The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 4 , Pages 1012-1018, April 2010

Ventricular restraint therapy for heart failure: The right ventricle is different from the left ventricle

Read at the Thirty-fifth Annual Meeting of The Western Thoracic Surgical Association, Banff, Alberta, Canada, June 24–27, 2009.

  • Lawrence S. Lee, MD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • Ravi K. Ghanta, MD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • Suyog A. Mokashi, MD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • Otavio Coelho-Filho, MD

      Affiliations

    • Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • Raymond Y. Kwong, MD, MPH

      Affiliations

    • Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • R. Morton Bolman III, MD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • ,
  • Frederick Y. Chen, MD, PhD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
    • Corresponding Author InformationAddress for reprints: Frederick Y. Chen, MD, PhD, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Received 19 June 2009; received in revised form 13 August 2009; accepted 2 September 2009.

Objective

Effects of ventricular restraint on the left ventricle are well documented, but effects on the right ventricle are not. We hypothesized that restraint affects the right and left ventricles differently.

Methods

We studied acute effects of restraint on left and right ventricular mechanics in healthy sheep (n = 14) with our previously described technique of adjustable and measurable restraint. Transmural pressure, myocardial oxygen consumption indices, diastolic compliance, and end-systolic elastance were assessed at 4 restraint levels for both ventricles. We then studied long-term effects of restraint for 4 months in an ovine model of ischemic dilated cardiomyopathy (n = 6). Heart failure was induced by coronary artery ligation, and polypropylene mesh was wrapped around the heart to simulate clinical restraint therapy. All subjects were followed up with serial cardiac magnetic resonance imaging to assess left and right ventricular volumes and function.

Results

Restraint decreased left ventricular transmural pressure (P < .03) and myocardial oxygen consumption indices (P < .05) but not left ventricular diastolic compliance (P = .52). Restraint had no effect on right ventricular transmural pressure (P = .82) or myocardial oxygen consumption indices (P = .72) but reduced right ventricular diastolic compliance (P < .01). In long-term studies, restraint led to reverse left ventricular remodeling with decreased left ventricular end-diastolic volume (P < .006) but did not affect right ventricular end-diastolic volume (P = .82).

Conclusions

Ventricular restraint affects the left and right ventricles differently. Benefits of restraint for right ventricular function are unclear. The left ventricle can tolerate more restraint than the right ventricle. With current devices, the right ventricle may limit overall therapeutic efficacy.

CTSNet classification: 17, 22, 36.4

Abbreviations and Acronyms: AMVR, adjustable and measurable ventricular restraint, Cd, diastolic compliance, CVP, central venous pressure, EDP, end-diastolic pressure, EDV, end-diastolic volume, Ees, end-systolic elastance, EF, ejection fraction, LV, left ventricle, MAP, mean arterial pressure, Mvo2, myocardial oxygen consumption, Pmax, maximal pressure tested, Ptm, transmural myocardial pressure, RV, right ventricle

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 Disclosures: Supported by Brigham and Women's Hospital, Department of Surgery (F.Y.C.), Brigham and Women's Hospital, Cardiac Surgery Research Fund (R.M.B.), Harvard Medical School, Warren Whitman Fellowship (L.S.L.), and the National Institutes of Health grants T32HL076130 (L.S.L.), RO1HL090862 (F.Y.C.), and R01HL091157 (R.Y.K.). Ethicon, Inc, Somerville, NJ, provided the polypropylene mesh used in this study.

PII: S0022-5223(09)01558-X

doi:10.1016/j.jtcvs.2009.09.064

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 4 , Pages 1012-1018, April 2010

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