TY - JOUR T1 - Cavoaortic shunt improves hemodynamics with preserved oxygen delivery in experimental right ventricular failure during left ventricular assist device therapy. AU - Vikholm,Per, AU - Schiller,Petter, AU - Johansson,Jakob, AU - Hellgren,Laila, Y1 - 2013/03/08/ PY - 2012/08/24/received PY - 2013/01/04/revised PY - 2013/02/11/accepted PY - 2013/3/13/entrez PY - 2013/3/13/pubmed PY - 2014/3/7/medline KW - 27 KW - CO KW - Cao(2) KW - Do(2) KW - LA KW - LV KW - LVAD KW - MAP KW - PVR KW - Pao(2) KW - RA KW - RV KW - RVAD KW - Sao(2) KW - Svo(2) KW - Vo(2) KW - arterial oxygen content KW - arterial oxygen partial pressure KW - arterial oxygen saturation KW - cardiac output KW - left atrium KW - left ventricular KW - left ventricular assist device KW - mean arterial pressure KW - mixed venous oxygen saturation KW - oxygen delivery KW - oxygen uptake KW - pulmonary vascular resistance KW - right atrium KW - right ventricular (ventricle) KW - right ventricular assist device SP - 625 EP - 31 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 147 IS - 2 N2 - OBJECTIVE: Right heart failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. This study evaluated the approach of a cavoaortic shunt included in the LVAD circuit, which would aim to relieve venous congestion and improve hemodynamics with preserved oxygen delivery during induced right ventricular failure. METHODS: Right ventricular failure was induced by coronary ligation in 10 pigs. An LVAD was implanted and a cavoaortic shunt was created from the right atrium and included in the assist circuit. Hemodynamic measures and blood gas analyses were analyzed. Oxygen delivery and oxygen consumption were estimated. RESULTS: Right atrial pressure decreased from more than 20 mm Hg to 17.2 mm Hg (14.8-18.4) with the LVAD and to 14.1 mm Hg (11.2-15.5) (P < .01) with the LVAD and cavoaortic shunt. Mean arterial pressure increased from 70.9 mm Hg (67.6-79.8) to 81.5 mm Hg (70.8-92.6) (P = .02) with addition of the shunt into the assist circuit. Cardiac output increased from 3.5 L/min (2.6-4.2) to 4.9 L/min (3.5-5.6) (P < .01) with cavoaortic shunting. Oxygen delivery with the cavoaortic shunt was 337 mL/min (± 70) as compared with left ventricular assist alone at 258 mL/min (± 52) (P < .01). Oxygen consumption was restored during use of the cavoaortic shunt. CONCLUSIONS: A cavoaortic shunt combined with an LVAD during right ventricular failure reduces central venous pressures, increases systemic arterial pressure, and enables increased cardiac output compared with device therapy alone. This was feasible with preserved oxygen delivery. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/23477692/Cavoaortic_shunt_improves_hemodynamics_with_preserved_oxygen_delivery_in_experimental_right_ventricular_failure_during_left_ventricular_assist_device_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)00160-8 DB - PRIME DP - Unbound Medicine ER -