Load-independent analysis of a pulsatile right ventricular assist device.

BACKGROUND

Right ventricular assist devices are becoming increasingly used as both a bridge to heart transplantation and as a means of temporary support after cardiopulmonary bypass. There has also been a resurgence of interest in pulsatile devices fueled by anecdotal, clinical reports. However, a load-independent analysis of biventricular function after right ventricular assistance comparing a pulsatile versus a continuous-flow right ventricular assist device has not been performed, and we hypothesize that a pulsatile device is less detrimental to cardiac function than a conventional, nonpulsatile pump.

METHODS

Sixteen dogs (20 to 25 kg) were instrumented through a median sternotomy for placement of left ventricular and right ventricular epicardial dimension transducers in the major, minor, and septal-free wall axes. Intracavitary micromanometers were placed in both ventricles as well. Baseline pressure-dimension data were collected, and the right atrium and pulmonary artery were cannulated. Right ventricular bypass with the use of a pneumatically driven pulsatile right ventricular assist device (SV = 60 ml; n = 7) or a conventional continuous-flow centrifugal right ventricular assist device (n = 9) was instituted for a 4-hour duration. Animals were then weaned from right ventricular support and decannulated. After bypass, biventricular function data were then collected. The load-insensitive stroke work-end diastolic volume relationship known as preload recruitable stroke work was derived and expressed as a fraction of baseline function along with conventional hemodynamic indexes, cardiac output, and pulmonary vascular resistance.

RESULTS

Results of this analysis show no significant benefit to either right ventricular or left ventricular function (right ventricular preload recruitable stroke work index: 0.863 +/- 0.3 [pulsatile] versus 0.849 +/- 0.2 [continuous], left ventricular preload recruitable stroke work index: 0.880 +/- 0.4 [pulsatile] versus 0.821 +/- 0.3 [continuous] after pulsatile right ventricular support. Likewise, cardiac output (1.4 +/- 0.1 [pulsatile] versus 1.5 +/- 0.2 [continuous] L/min) and pulmonary vascular resistance (4.8 +/- 1.0 [pulsatile] versus 3.2 +/- 1.1 [continuous] Wood Units) were not significantly different in either study group.

CONCLUSIONS

We conclude from these data that pneumatically driven pulsatile right ventricular assist devices provide no additional benefit to myocardial performance beyond that of conventional, nonpulsatile pumps. Further studies investigating a speculative benefit from pulsatile circulatory support are necessary to further define a potential role for these novel devices.