ± 6 versus 11 ± 6 mm Hg and 1.6 ± 0.4 versus 1.0 ± 0.4 L/(min/m²), respectively, p < 0.05). In the group subjected to pulmonary hypertension, left ventricular failure, and left ventricular support, left atrial pressure dropped to values near zero but cardiac index remained unaltered as compared with results with the same regimen without pulmonary hypertension. However, when right ventricular failure was added (that is, pulmonary hypertension, left ventricular failure, left ventricular support, and right ventricular failure during support with the left ventricular assist device) left atrial pressure dropped to negative values (p < 0.05) and cardiac index progressively deteriorated. When, in an additional group of dogs, biventricular support was installed in the latter regimen, circulation was initially well supported but oxygenation deteriorated in 60% of cases. We conclude that (1) adequate right ventricular function was indispensable during support with the left ventricular assist device, (2) the combination of pulmonary hypertension and right ventricular failure led to the "low left ventricular assist device output syndrome," and (3) biventricular mechanical support in the presence of pulmonary hypertension may be complicated by the alveolar leakage syndrome. (J THORACCARDIOVASCSURG1996;112:484-93)

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