Preservation of myocardial function by mechanical circulatory support during prolonged ischaemia.
The effect of mechanical circulatory support on left ventricular (LV) function was evaluated during prolonged myocardial ischaemia. Regional wall thickening of a normal and an ischaemic LV region were determined in eight calves (mean body weight 76 kg) using pairs of ultrasonic crystals. LV end-diastolic (mmHg) and peak systolic (mmHg) pressure as well as maximum dP/dt (mmHg s-1) were calculated from LV high-fidelity pressure tracings. The left circumflex coronary artery was ligated proximally for 6 h and reperfused for 18 h. Circulatory support by the assist device was performed from the beginning of ischaemia to the end of the experiment. After a mean time of 4 h all animals showed ventricular fibrillation, which was converted successfully in six animals after a mean time interval of 5 h. Five animals survived after 24 h. The non-surviving animals had larger infarcts, greater creatine kinase release and a larger drop in cardiac output during ischaemia. Haemodynamic measurements were carried out after turning off the assist device. Inotropic stimulation with 0.68 mg.min-1 dopamine i.v. was performed at the end of the study. LV regional function showed systolic bulging during myocardial ischaemia. After 18 h of reperfusion, the ischaemic wall recovered and showed normal systolic wall thickening in the presence of an increased LV preload. LV relaxation was prolonged after reperfusion, suggesting diastolic dysfunction. It is concluded that mechanical circulatory support is effective in protecting myocardial function during prolonged ischaemia in approximately two-thirds of the animals, despite severe ischaemic ventricular dysfunction and intermittent ventricular fibrillation.
Tjon-A-Meeuw
L
L
Department of Internal Medicine, University Hospital Zürich, Switzerland.
Hess
O M
OM
Segesser
L V
LV
Suetsch
G
G
Leskosek
B
B
Turina
M
M
D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D002417:Cattle; D004867:Equipment Design; D006353:Heart-Assist Devices; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology* / Q000517:prevention & control; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000209:etiology; D016277:Ventricular Function, Left / Q000502:physiology*