Quantitative approach to determine the application time of the left ventricular assist device.

Abstract

This study was designed to establish a method for determining the optimal time of the application of the left ventricular assist device from the viewpoint of the metabolism of the vital organs. Quantitative systemic low flow states were made utilizing goats with total artificial hearts. During these experiments, arterial lactate and pyruvate values were sequentially measured. The behavior of anaerobic metabolism during low cardiac output states and in the recovery process following normalization of the cardiac output was quantitatively described and evaluated. The experimental results are summarized as follows: If a time when the decay of arterial lactate ceases at a level above the normal level by greater than 30 mg/dl is observed despite the use of intraaortic balloon pumping, that time is the exact optimal time for application of the left ventricular assist device. There is a great possibility that circulatory failure will be irreversible if left ventricular assist pumping is not initiated before the arterial lactate value increases to greater than or equal to 140 mg/dl. The method of evaluating the alteration of anaerobic metabolism described in this study is useful for determining the application time of the left ventricular assist device.