title: Dynamic biventricular response to alterations in preload in patients undergoing left ventricular device implantation.
abstract: Ventricular interdependence is important for the successful use of a left ventricular assist device (LVAD) because the filling of the device depends on right ventricular (RV) function as well as the interactions between the ventricles. The pulmonary arterial (PAP) and systemic arterial (AP) response to inferior vena caval (IVC) occlusion before and after insertion of an LVAD in 15 patients was used to "dissect out" the determinants of these interactions. PAP and AP were recorded during each IVC occlusion and peak systolic values calculated for each beat. Linear regression analysis was used to calculate the slope (k) between peak systolic AP values and peak systolic PAP values. k, a measure of preload responsiveness of the heart, is predominantly linear. k is relatively "flat" in selected LV failure patients pre-LVAD but increases significantly (P < 0.001) after LVAD (0.67 +/- 0.55 vs. 2.71 +/- 1.39). The increase in this parameter after LVAD suggests that the loss of RV-to-LV ventricular interdependence in patients with congestive heart failure appears to recover somewhat once an LVAD is inserted.
authors.affiliation: Division of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Mandarino
authors.forename: R L
authors.initials: RL
authors.lastname: Kormos
authors.forename: A
authors.initials: A
authors.lastname: Kawai
authors.forename: T A
authors.initials: TA
authors.lastname: Gasior
authors.forename: M R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: B P
authors.initials: BP
authors.lastname: Griffith
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology; D014655:Vascular Resistance; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology