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A New Technique for Bridging to Heart Transplantation: Feasibility of Monoventricularization of Bilateral Ventricles with LVAD
Author(s) -
Yozu Ryohei,
Haga Yoshiyuki
Publication year - 1991
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1991.tb00772.x
Subject(s) - medicine , cardiology , ventricular assist device , hemodynamics , transplantation , vascular resistance , heart failure , central venous pressure , aorta , cardiac output , blood pressure , heart rate
Because the prognosis of ventricular septal perforation (VSP) and mitral regurgitation (MR) after acute myocardial infarction (MI) is remarkably poor, heart transplantation would be necessary for many of those patients. A new bridging technique was examined in canine models. The bilateral ventricles communicating through VSP were monoventricularized with mitral valve closure and maintained the pulmonary circulation, which had low vascular resistance. The systemic circulation was maintained by a left ventricular assist device (LVAD) placed between the left atrium and the aorta. VSP and MR were made in eight mongrel dogs (pulmonary to systemic flow ratio = 2.24 ± 0.90). They were then monoventricularized and equipped with LVADs. The hemodynamic state was evaluated (a) in intact hearts, (b) after VSP and MR were made, and (c) after monoventricularization and assisted circulation by LVAD. Cardiac output was (a) 90.60 ± 23.16, (b) 42.23 ± 15.76, and (c) 73.43 ± 15.14 ml/ min/kg (a vs. c: not significant; a vs. b and b vs. c: p < 0.01); mean aortic pressure was (a) 96.75 ± 24.69, (b) 30.25 ± 11.08, and (c) 66.50 ± 18.40 mm Hg (a vs. b: p < 0.01, a vs. c and b vs. c: p < 0.05); central venous pressure was (a) 4.76 ± 1.68, (b) 8.94 ± 2.17, and (c) 10.68 ± 2.43 mmHg(a vs. c: p < 0.01, a vs. b: p < 0.05, and b vs. c: not significant). Mean pulmonary arterial pressure and mean left atrial pressure did not show any significant difference among the three groups. This study supports the feasibility of maintenance of hemodynamics by monoventricularization and LVAD in patients with acute MI complicating VSP and MR.