A Simple Way to Decompress the Left Ventricle during Venoarterial Bypass

Abstract

Objective: The aim of this investigation was to improve the hemodynamics during venoarterial bypass by remote decompression of the left ventricle (LV). Methods: Venoarterial bypass was established in 5 bovine experiments (69 ± 10 kg) by the transjugular insertion of a self-expanding cannula (smartcanula®) with return through a carotid artery. Cardiogenic shock was simulated with ventricular fibrillation induced by an external stimulator. Left ventricular decompression was achieved by switching to transfemoral drainage of the pulmonary artery (PA) with a long self-expanding cannula. Results: Initial pump flow was 4.7 ± 0.9 l/min and the aortic pressure accounted for 75 ± 21 mmHg. After induction of ventricular fibrillation, the pump flow dropped after 11 ± 8 min to 2.5 ± 0.1 l/min. Transfemoral decompression increased the pump flow to 5.6 ± 0.7 l/min, while the RV pressure decreased from 27 ± 9 to 3 ± 5 mmHg, the PA pressure decreased from 29 ± 7 to 5 ± 4 mmHg, the LV pressure decreased from 29 ± 6 to 7 ± 2 mmHg, and the aortic pressure increased from 31 ± 3 to 47 ± 11 mmHg. Conclusions: Remote drainage of the pulmonary artery during venoarterial bypass allows for effective decompression of the left ventricle and provides superior hemodynamics.

Key words

cardiomyopathy - heart and lung transplantation - heart disease - heart valve surgery - myocardial infarction - myocardial protection - cardiopulmonary support - ECMO - cannula - left ventricular decompression - mechanical circulatory support

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