title: Right-to-left veno-arterial shunting for right-sided circulatory failure.
abstract: BACKGROUND
  Right-sided circulatory failure, a complication of heart transplantation and left ventricular assist device use, results in decreased cardiac output due to diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled right-to-left shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. We also hypothesized that a peripheral veno-arterial shunt is physiologically superior to a central shunt.
  
  
  METHODS
  Right atrial-femoral artery and right atrial-left atrial shunts were created in a large animal model (calf). Right-sided circulatory failure was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states.
  
  
  RESULTS
  Peripheral and central shunts resulted in decreased right-sided pressures and increased cardiac output. Arterial oxygen saturation remained greater than 90% during shunting. The peripheral shunt had the added advantage of decreasing left ventricular end-diastolic pressure and left ventricular stroke work.
  
  
  CONCLUSIONS
  A controlled right-to-left shunt improved hemodynamics and cardiac output in a large animal model with right-sided circulatory failure. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative right-sided circulatory failure. Our studies also indicate that creation of a peripheral shunt has both physiologic and technical advantages over a central shunt.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Slater
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: R C
authors.initials: RC
authors.lastname: Ashton
authors.forename: H R
authors.initials: HR
authors.lastname: Levin
authors.forename: H M
authors.initials: HM
authors.lastname: Spotnitz
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical; D001243:Assisted Circulation / Q000379:methods*; D002303:Cardiac Output, Low / Q000503:physiopathology* / Q000601:surgery*; D002417:Cattle; D003326:Coronary Circulation; D005263:Femoral Artery / Q000601:surgery; D006439:Hemodynamics; D010100:Oxygen / Q000097:blood; D011651:Pulmonary Artery; D016278:Ventricular Function, Right
chemical_list: D010100:Oxygen