(Circulation. 1999;99:2177-2184.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Hemodynamic Effects of Direct Biventricular Compression Studied in Isovolumic and Ejecting Isolated Canine Hearts
From the Department of Surgery, Division of Cardiothoracic Surgery (J.H.A.), and the Department of Medicine, Division of Circulatory Physiology (J.W., D.B.), College of Physicians and Surgeons, Columbia University, New York, NY, and Cardio Technologies, Inc, Pine Brook, NJ (A.R.L., H.R.L., J.E.T.). Dr Tsitlik is now at JVT Consultants, Cliffside Park, NJ.
Correspondence to John H. Artrip, MD, c/o Daniel Burkhoff, MD, PhD, Department of Medicine, Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, MHB 5-435, 177 Fort Washington Ave, New York, NY 10032. E-mail ja276{at}columbia.edu
Background—Biventricular direct cardiac compression (DCC) can potentially support the failing heart without the complications associated with a blood/device interface. The effect of uniform DCC on left and right ventricular performance was evaluated in 7 isolated canine heart preparations.
Methods and Results—A computer-controlled afterload system either
constrained the isolated heart to contract isovolumically or simulated
hemodynamic properties of
physiological ejection. Biventricular
DCC was provided by a chamber surrounding the heart that allowed
adjustment of the compression pressure, onset time, and duration.
Through a series of ventricular preloads, the effect of DCC
on the end-systolic pressure-volume relationship (ESPVR) was
evaluated under isovolumic and ejecting conditions. Under both
conditions, DCC shifted the ESPVR of the left and right ventricles
upward by an amount approximately equal to the compression pressure.
The augmentation of end-systolic pressure for each initial
preload tested, however, was less under ejecting conditions, because
reductions in end-systolic and end-diastolic
volumes occurred with ejection. Nevertheless, the net effect was to
increase stroke volume. Measurement of
M
O2 demonstrated that at a given
ventricular volume, MO2 did
not change with DCC; however, peak ventricular pressure
increased substantially, so that the effective pressure-volume area
increased.
Conclusions—Biventricular DCC can augment
end-systolic pressure with no added costs of
MO2. Under ejecting conditions, this
augmentation of ventricular contracting ability manifests
as increases in stroke volume. Thus, DCC represents a feasible
alternative form of ventricular assist, and devices that
support the heart in this manner should be further explored.
Key Words: heart-assist device • heart failure • physiology • hemodynamics • ventricles
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