title: Novel techniques of mechanical circulatory support for the right heart and Fontan circulation.
abstract: BACKGROUND
  Currently available ventricular assist devices are designed primarily for use in patients with left sided heart failure. This study evaluated the efficacy of the Jarvik 2000 ventricular assist device (VAD) as a pulmonary pump to power a Fontan circuit in a large animal model.
  
  
  METHODS
  Without the use of cardiopulmonary bypass, Fontan circulations were surgically created in 4 pigs (50 kg) using synthetic grafts from the inferior and superior vena cavas to the main pulmonary artery. Subsequently, the VAD was implanted within the common Fontan graft to provide a pulmonary pump. Direct chamber pressures and epicardial Doppler images were taken during the various phases of the experiment. Heart rate, femoral artery blood pressure, oxygen saturation, and aortic flow rate were continuously recorded. The outflow cannula of the VAD was then partially banded by 50% and then 75% to mimic increased afterload.
  
  
  RESULTS
  Fontan and VAD implantation was successfully performed in all 4 animals. Arterial pressure and aortic flow decreased dramatically with institution of the Fontan but were restored to baseline upon activation of the VAD. The pressure within the systemic venous circulation rose precipitously with institution of the Fontan circulation and improved appropriately with activation of the VAD. Adequate perfusion was maintained during increased afterload.
  
  
  CONCLUSIONS
  An axial flow VAD can restore normal hemodynamics and cardiac output when used as a pulmonary pump in a Fontan circulation. A VAD can rescue a failing Fontan as a bridge to transplant or recovery, even in the setting of high pulmonary resistance.
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Division of Cardiology, United States; UCLA Cardiothoracic Surgery Department, United States. Electronic address: grderk@gmail.com.
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Derk
authors.affiliation: UCLA Cardiothoracic Surgery Department, United States.
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
authors.affiliation: UCLA Cardiothoracic Surgery Department, United States.
authors.forename: Reshma
authors.initials: R
authors.lastname: Biniwale
authors.affiliation: UCLA Cardiothoracic Surgery Department, United States.
authors.forename: Sanjeet
authors.initials: S
authors.lastname: Patel
authors.affiliation: UCLA Cardiac Perfusion Services, United States.
authors.forename: Kim
authors.initials: K
authors.lastname: De LaCruz
authors.affiliation: UCLA Anesthesiology Department, United States.
authors.forename: Einat
authors.initials: E
authors.lastname: Mazor
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Division of Cardiology, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Williams
authors.affiliation: UCLA Bioengineering Department, United States.
authors.forename: John
authors.initials: J
authors.lastname: Valdovinos
authors.affiliation: UCLA Division of Pediatric Cardiology, United States.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Levi
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Division of Cardiology, United States; UCLA Division of Pediatric Cardiology, United States.
authors.forename: Leigh
authors.initials: L
authors.lastname: Reardon
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Division of Cardiology, United States; UCLA Division of Pediatric Cardiology, United States.
authors.forename: Jamil
authors.initials: J
authors.lastname: Aboulhosn
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology*; D018729:Fontan Procedure / Q000379:methods*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D013552:Swine; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Congenital; Heart failure; Ventricular assist device