Left ventricular assist via percutaneous transhepatic transseptal cannulation in swine.
OBJECTIVE
To report the in vivo testing of transhepatic, transseptal cannula insertion to support the left ventricle.


BACKGROUND
Percutaneous cannulation for circulatory assist poses particular challenges in pediatrics. We utilized a strategy using a transhepatic, transseptal venous cannula inserted into the left atrium, a centrifugal pump, and arterial cannula.


METHODS
Yorkshire swine of 5-20 kg (n = 6) were anesthetized for the procedure. After hepatic venous angiography, percutaneous puncture of the hepatic vein was performed, followed by transseptal puncture with echocardiographic guidance. A 10-14 Fr 26-cm venous inflow cannula was placed in the left atrium via hepatic approach. The femoral artery was cannulated with a 6-10 Fr femoral cannula, and the circuit completed with the TandemHeart centrifugal pump.


RESULTS
Implantation of the system utilizing the transhepatic approach was successful in all experiments. The pump delivered flows ranging from 0.8 to 1.4 L/min, which corresponded to 40-86% of the baseline systemic outputs. Decannulation and occlusion of the hepatic tract was successful utilizing transcatheter vascular occlusion plugs.


CONCLUSIONS
The transhepatic, transseptal insertion of the inflow cannula, coupled with the TandemHeart centrifugal pump and femoral arterial cannulation allows percutaneous circulatory support in 5- to 20-kg models.
Lim
D Scott
DS
Department of Pediatrics, University of Virginia, Charlottesville, VA 22908-0386, USA. SL9PC@virginia.edu
Cortese
Cory J
CJ
Loree
Amber N
AN
Dean
David A
DA
Svitek
Robert G
RG
D000818:Animals; D001835:Body Weight; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D005240:Feasibility Studies; D005263:Femoral Artery; D006346:Heart Septum / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006353:Heart-Assist Devices; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D008422:Materials Testing; D010690:Phlebography; D011677:Punctures; D015641:Radiography, Interventional; D013552:Swine; D013997:Time Factors; D018084:Ultrasonography, Interventional