Recovery of the failing canine heart with biventricular support in a previously fatal experimental model.
Prolonged normothermic ischemia in the canine model is generally fatal with standard resuscitative techniques. To determine whether such myocardial injury is recoverable with biventricular support, we subjected 10 dogs to 45 minutes of ischemia at 37 degrees C. After ischemia, the animals were supported for 24 hours with biventricular assist with the centrifugal pump. During early reperfusion, none of the hearts could sustain a stable rhythm or blood pressure. Myocardial adenosine triphosphate concentration, expressed as micromoles per gram of heart protein, was dramatically reduced from a control of 31.5 +/- 2.4 to 14.6 +/- 2.9 (p less than 0.01 versus control), a 54% reduction. Ultrastructural analysis did not reveal the explosive cell swelling of irreversible cell injury. After 12 hours of biventricular assist, developed pressure partially recovered to 60.0 +/- 10 mm Hg (p less than 0.01 versus control) and maximal positive dP/dt measured 2,649 +/- 412 mm Hg/sec (p less than 0.01 versus control). Adenosine triphosphate concentration increased to 25.2 +/- 5.5 (p less than 0.01 versus control). Electron microscopic examination showed less chromatin clumping, no further mitochondrial distortion, and more abundant glycogen. After 24 hours of biventricular assist, cardiac output in the seven dogs successfully weaned from biventricular assist measured 3.6 +/- 0.6 L/min, developed pressure recovered to 76.3 +/- 8.9 mm Hg, and its first derivative recovered to 4,282 +/- 585 mm Hg/sec (all measurements not significant compared with control). Examination by an electron microscope revealed no severe mitochondrial injury.
Magovern
G J
GJ
Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pa. 15212.
Christlieb
I Y
IY
Kao
R L
RL
Liebler
G A
GA
Park
S B
SB
Burkholder
J A
JA
Maher
T D
TD
Benckart
D H
DH
Magovern
G J
GJ
D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D001243:Assisted Circulation; D001794:Blood Pressure; D003327:Coronary Disease / Q000628:therapy*; D004285:Dogs; D006353:Heart-Assist Devices; D009200:Myocardial Contraction; D009206:Myocardium / Q000378:metabolism / Q000648:ultrastructure; D012151:Resuscitation; D013997:Time Factors
D000255:Adenosine Triphosphate