Right heart function during left ventricular assistance in an open-chest porcine model of acute right heart failure

Changes in the right ventricular function measured with a thermodilution ejection fraction catheter have been recorded in open-chest normal pigs and pigs with acute right heart failure (RVF) undergoing left ventricular assistance with a pneumatic-sac-type device (LVAD). To produce acute right heart failure, 5 pigs underwent ligation of the right ventricular free wall coronary arteries. Compared with normal pigs, cardiac output in ligated pigs fell by 21% (7.5 +/- 0.5 vs 9.5 +/- 1.2 L/min; p < 0.05) and the right ventricular end diastolic pressure rose (11.4 +/- 2.6 vs 5.7 +/- 3.6 vs mmHg: p < 0.05). With the left ventricular assist device connected, the right atrial pressure was increased to 3, 5, 7, 10 and 12 mmHg by volume loading while maintaining the haematocrit at 35 +/- 6%. The right ventricular stroke work index (RVSWI) increased with volume loading in normal pigs. In RVF pigs, RVSWI increased significantly with the LVAD (59.2 +/- 5.8 vs 23.5 +/- 7.8 mmHg ml/min/kg, p < 0.01), approaching that of normal pigs (62.3 +/- 4.8 mmHg ml/min/kg). Similar changes were observed in the cardiac output and right ventricular stroke volume. These results show that, in this model of open-chest, mild, acute right heart failure, left ventricular assistance allows right ventricular function to return to normal, despite volume overloading, by decreasing right ventricular after load and increasing right ventricular compliance.