A novel mechanical lung assist system sustains primary bidirectional cavopulmonary shunt circulation in pigs

ASAIO J. 2007 Nov-Dec;53(6):720-4. doi: 10.1097/MAT.0b013e3181569bdb.

Abstract

Primary creation of a bidirectional cavopulmonary shunt (BCPS), which provides a stable in-series circulation, might improve survival in patients with hypoplastic left heart syndrome. However, pulmonary vascular immaturity and high pulmonary vascular resistance must be overcome to achieve a successful primary neonatal BCPS. This study tested the hypothesis that a novel mechanical lung assist (MLA) system would permit a primary BCPS in juvenile pigs. A BCPS (1(1/2) ventricle repair physiology) was created in nine 4-5-week-old pigs (mean weight 17.9 kg), followed by MLA with a miniature centrifugal pump and a hand-made double-lumen cannula for 2 hours. Systemic and cerebral hemodynamic and metabolic data were evaluated. A mean BCPS flow of 331 +/- 56 ml/min was obtained with a mean pump speed of 3899 +/- 306 rpm at 30 minutes after MLA initiation. Adequate oxygenation, ventilation, and hemodynamics were maintained. Transcranial Doppler ultrasound demonstrated consistent pre- and postoperative peak systolic and diastolic velocities of the middle cerebral artery, indicating sustained cerebral perfusion pressure. This study demonstrated that the MLA is able to sustain a high-resistance BCPS and provides a strategy or rationale for developing a primary neonatal cavopulmonary connection in appropriately selected neonates with congenital heart disease.

MeSH terms

  • Angiography
  • Animals
  • Blood Flow Velocity
  • Blood Gas Analysis
  • Blood Pressure
  • Catheterization
  • Cerebrovascular Circulation
  • Energy Metabolism
  • Heart Atria / surgery
  • Heart Bypass, Right / methods*
  • Heart-Lung Machine*
  • Hemodynamics
  • Lactates / blood
  • Lung / blood supply*
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / physiology
  • Miniaturization
  • Models, Cardiovascular
  • Oxygen / blood
  • Perfusion / methods
  • Prosthesis Design
  • Swine
  • Ultrasonography
  • Vascular Resistance
  • Vena Cava, Superior / surgery
  • Ventilators, Mechanical*

Substances

  • Lactates
  • Oxygen