Suyog A. Mokashi, MD, Lawrence S. Lee, MD, Jan D

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Presentation transcript:

Restraint to the left ventricle alone is superior to standard restraint Suyog A. Mokashi, MD, Lawrence S. Lee, MD, Jan D. Schmitto, MD, PhD, Ravi K. Ghanta, MD, Siobhan McGurk, MS, Rita G. Laurence, BS, R. Morton Bolman, MD, Lawrence H. Cohn, MD, Frederick Y. Chen, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 1, Pages 192-197 (July 2013) DOI: 10.1016/j.jtcvs.2012.09.027 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Timeline of heart failure creation and terminal study. Myocardial infarction is induced at time 0; cardiac magnetic resonance imaging (MRI) to document heart failure is performed 8 weeks after myocardial infarction; and terminal study, 1 week after cardiac MRI. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 192-197DOI: (10.1016/j.jtcvs.2012.09.027) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The partial left ventricular restraint device. A half-ellipsoidal fluid-filled balloon, which allows for adjustable and measurable restraint therapy, is positioned on the left ventricle. The restraint level may be adjusted by changing the volume of fluid instilled in the balloon. The anterior and posterior part of device are secured just right of the left anterior descending artery and posterior descending artery, respectively, whereas the superior part is secured to the heart along the atrioventricular groove. The outer layer is inelastic. SCV, Superior vena cava; LA, left atrium; ICV, inferior vena cava. (Modified from Cohn,22 Figure 2-2). The Journal of Thoracic and Cardiovascular Surgery 2013 146, 192-197DOI: (10.1016/j.jtcvs.2012.09.027) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Immediate effect of partial restraint therapy on pressure–volume loops. The pressure–volume loop shifts toward the right with increased partial restraint therapy. LV, Left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 192-197DOI: (10.1016/j.jtcvs.2012.09.027) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Mean aortic pressure (MAP) and central venous pressure (CVP) as a function of left ventricular restraint level. Despite increasing the restraint level upward of 12 mm Hg and 14 mm Hg, the MAP and CVP remain unchanged. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 192-197DOI: (10.1016/j.jtcvs.2012.09.027) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Partial restraint therapy and left ventricular (LV) luminal and transmural pressure. At the 5 to 8-mm Hg restraint level, the LV luminal pressure begins increasing. The LV transmural pressure, however, continues to decrease significantly. *P < .05 for change from baseline. Ptm, Transmural myocardial pressure; LVP, left ventricular chamber pressure. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 192-197DOI: (10.1016/j.jtcvs.2012.09.027) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions