Restraint to the left ventricle alone is superior to standard restraint.
OBJECTIVE
In standard ventricular restraint therapy, a single level of restraint is applied to the entire ventricular surface. We showed previously that at high restraint levels, cardiac tamponade develops because of the thin-walled right ventricle, even while the left ventricle remains unaffected. We now hypothesize that applying restraint exclusively to the left ventricle permits higher levels of restraint, resulting in increased benefit to the left ventricle.


METHODS
The acute effect of restraint applied to the left ventricle alone was analyzed in healthy and cardiomyopathic sheep hearts. Restraint therapy was applied by fluid-filled epicardial balloons placed solely around the left ventricle. Restraint level was defined by the measured balloon luminal pressure at end diastole. At incrementally higher restraint levels (0, 3, 5, 8, 10, 12, and 14 mm Hg), transmural myocardial left ventricular pressure (P(tm) = Left ventricle pressure - Balloon pressure) and indices of myocardial oxygen consumption were measured in healthy sheep (n = 5) and in sheep with heart failure (n = 6).


RESULTS
Increasing restraint from 0 to 14 mm Hg decreased transmural myocardial pressure by 48.8% (P ≤ .02) and the left ventricle tension-time index by 39.1% (P ≤ .01), and the pressure-volume area decreased by 58.4% (P ≤ .01). Similarly, stroke work decreased by 57.9% (P ≤ .03). Systemic hemodynamics were unchanged. There was no difference in the trend for all indices between animals that were healthy and those with heart failure.


CONCLUSIONS
We showed previously that, with standard restraint, right ventricle tamponade develops at high restraint levels, limiting restraint therapy. We now show that restraint applied to the left ventricle alone permits increased restraint levels, without causing right ventricle or left ventricle tamponade, for greater therapeutic benefit. We conclude that partial left ventricle restraint may be more effective than standard restraint.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Suyog A
SA
Mokashi
Lawrence S
LS
Lee
Jan D
JD
Schmitto
Ravi K
RK
Ghanta
Siobhan
S
McGurk
Rita G
RG
Laurence
R Morton
RM
Bolman
Lawrence H
LH
Cohn
Frederick Y
FY
Chen
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002305:Cardiac Tamponade / Q000209:etiology / Q000517:prevention & control; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles; D008297:Male; D019736:Prostheses and Implants; D012756:Sheep