Complete unloading alone may not adequately protect the left ventricle

Masashi Komeda, Abelardo DeAnda, Julie R. Glasson, Ann F. Bolger, George T. Daughters, Neil B. Ingels, D. Craig Miller

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background. The benefit of left ventricular (LV) unloading for preserving LV function is commonly accepted, but its efficacy remains incompletely defined. Methods. We studied the influence of complete LV unloading on LV systolic and diastolic mechanics using an in situ isovolumic preparation with two different coronary perfusion pressures (CPPs) in 12 dogs during prolonged normothermic cardiopulmonary bypass. Results. Multivariate analysis of covariance with time as a covariate revealed that a high CPP (143 ± 36 mm Hg; n = 6) was associated with better preservation of systolic LV function over time as assessed by LV end-systolic elastance (p <0.001) and the end-systolic pressure-volume relation physiologic intercept (p <0.001) compared with a moderate CPP (107 ± 18 mm Hg; p <0.005 versus a high CPP by t-test; n = 6). Dobutamine (2 μg · kg-1 · min-1) improved LV end- systolic elastance (p <0.005) and LV physiologic intercept (p <0.01) only in the high-CPP group. Conversely, impaired LV diastolic function (as measured by LV stiffness) was observed (p <0.001) with a high CPP, but did not change with a moderate CPP. Conclusions. These observations in canine hearts suggest that complete LV unloading may not preserve LV systolic function adequately over time when CPP is maintained in the accepted clinical range. A higher CPP is required to prevent deterioration over prolonged cardiopulmonary bypass times, but diastolic dysfunction still occurs.

Original languageEnglish (US)
Pages (from-to)1250-1255
Number of pages6
JournalAnnals of Thoracic Surgery
Volume64
Issue number5
DOIs
StatePublished - Nov 1997
Externally publishedYes

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Heart Ventricles
Perfusion
Pressure
Left Ventricular Function
Cardiopulmonary Bypass
Dobutamine
Mechanics
Canidae
Multivariate Analysis
Dogs
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Komeda, M., DeAnda, A., Glasson, J. R., Bolger, A. F., Daughters, G. T., Ingels, N. B., & Miller, D. C. (1997). Complete unloading alone may not adequately protect the left ventricle. Annals of Thoracic Surgery, 64(5), 1250-1255. https://doi.org/10.1016/S0003-4975(97)00907-7

Complete unloading alone may not adequately protect the left ventricle. / Komeda, Masashi; DeAnda, Abelardo; Glasson, Julie R.; Bolger, Ann F.; Daughters, George T.; Ingels, Neil B.; Miller, D. Craig.

In: Annals of Thoracic Surgery, Vol. 64, No. 5, 11.1997, p. 1250-1255.

Research output: Contribution to journalArticle

Komeda, M, DeAnda, A, Glasson, JR, Bolger, AF, Daughters, GT, Ingels, NB & Miller, DC 1997, 'Complete unloading alone may not adequately protect the left ventricle', Annals of Thoracic Surgery, vol. 64, no. 5, pp. 1250-1255. https://doi.org/10.1016/S0003-4975(97)00907-7
Komeda, Masashi ; DeAnda, Abelardo ; Glasson, Julie R. ; Bolger, Ann F. ; Daughters, George T. ; Ingels, Neil B. ; Miller, D. Craig. / Complete unloading alone may not adequately protect the left ventricle. In: Annals of Thoracic Surgery. 1997 ; Vol. 64, No. 5. pp. 1250-1255.
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