title: Cavopulmonary support with a microaxial pump for the failing Fontan physiology.
abstract: The number of patients with the failing Fontan physiology is increasing. We tested a novel in situ microaxial pump (Impella) to support the failing atrio-pulmonary Fontan circulation in an acute pig model. A Fontan model was established in eight juvenile pigs by connecting the right atrium to the main pulmonary artery after tricuspid valve destruction. The Impella pump was inserted retrograde from the distal main pulmonary artery into the right atrium. Hemodynamics, blood gas, and echocardiographic data were compared among baseline, pure Fontan physiology (10 minutes), and mechanically assisted Fontan physiology (up to 12 hours). The Impella system generated a blood flow of 75-85 ml/kg/minute in six animals, and 55-65 ml/kg/minute in two animals. The mechanically assisted Fontan attained a significantly higher mean blood pressure (39.6 ± 7 vs. 24.7 ± 3.3 mm Hg, p < 0.01), lower central venous pressure (5 ± 2.4 vs. 12.8 ± 1.7 mm Hg, p < 0.01), and higher mixed venous saturation (60.4 ± 10.8 vs. 23.4 ± 8.4 mm Hg, p < 0.01) compared with pure Fontan physiology. Cardiac output and stroke volume were similar during baseline and mechanically assisted Fontan (p = not significant). This acute pig study demonstrated the feasibility of mechanical circulatory support in the failing Fontan physiology. The in situ microaxial pump maintained cardiac output while increasing blood pressure and reducing venous pressure.
authors.affiliation: From the *Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada; †Cardiothoracic Surgery Department, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China; ‡Division of Cardiovascular Surgery, Toronto General Hospital; and §Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Jiaquan
authors.initials: J
authors.lastname: Zhu
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Yaqin Y
authors.initials: YY
authors.lastname: Fu
authors.forename: Lisa
authors.initials: L
authors.lastname: Zhao
authors.forename: Celeste
authors.initials: C
authors.lastname: Foreman
authors.forename: Lisa
authors.initials: L
authors.lastname: Davey
authors.forename: Richard D
authors.initials: RD
authors.lastname: Weisel
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
mesh_terms: D000818:Animals; D002302:Cardiac Output; D004867:Equipment Design; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D023421:Models, Animal; D008955:Models, Cardiovascular; D013318:Stroke Volume; D013552:Swine; D057170:Translational Research, Biomedical