Nitric oxide inhalation prompts weaning from the right ventricular assist device: Evaluation under continuous-flow biventricular assistance George J.

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Presentation transcript:

Nitric oxide inhalation prompts weaning from the right ventricular assist device: Evaluation under continuous-flow biventricular assistance George J. Endo, MD, Kazushi Kojima, MD, Kunihide Nakamura, MD, PhD, Yasunori Matsuzaki, MD, PhD, Toshio Onitsuka, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 124, Issue 4, Pages 739-749 (October 2002) DOI: 10.1067/mtc.2002.124669 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Protocol of this study. After CFBVAD was in place, global ischemia was induced by clamping base of ascending aorta for 30 minutes in ischemia groups (group I) and nitric oxide group (group N). Nitrogen (control group [group C] and ischemia group) or 40-ppm nitric oxide (NO, nitric oxide group) inhalation was administered, at same flow rate, when RVAD support was initiated. Hemodynamic data were collected every 5 minutes after start of LVAD support. In addition, blood was sampled every hour for blood chemistry analysis. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 739-749DOI: (10.1067/mtc.2002.124669) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Time course of pump flow in each group. A, Control group (group C). B, Ischemia group (group I). C, Nitric oxide group (group N). The Journal of Thoracic and Cardiovascular Surgery 2002 124, 739-749DOI: (10.1067/mtc.2002.124669) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Time courses of on-PAP (A) and PVR (B). Inhalation of 40-ppm nitric oxide during CFBVAD support reduced PVR and PAP immediately in nitric oxide group (group N), whereas it remained higher level in ischemia group (group I). Group C, Control group. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 739-749DOI: (10.1067/mtc.2002.124669) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Time courses of hemodynamic changes based on native circulation. A, CO. B, Maximum LV dp/dt (LV max dp/dt). C, LVEDP. D, Maximum RV dp/dt (RV max dp/dt). E, RVEDP. Within observation time (6 hours), recovery of CO was not observed in ischemia group but was observed in nitric oxide group, in which CO recovered to almost same grade as control group. Moreover, although LVEDP and RVEDP showed no significant differences in each group, recoveries of LV dp/dt and RV dp/dt at same grade were observed, without time lag. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 739-749DOI: (10.1067/mtc.2002.124669) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions