title: Cavoaortic shunt improves hemodynamics with preserved oxygen delivery in experimental right ventricular failure during left ventricular assist device therapy.
abstract: OBJECTIVE
  Right heart failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. This study evaluated the approach of a cavoaortic shunt included in the LVAD circuit, which would aim to relieve venous congestion and improve hemodynamics with preserved oxygen delivery during induced right ventricular failure.
  
  
  METHODS
  Right ventricular failure was induced by coronary ligation in 10 pigs. An LVAD was implanted and a cavoaortic shunt was created from the right atrium and included in the assist circuit. Hemodynamic measures and blood gas analyses were analyzed. Oxygen delivery and oxygen consumption were estimated.
  
  
  RESULTS
  Right atrial pressure decreased from more than 20 mm Hg to 17.2 mm Hg (14.8-18.4) with the LVAD and to 14.1 mm Hg (11.2-15.5) (P < .01) with the LVAD and cavoaortic shunt. Mean arterial pressure increased from 70.9 mm Hg (67.6-79.8) to 81.5 mm Hg (70.8-92.6) (P = .02) with addition of the shunt into the assist circuit. Cardiac output increased from 3.5 L/min (2.6-4.2) to 4.9 L/min (3.5-5.6) (P < .01) with cavoaortic shunting. Oxygen delivery with the cavoaortic shunt was 337 mL/min (± 70) as compared with left ventricular assist alone at 258 mL/min (± 52) (P < .01). Oxygen consumption was restored during use of the cavoaortic shunt.
  
  
  CONCLUSIONS
  A cavoaortic shunt combined with an LVAD during right ventricular failure reduces central venous pressures, increases systemic arterial pressure, and enables increased cardiac output compared with device therapy alone. This was feasible with preserved oxygen delivery.
authors.affiliation: Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Vikholm
authors.affiliation: Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Schiller
authors.affiliation: Department of Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Johansson
authors.affiliation: Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden. Electronic address: laila.hellgren.johansson@akademiska.se.
authors.forename: Laila
authors.initials: L
authors.lastname: Hellgren
mesh_terms: D000818:Animals; D001011:Aorta / Q000503:physiopathology*; D062186:Arterial Pressure; D062185:Atrial Pressure; D001784:Blood Gas Analysis; D002302:Cardiac Output; D002496:Central Venous Pressure; D004195:Disease Models, Animal; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D013552:Swine; D014683:Vena Cava, Superior / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D010100:Oxygen
keywords: 27; CO; Cao(2); Do(2); LA; LV; LVAD; MAP; PVR; Pao(2); RA; RV; RVAD; Sao(2); Svo(2); Vo(2); arterial oxygen content; arterial oxygen partial pressure; arterial oxygen saturation; cardiac output; left atrium; left ventricular; left ventricular assist device; mean arterial pressure; mixed venous oxygen saturation; oxygen delivery; oxygen uptake; pulmonary vascular resistance; right atrium; right ventricular (ventricle); right ventricular assist device