Long-term cardiopulmonary bypass by peripheral cannulation in a model of total heart failure. The decompression of the left heart through a percutaneous helical spring positioned within the lumen of the tricuspid and pulmonary artery valves.
We performed long-term closed-chest cardiopulmonary bypass in an animal model of total heart failure (induced ventricular fibrillation). The extracorporeal system included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator system. We cannulated the right external jugular vein for venous drainage and the right subclavian artery for arterial return. To decompress the left heart we passed by percutaneous cannulation a special helical spring mounted on a Swan-Ganz catheter (Baxter Edwards Divisions, Irvine, Calif.) and positioned it to rest within the pulmonary artery and tricuspid valves, which rendered them partly incompetent. After induced ventricular fibrillation, blood flow was raised to keep the central venous pressure at baseline values. The lungs were ventilated with 5% carbon dioxide in room air. During bypass, mean pulmonary artery pressure was 10.0 +/- 1.7 mm Hg, mean wedge pressure 11.9 +/- 1.8 mm Hg, and mean blood pressure 95.2 +/- 5.6 mm Hg. After 2 days (four animals) and 3 days (two animals) the hearts were defibrillated. There was immediate ejection from both sides of the heart. All sheep were weaned from bypass within 29 +/- 11 minutes and their lungs were ventilated with room air within 42 +/- 34 minutes. At autopsy hearts and lungs grossly appeared normal. We conclude that the percutaneous helical spring resting within right heart valves provided excellent decompression throughout the study, with full recovery of heart and lung function on defibrillation.
Rossi
F
F
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md. 20892.
Kolobow
T
T
Foti
G
G
Borelli
M
M
Mandava
S
S
D000818:Animals; D002303:Cardiac Output, Low / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D002407:Catheterization, Swan-Ganz; D004562:Electrocardiography; D005112:Extracorporeal Circulation / Q000295:instrumentation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D011312:Pressure; D011664:Pulmonary Valve; D012756:Sheep; D014261:Tricuspid Valve; D014693:Ventricular Fibrillation / Q000150:complications