The impact of Interventricular Dependence on Right Ventricular Function during Left Ventricular Unloading in Cardiogenic Shock: A Porcine Model

Cardiogenic shock (CS) is a life-threatening condition with high morbidity and mortality that often necessitates mechanical circulatory support. The Impella device is widely used to unload the left ventricle (LV) with proven mortality benefit. However, the impact of LV unloading on right ventricular (RV) function remains unclear. Interventricular dependence arises from shared myocardial fibers, septal interactions, and pericardial constraints. LV unloading shifts the interventricular septum leftward, potentially reducing RV performance. Over-unloading could exacerbate RV dysfunction, while insufficient unloading may fail to provide adequate circulatory support. Our aim is to determine the LV unloading strategy that optimizes RV function in cardiogenic shock, we will characterize LV-RV interdependence during mechanical support, determine the influence of RV afterload on interventricular dependence, evaluate diastolic interventricular interactions, assess the role of pericardial constraint, and validate Impella-derived measurements against invasive assessments. Through systematic investigation of these objectives, we aim to establish physiological principles that can guide clinical decision-making for patients requiring mechanical circulatory support.