Effects of intraluminal and extracorporeal inferior vena caval bypass on canine hemodynamics.
OBJECTIVE
To compare inferior vena cava-right atrial extracorporeal bypass with intraluminal atriocaval shunting during hepatic vascular isolation.


METHODS
Prospective, randomized, controlled animal study.


METHODS
University research laboratory.


METHODS
Adult mongrel dogs (n = 5) weighing 20 to 27 kg.


METHODS
Anesthetized dogs underwent laparotomy and sternotomy for vascular isolation. For atriocaval shunting, 20- and 24-Fr intraluminal shunts were inserted into the inferior vena cava via right atriotomy. For extracorporeal bypass, each animal underwent inferior vena cava, portal vein, and right atrial cannulation for venovenous bypass, utilizing a centrifugal pump. Hemodynamic data were recorded at baseline and at intervals after caval occlusion, Pringle maneuver, and caval occlusion with Pringle maneuver.


RESULTS
Isolated Pringle maneuver and caval occlusion with Pringle maneuver produced significant reductions in mean arterial pressure (MAP) and cardiac output, irrespective of pulmonary artery occlusion pressure. Extracorporeal bypass, including both caval and portal venous return, produced significant increases in MAP and cardiac output during caval occlusion with Pringle maneuver, while atriocaval shunting and extracorporeal bypass without portal venous return did not improve MAP or cardiac output.


CONCLUSIONS
Venovenous extracorporeal bypass with portal return, acting as a right ventricular assist device, is superior to intraluminal atriocaval shunting in maintaining hemodynamic stability during hepatic vascular isolation.
Howdieshell
T R
TR
Department of Surgery, Medical College of Georgia, Augusta, USA.
Wood
M
M
Swayne
M
M
Duvall
R
R
Mooney
S
S
Stark
N
N
D000818:Animals; D016275:Atrial Function; D004285:Dogs; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D011897:Random Allocation; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000502:physiology*