Cavopulmonary assist in the neonate: an alternative strategy for single-ventricle palliation.
BACKGROUND
Cavopulmonary blood flow, rather than a systemic arterial source of pulmonary blood flow, stabilizes Norwood physiology. We hypothesized that pump-assisted cavopulmonary diversion would yield stable pulmonary and systemic hemodynamics in the neonate. This was tested in a newborn animal model of total cavopulmonary diversion and univentricular Fontan circulation.


METHODS
Lambs (n = 13; mean weight, 5.6 +/- 1.5 kg; mean age, 6.8 +/- 4.0 days) were anesthetized and mechanically ventilated. Baseline hemodynamic parameters were measured. Total cavopulmonary diversion was performed with bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to assist cavopulmonary flow. Support was titrated to normal physiologic parameters. Hemodynamic data, arterial blood gases, and lactate values were measured for 8 hours. Baseline, 1-hour, and 8-hour time points were compared by using analysis of variance.


RESULTS
All animals remained stable without the use of volume loading, inotropic support, or pulmonary vasodilator therapy. Cardiac index, systemic arterial pressure, left atrial pressure, and lactate values were similar to baseline values 8 hours after surgery. Mean pulmonary arterial pressure and pulmonary vascular resistance were modestly increased 8 hours after surgery. Mean arterial pH, Po(2), and Pco(2) values remained stable throughout the study.


CONCLUSIONS
Cavopulmonary assist is feasible in a neonatal animal model of total cavopulmonary diversion and univentricular Fontan circulation with acceptable pulmonary arterial pressures and without altering regional volume distribution or cardiac output. Pump-assisted cavopulmonary diversion, in combination with Norwood aortic arch reconstruction, could solve several major problems associated with a systemic shunt-dependent univentricular circulation, including hypoxemia, impaired diastolic coronary perfusion, and ventricular volume overload.
Department of Surgery, Section of Cardiothoracic Surgery, Indiana University School of Medicine, Emerson Hall 215, 545 Barnhill Drive, Indianapolis, IN 46202, USA. rodefeld@iupui.edu
Mark D
MD
Rodefeld
Jack H
JH
Boyd
Cynthia D
CD
Myers
Robert G
RG
Presson
Wiltz W
WW
Wagner
John W
JW
Brown
D000818:Animals; D000831:Animals, Newborn; D018610:Heart Bypass, Right; D006352:Heart Ventricles / Q000002:abnormalities*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D010166:Palliative Care; D015656:Respiratory Mechanics; D012756:Sheep