title: A simple way to decompress the left ventricle during venoarterial bypass.
abstract: OBJECTIVE
  The aim of this investigation was to improve the hemodynamics during venoarterial bypass by remote decompression of the left ventricle (LV).
  
  
  METHODS
  Venoarterial bypass was established in 5 bovine experiments (69+/-10 kg) by the transjugular insertion of a self-expanding cannula (smartcanula) with return through a carotid artery. Cardiogenic shock was simulated with ventricular fibrillation induced by an external stimulator. Left ventricular decompression was achieved by switching to transfemoral drainage of the pulmonary artery (PA) with a long self-expanding cannula.
  
  
  RESULTS
  Initial pump flow was 4.7+/-0.9 l/min and the aortic pressure accounted for 75+/-21 mmHg. After induction of ventricular fibrillation, the pump flow dropped after 11+/-8 min to 2.5+/-0.1 l/min. Transfemoral decompression increased the pump flow to 5.6+/-0.7 l/min, while the RV pressure decreased from 27+/-9 to 3+/-5 mmHg, the PA pressure decreased from 29+/-7 to 5+/-4 mmHg, the LV pressure decreased from 29+/-6 to 7+/-2 mmHg, and the aortic pressure increased from 31+/-3 to 47+/-11 mmHg.
  
  
  CONCLUSIONS
  Remote drainage of the pulmonary artery during venoarterial bypass allows for effective decompression of the left ventricle and provides superior hemodynamics.
authors.affiliation: Cardiovascular Surgery, CHUV, Lausanne, Switzerland. ludwig.von-segesser@chuv.ch
authors.forename: L K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: K
authors.initials: K
authors.lastname: Kwang
authors.forename: P
authors.initials: P
authors.lastname: Tozzi
authors.forename: J
authors.initials: J
authors.lastname: Horisberger
authors.forename: W
authors.initials: W
authors.lastname: Dembitsky
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D002406:Catheterization, Peripheral; D002417:Cattle; D019299:Decompression, Surgical / Q000379:methods*; D004195:Disease Models, Animal; D004322:Drainage; D015199:Extracorporeal Membrane Oxygenation; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D011651:Pulmonary Artery / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D017725:Ventricular Pressure