A novel mechanical lung assist system sustains primary bidirectional cavopulmonary shunt circulation in pigs.
Primary creation of a bidirectional cavopulmonary shunt (BCPS), which provides a stable in-series circulation, might improve survival in patients with hypoplastic left heart syndrome. However, pulmonary vascular immaturity and high pulmonary vascular resistance must be overcome to achieve a successful primary neonatal BCPS. This study tested the hypothesis that a novel mechanical lung assist (MLA) system would permit a primary BCPS in juvenile pigs. A BCPS (1(1/2) ventricle repair physiology) was created in nine 4-5-week-old pigs (mean weight 17.9 kg), followed by MLA with a miniature centrifugal pump and a hand-made double-lumen cannula for 2 hours. Systemic and cerebral hemodynamic and metabolic data were evaluated. A mean BCPS flow of 331 +/- 56 ml/min was obtained with a mean pump speed of 3899 +/- 306 rpm at 30 minutes after MLA initiation. Adequate oxygenation, ventilation, and hemodynamics were maintained. Transcranial Doppler ultrasound demonstrated consistent pre- and postoperative peak systolic and diastolic velocities of the middle cerebral artery, indicating sustained cerebral perfusion pressure. This study demonstrated that the MLA is able to sustain a high-resistance BCPS and provides a strategy or rationale for developing a primary neonatal cavopulmonary connection in appropriately selected neonates with congenital heart disease.
Honjo
Osami
O
The Labatt Family Heart Centre.
Merklinger
Sandra L
SL
Poe
John
J
Guerguerian
Anne-Marie
AM
Alghamdi
Abdullah A
AA
Takatani
Setsuo
S
Van Arsdell
Glen S
GS
D000792:Angiography; D000818:Animals; D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D001794:Blood Pressure; D002404:Catheterization; D002560:Cerebrovascular Circulation; D004734:Energy Metabolism; D006325:Heart Atria / Q000601:surgery; D018610:Heart Bypass, Right / Q000379:methods*; D006355:Heart-Lung Machine; D006439:Hemodynamics; D007773:Lactates / Q000097:blood; D008168:Lung / Q000098:blood supply*; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000502:physiology; D008904:Miniaturization; D008955:Models, Cardiovascular; D010100:Oxygen / Q000097:blood; D010477:Perfusion / Q000379:methods; D011474:Prosthesis Design; D013552:Swine; D014463:Ultrasonography; D014655:Vascular Resistance; D014683:Vena Cava, Superior / Q000601:surgery; D012122:Ventilators, Mechanical
D007773:Lactates; D010100:Oxygen