title: Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement.
abstract: Right sided circulatory failure (RSCF), a common complication after left ventricular assist device (LVAD) implantation, results in decreased systemic output due to diminished blood flow across the pulmonary vasculature. The authors hypothesized that creation of a venoarterial shunt (VAS) would decompress the right-sided circulation and improve systemic pressure and perfusion with significant arterial desaturation. An experimental model was created in which RSCF was induced acutely in a large animal (n = 6) by beta-blockade after LVAD placement. After VAS creation, hemodynamic and blood gas determinations were performed to compare non shunt and shunt states. After induction of heart failure after LVAD placement, VAS resulted in a 22% elevation in systemic blood pressure (p < 0.0001), a 36% elevation in cerebral blood flow (p = 0.02), and an 18% decrease in right sided filling pressures (p = 0.08). Systemic pH and aortic oxygen saturation remained unchanged from baseline. In a large animal model of RSCF after LVAD implantation, VAS improves systemic hemodynamics without a significant cost in arterial oxygenation to critical organs and without creating acid-base imbalance. Beside implementation, adjustable capabilities, easy removal and salutatory hemodynamic effects suggest that VAS may serve as a first line, short-term therapy for LVAD recipients who develop perioperative RSCF.
authors.affiliation: Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: R C
authors.initials: RC
authors.lastname: Ashton
authors.forename: J P
authors.initials: JP
authors.lastname: Slater
authors.forename: M
authors.initials: M
authors.lastname: Pearson
authors.forename: J A
authors.initials: JA
authors.lastname: Seldomridge
authors.forename: D A
authors.initials: DA
authors.lastname: D'Alessandro
authors.forename: D A
authors.initials: DA
authors.lastname: Jordan
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
mesh_terms: D000208:Acute Disease; D000818:Animals; D001166:Arteriovenous Shunt, Surgical; D002303:Cardiac Output, Low / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D002417:Cattle; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D016278:Ventricular Function, Right