Mechanical circulatory support of a univentricular Fontan circulation with a continuous axial-flow pump in a piglet model.
Despite the significant contribution of the Fontan procedure to the therapy of complex congenital heart diseases, many patients progress to failure of their Fontan circulation. The use of ventricular assist devices to provide circulatory support to these patients remains challenging. In the current study, a continuous axial-flow pump was used to support a univentricular Fontan circulation. A modified Fontan circulation (atrio-pulmonary connection) was constructed in six Yorkshire piglets (8-14 kg). A Dacron conduit (12 mm) with two branches was constructed to serve as a complete atrio-pulmonary connection without the use of cardiopulmonary bypass. The Impella pump was inserted into the conduit through an additional Polytetrafluoroethylene (PTFE) graft in five animals. Hemodynamic data were collected for 6 hours under the supported Fontan circulation. The control animal died after initiating the Fontan circulation independent of resuscitation. Four pump supported animals remained hemodynamically stable for 6 hours with pump speeds between 18,000 rpm and 22,000 rpm (P1-P3). Oxygen saturation was maintained between 95% and 100%. Normal organ perfusion was illustrated by blood gas analysis and biochemical assays. A continuous axial-flow pump can be used for temporal circulatory support to the failing Fontan circulation as "bridge" to heart transplantation or recovery.
From the Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Xufeng
X
Wei
Pablo G
PG
Sanchez
Yang
Y
Liu
Tieluo
T
Li
A Claire
AC
Watkins
Zhongjun J
ZJ
Wu
Bartley P
BP
Griffith
D000818:Animals; D001243:Assisted Circulation / Q000295:instrumentation* / Q000379:methods; D018729:Fontan Procedure / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006353:Heart-Assist Devices; D006439:Hemodynamics; D019344:Lactic Acid / Q000097:blood; D008904:Miniaturization; D023421:Models, Animal; D010100:Oxygen / Q000097:blood; D034421:Sus scrofa
D019344:Lactic Acid; D010100:Oxygen