title: Cavo-pulmonary anastomosis associated with left ventricular in comparison with biventricular circulatory support in acute heart failure.
abstract: OBJECTIVE
  Right ventricular (RV) failure during left ventricular assist device (LVAD) support can result in severe hemodynamic compromise with high mortality. This study investigated the acute effects of cavo-pulmonary anastomosis on LVAD performance and RV myocardial compromise in comparison with biventricular circulatory support, in a model of biventricular failure.
  
  
  METHODS
  LVAD support was performed by centrifugal pump in 21 pigs with severe biventricular failure obtained by FV induction. Animals were randomized to be submitted to cavo-pulmonary anastomosis, to biventricular circulatory support or to control group. They were maintained under circulatory support and hemodynamic monitoring for 3h. Venous lactate and cytokines serum levels were also obtained. Endocardium samples were analyzed by electronic microscopy.
  
  
  RESULTS
  FV maintenance was responsible for acute LVAD impairment after 180 min in the control group. cavo-pulmonary anastomosis resulted in non-significant improvement of LVAD pump flow in relation to control group (+55±14 ml/kg/min, P=0.072), while animals under biventricular support maintained higher LVAD flow (+93±17 ml/kg/min, P=0.012). Mean arterial pressure remained constant only in biventricular group (P<0.001), which also presented decrease of right atrial and ventricular pressures. Similar increases in lactate and cytokines levels were observed in the three groups. Ultra-structural analysis documented low levels of myocardial swelling in the biventricular group (P=0.017).
  
  
  CONCLUSIONS
  The concomitant use of cavo-pulmonary anastomosis during LVAD support in a pig model of severe biventricular failure resulted in non-significant improvement of hemodynamic performance and it did not effectively replace the use of biventricular support.
authors.affiliation: Heart Institute at Clinics Hospital, University of São Paulo Medical School, São Paulo, SP, Brazil. l_saraiva@ig.com.br
authors.forename: Luis Alberto Saraiva
authors.initials: LA
authors.lastname: Santos
authors.forename: Anderson
authors.initials: A
authors.lastname: Benício
authors.forename: Ewaldo de
authors.initials: Ed
authors.lastname: Mattos Júnior
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Benvenutti
authors.forename: Idágene Aparecida
authors.initials: IA
authors.lastname: Cestari
authors.forename: Noedir Antonio Groppo
authors.initials: NA
authors.lastname: Stolf
authors.forename: Luiz Felipe Pinho
authors.initials: LF
authors.lastname: Moreira
mesh_terms: D000818:Animals; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D018610:Heart Bypass, Right / Q000379:methods*; D006333:Heart Failure / Q000097:blood / Q000601:surgery*; D006352:Heart Ventricles / Q000648:ultrastructure*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology*; D019344:Lactic Acid / Q000097:blood; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013552:Swine; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology* / Q000601:surgery
chemical_list: D016207:Cytokines; D019344:Lactic Acid