Cavopulmonary anastomosis improves left ventricular assist device support in acute biventricular failure


Autoria(s): SUCCI, Guilherme M.; MOREIRA, Luiz Felipe R.; LEIRNER, Adolfo A.; SILVA, Rodrigo S.; STOLF, Noedir A. G.
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2009

Resumo

Objective: Right ventricular failure during left ventricular assist device (WAD) support can result in severe hemodynamic compromise with high mortality. This study investigated the acute effects of cavopulmonary anastomosis on right ventricular loading and WAD performance in a model of severe biventricular failure. Methods: LVAD support was performed by means of centrifugal pump implantation in 14 anesthetized dogs (20-30 kg) with severe biventricular failure obtained by ventricular fibrillation induction. Animals were randomized to be submitted to classical cavopulmonary anastomosis (Glenn shunt) or to control group and were maintained under WAD support for 2 h. Left and right atrial, right ventricular and systemic pressures were monitored, white total pulmonary flow was simultaneously recorded by transonic flowmeters located on the superior vena cava and pulmonary trunk. Blood gas and venous lactate determinations were also obtained. Results: Ventricular fibrillation maintenance resulted in acute WAD performance impairment after 90 min in the control group, while animals with Glenn circuit maintained normal WAD pump flow (55 +/- 13 ml kg(-1) min(-1) vs 21 +/- 4 ml kg(-1) min(-1), p < 0.001) and better peripheral perfusion (blood lactate of 29 +/- 10 pg/ml vs 46 +/- 9 pg/ml, p < 0.001). Left and right atrial pressures did not change significantly, while right ventricular pressure was tower in animals with Glenn circuit (13 +/- 3 mmHg vs 22 +/- 8 mmHg, p = 0.005). Right ventricular unloading with Glenn shunt also resulted in superior total pulmonary flow (59 +/- 13 ml kg(-1) min(-1) vs 17 +/- 3 ml kg(-1) min(-1), p < 0.001). Conclusion: The concomitant use of cavopulmonary anastomosis during LVAD support in a model of severe biventricular failure limited right ventricular overloading and resulted in better hemodynamic performance. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Identificador

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, v.35, n.3, p.528-533, 2009

1010-7940

http://producao.usp.br/handle/BDPI/23348

10.1016/j.ejcts.2008.11.026

http://dx.doi.org/10.1016/j.ejcts.2008.11.026

Idioma(s)

eng

Publicador

ELSEVIER SCIENCE BV

Relação

European Journal of Cardio-thoracic Surgery

Direitos

restrictedAccess

Copyright ELSEVIER SCIENCE BV

Palavras-Chave #Circulatory support #Assisted circulation #Biventricular failure #Cavopulmonary anastomosis #Right ventricle #PULMONARY-HYPERTENSION #CARDIAC TRANSPLANTATION #HEART-TRANSPLANTATION #CIRCULATORY SUPPORT #RECIPIENTS #CARDIOMYOPATHY #DYSFUNCTION #SURVIVAL #BRIDGE #Cardiac & Cardiovascular Systems #Respiratory System #Surgery
Tipo

article

proceedings paper

publishedVersion