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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 108-114, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Effects of bilateral transvenous diaphragm pacing on hemodynamic function in patients after cardiac operations. Experimental and clinical study

K Ishii, H Kurosawa, H Koyanagi, K Nakano, N Sakakibara, I Sato, M Noshiro and M Ohsawa
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.

The effects of bilateral transvenous diaphragm pacing and intermittent positive-pressure ventilation on hemodynamic function were compared by animal experiment in 18 dogs and by clinical study in 14 patients during the postoperative period after cardiac operations. Aortic, pulmonary arterial, right atrial, and left atrial pressures (transmural) and aortic flow were increased by diaphragm pacing in the canine experiment. In dogs with induced tricuspid insufficiency, aortic pressure, right and left atrial pressures, and aortic blood flow increased, similar to the results obtained in the clinical study. Diaphragm pacing produced a sufficient tidal volume (7.2 to 12 ml/kg) for maintenance of normal blood gas levels in the patients, all of whom recovered spontaneous breathing without any weaning problems after 2 to 6 hours of diaphragm pacing. The catheter electrode used for stimulation was placed 30 mm away from the sinus node to avoid arrhythmias. Respiratory control by diaphragm pacing is hemodynamically superior to that by intermittent positive-pressure ventilation, and its efficacy is expected, especially in critical cases or in diseases or conditions in which the decrease in the load of the right heart affects the hemodynamic status of the patient.

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