A simple way to decompress the left ventricle during venoarterial bypass.
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.
von Segesser
L K
LK
Cardiovascular Surgery, CHUV, Lausanne, Switzerland. ludwig.von-segesser@chuv.ch
Kwang
K
K
Tozzi
P
P
Horisberger
J
J
Dembitsky
W
W
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