Time-dependent response of both ventricles after septal ablation: Implications for biventricular support after left ventricular assist device placement

Objectives

An ovine model of septal ablation was studied to elucidate the mechanisms involved in right ventricular failure when commencing left ventricular mechanical assistance. The disruption of ventricular interdependence after acute and chronic septal injury was examined.

Methods

Twelve sheep underwent percutaneous transluminal septal myocardial ablation using 0.6 mL ethanol. Twelve other sheep underwent a sham procedure. Left ventricular and right ventricular pressure and volume (conductance) response 15 minutes and 4 weeks postinjury were measured. Ultrasonic crystals measured chamber dimensions and wall movement. Areas at risk and infarct zones were quantified.

Results

Compared with sham, ablation chronically reduced systolic interventricular septal thickening (18.4% ± 5.8% vs 7.3% ± 3.1%; P < .001) and acutely increased right ventricular ejection fraction (37.6% ± 8.5% vs 69.9% ± 7.2%; P < .001), preload recruitable stroke work (42.0 ± 4.4 erg·10³ vs 48.7 ± 2.0 erg·10³, P < .001), end-systolic elastance (1.03 ± 0.19 mm Hg mL⁻¹ vs 1.31 ± 0.18 mm Hg mL⁻¹; P < .001), and Tau (24.9 ± 3.8 ms vs 29.6 ± 8.2 ms; P < .001). In contrast, for left ventricular ejection fraction (55.5% ± 5.9% vs 38.9% ± 7.7%; P < .001), preload recruitable stroke work (85.9 ± 10.6 mm Hg vs 66.5 ± 9.6 mm Hg; P < .001) and elastance (2.13 ± 0.51 mm Hg mL⁻¹ vs 1.81 ± 0.44 mm Hg mL⁻¹; P < .001) were reduced, but Tau increased (22.0 ± 3.5 ms vs 28.9 ± 5.8 ms; P < .001) and remained elevated at 4 weeks compared with sham. The area at risk was the same between groups, and injury was limited to the septum (17.2% ± 2.7% vs 2.9% ± 5.8%; P < .001).

Conclusions

Acute and chronic hemodynamic responses are distinctly different after septal injury; the acute response demonstrates a paradoxical motion. Resolution of this motion at 4 weeks is suggestive of reduced septal compliance and buttressing. Ventricular interactions after placement of a left ventricular assist device will vary depending on the injury duration.

CTSNet classification: 17, 27

Abbreviations and Acronyms: CVP, central venous pressure, Ees, slope of end-systolic pressure–volume relationship, EF, ejection fraction, LV, left ventricular, PRSW, preload recruitable stroke work, RV, right ventricular