The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 153-160, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Pulmonary artery balloon counterpulsation for right ventricular failure after right ventriculotomy in the swine
L Gonzalez-Lavin, J Gu, LB McGrath, SB Amini, A Cernaianu, D Graf, L DeSandis and C Daloisio
Department of Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Browns Mills.
To assess the efficacy of intrapulmonary balloon counterpulsation in the
management of right ventricular failure after right ventriculotomy, we
undertook an experimental study in a swine model. To mimic the clinical
settings more closely, (1) we left the automatic control of the heart
intact (2) did not use cardiopulmonary bypass to support the left side of
the heart, and (3) induced right ventricular failure by means of a generous
surgical incision (50% to 70% of the anterior wall) of the right ventricle.
The criteria set for right ventricular failure were (1) 50% increase in
right ventricular end-diastolic pressure, (2) 30% decrease in mean arterial
pressure, and (3) 30% decrease in cardiac output. Right ventricular failure
was attained in all animals studied: A 230% increase in right ventricular
end-diastolic pressure, a 43% decrease in cardiac output, and a 34%
decrease in mean arterial pressure were evident after the right
ventriculotomy. A specially designed intrapulmonary balloon catheter
(Datascope Corp., Oakland, N.J.) was placed into the left pulmonary artery
through the right ventricular outflow tract. A Datascope console was used
for counterpulsation. Effects of counterpulsation for 40 minutes in a 1:1
mode were assessed after surgical induction of right ventricular failure in
14 swine. Each animal served as its own control. The mean hemodynamic
changes are outlined: Right ventricular end-diastolic pressure decreased by
48.9% (p = 0.01). Mean arterial pressure increased by 68.8% (p = 0.01) and
cardiac output by 44.2% (p = 0.01). Histologic studies disclosed no
morphologic damage to the pulmonary artery or valve in the specimens
analyzed. In addition, these results were compared with those in a second
group of seven swine in which right ventricular failure was induced by
right ventriculotomy and a balloon was placed into the left pulmonary
artery but not activated. These results of short-term counterpulsation
should be evaluated in a longer term model so as to mimic more closely the
clinical setting. If the hemodynamic benefits are duplicated,
intrapulmonary balloon counterpulsation should be considered as a simple,
effective device when right ventricular failure develops after right
ventriculotomy. It effectively improves right ventricular function without
damaging the pulmonary artery or valve.
