Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study.
BACKGROUND
Right ventricular failure (RVF) and -support is associated with poor results. We aimed for a new approach of right - sided assistance bypassing the right ventricle and pulmonary circulation in order to better decompress the right ventricle and optimize left ventricular filling.


METHODS
From a microaxial pump (Abiomed), a low resistance oxygenator (Maquet and Novalung) and two cannulas (28 and 27 Fr) a system was set up and evaluated in an ovine model (n = 7). Connection with the heart was the right and left atrium. One hour the system was operated without RVF and turned of again. Then a RVF was induced and the course with the system running was evaluated. Complete hemodynamic monitoring was performed as well as echocardiography, flow measurement and blood gas analysis.


RESULTS
The overall performance of the system was reliable. Without RVF no relevant changes of hemodynamics occurred; blood gases were supra normal. In RVF a cardiogenic shock developed (MAP 35 ± 13 mmHg, CO 1,1 ± 0,7 l/min). Immediately after starting the system the circulation normalized (significant increase of MAP to 85 ± 13 mmHg, of CO to 4,5 ± 1,9). Echocardiography also revealed right ventricular recovery. After stopping the system, RVF returned.


CONCLUSIONS
Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed.
Department for Cardiothoracic- and Vascular Surgery, University Hospital RWTH Aachen, Pauwelsstr, 30, D-52074 Aachen. jspillner@ukaachen.de
Jan
J
Spillner
Christian
C
Stoppe
Nima
N
Hatam
Andrea
A
Amerini
Ares
A
Menon
Christoph
C
Nix
Ulrich
U
Steinseifer
Yousef
Y
Abusabha
Hanna
H
Giessen
Rüdiger
R
Autschbach
Marcus
M
Haushofer
D000818:Animals; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D011652:Pulmonary Circulation; D012756:Sheep