Creation of a controlled venoarterial shunt: A surgical intervention for right-side circulatory failure

J. P. Slater, A. Yamada, O. J. Yano, R. Stennet, D. J. Goldstein, H. R. Levin, H. M. Spotnitz, M. C. Oz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Right-side circulatory failure (RSCF), a common complication of heart transplant and left ventricular assist device recipients, results in decreased cardiac output because of diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled venoarterial shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. Methods and Results: A venoarterial shunt was created in a large-animal model (calf, n=6). RSCF was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Pulmonary artery banding increased mean right ventricular systolic pressure from 44.9±2.1 mm Hg (mean±SEM) to 85.9±6.9 mm Hg (P<.05, paired t test) and decreased mean aortic flow from 7.8±1.0 to 4.2±1.1 L/min (P<.05). Flow through a venoarterial shunt at approximately 40% of cardiac output resulted in a decrease in right ventricular end-systolic pressure from 85.9±6.9 to 72.1±5.6 mm Hg (P<.01, ANOVA), a decrease in mean pulmonary artery pressure from 42.9±5.0 to 37.2±3.8 mm Hg (P<.01), and an increase in aortic flow from 4.2±.05 to 5.1 L/min (P<.01). Left ventricular stroke work decreased from 2.22±0.28 to 1.55±0.88 (P<.05). Carotid artery oxygen saturation did not change significantly (99.9±.02 to 97.6±1.7) during shunting. Conclusions: A controlled venoarterial shunt improved hemodynamics and cardiac output in a large animal model with RSCF. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative RSCF.

Original languageEnglish (US)
JournalCirculation
Volume92
Issue number9 SUPPL.
StatePublished - Jan 1 1995
Externally publishedYes

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Cardiac Output
Shock
Pulmonary Artery
Heart-Assist Devices
Animal Models
Hemodynamics
Oxygen
Blood Pressure
Transplants
Ventricular Pressure
Decompression
Carotid Arteries
Heart Ventricles
Analysis of Variance
Gases
Stroke
Pressure
Lung

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Slater, J. P., Yamada, A., Yano, O. J., Stennet, R., Goldstein, D. J., Levin, H. R., ... Oz, M. C. (1995). Creation of a controlled venoarterial shunt: A surgical intervention for right-side circulatory failure. Circulation, 92(9 SUPPL.).
Slater, J. P. ; Yamada, A. ; Yano, O. J. ; Stennet, R. ; Goldstein, D. J. ; Levin, H. R. ; Spotnitz, H. M. ; Oz, M. C. / Creation of a controlled venoarterial shunt : A surgical intervention for right-side circulatory failure. In: Circulation. 1995 ; Vol. 92, No. 9 SUPPL.
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abstract = "Background: Right-side circulatory failure (RSCF), a common complication of heart transplant and left ventricular assist device recipients, results in decreased cardiac output because of diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled venoarterial shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. Methods and Results: A venoarterial shunt was created in a large-animal model (calf, n=6). RSCF was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Pulmonary artery banding increased mean right ventricular systolic pressure from 44.9±2.1 mm Hg (mean±SEM) to 85.9±6.9 mm Hg (P<.05, paired t test) and decreased mean aortic flow from 7.8±1.0 to 4.2±1.1 L/min (P<.05). Flow through a venoarterial shunt at approximately 40{\%} of cardiac output resulted in a decrease in right ventricular end-systolic pressure from 85.9±6.9 to 72.1±5.6 mm Hg (P<.01, ANOVA), a decrease in mean pulmonary artery pressure from 42.9±5.0 to 37.2±3.8 mm Hg (P<.01), and an increase in aortic flow from 4.2±.05 to 5.1 L/min (P<.01). Left ventricular stroke work decreased from 2.22±0.28 to 1.55±0.88 (P<.05). Carotid artery oxygen saturation did not change significantly (99.9±.02 to 97.6±1.7) during shunting. Conclusions: A controlled venoarterial shunt improved hemodynamics and cardiac output in a large animal model with RSCF. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative RSCF.",
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Slater, JP, Yamada, A, Yano, OJ, Stennet, R, Goldstein, DJ, Levin, HR, Spotnitz, HM & Oz, MC 1995, 'Creation of a controlled venoarterial shunt: A surgical intervention for right-side circulatory failure', Circulation, vol. 92, no. 9 SUPPL..

Creation of a controlled venoarterial shunt : A surgical intervention for right-side circulatory failure. / Slater, J. P.; Yamada, A.; Yano, O. J.; Stennet, R.; Goldstein, D. J.; Levin, H. R.; Spotnitz, H. M.; Oz, M. C.

In: Circulation, Vol. 92, No. 9 SUPPL., 01.01.1995.

Research output: Contribution to journalArticle

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T1 - Creation of a controlled venoarterial shunt

T2 - A surgical intervention for right-side circulatory failure

AU - Slater, J. P.

AU - Yamada, A.

AU - Yano, O. J.

AU - Stennet, R.

AU - Goldstein, D. J.

AU - Levin, H. R.

AU - Spotnitz, H. M.

AU - Oz, M. C.

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Y1 - 1995/1/1

N2 - Background: Right-side circulatory failure (RSCF), a common complication of heart transplant and left ventricular assist device recipients, results in decreased cardiac output because of diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled venoarterial shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. Methods and Results: A venoarterial shunt was created in a large-animal model (calf, n=6). RSCF was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Pulmonary artery banding increased mean right ventricular systolic pressure from 44.9±2.1 mm Hg (mean±SEM) to 85.9±6.9 mm Hg (P<.05, paired t test) and decreased mean aortic flow from 7.8±1.0 to 4.2±1.1 L/min (P<.05). Flow through a venoarterial shunt at approximately 40% of cardiac output resulted in a decrease in right ventricular end-systolic pressure from 85.9±6.9 to 72.1±5.6 mm Hg (P<.01, ANOVA), a decrease in mean pulmonary artery pressure from 42.9±5.0 to 37.2±3.8 mm Hg (P<.01), and an increase in aortic flow from 4.2±.05 to 5.1 L/min (P<.01). Left ventricular stroke work decreased from 2.22±0.28 to 1.55±0.88 (P<.05). Carotid artery oxygen saturation did not change significantly (99.9±.02 to 97.6±1.7) during shunting. Conclusions: A controlled venoarterial shunt improved hemodynamics and cardiac output in a large animal model with RSCF. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative RSCF.

AB - Background: Right-side circulatory failure (RSCF), a common complication of heart transplant and left ventricular assist device recipients, results in decreased cardiac output because of diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled venoarterial shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. Methods and Results: A venoarterial shunt was created in a large-animal model (calf, n=6). RSCF was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Pulmonary artery banding increased mean right ventricular systolic pressure from 44.9±2.1 mm Hg (mean±SEM) to 85.9±6.9 mm Hg (P<.05, paired t test) and decreased mean aortic flow from 7.8±1.0 to 4.2±1.1 L/min (P<.05). Flow through a venoarterial shunt at approximately 40% of cardiac output resulted in a decrease in right ventricular end-systolic pressure from 85.9±6.9 to 72.1±5.6 mm Hg (P<.01, ANOVA), a decrease in mean pulmonary artery pressure from 42.9±5.0 to 37.2±3.8 mm Hg (P<.01), and an increase in aortic flow from 4.2±.05 to 5.1 L/min (P<.01). Left ventricular stroke work decreased from 2.22±0.28 to 1.55±0.88 (P<.05). Carotid artery oxygen saturation did not change significantly (99.9±.02 to 97.6±1.7) during shunting. Conclusions: A controlled venoarterial shunt improved hemodynamics and cardiac output in a large animal model with RSCF. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative RSCF.

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Slater JP, Yamada A, Yano OJ, Stennet R, Goldstein DJ, Levin HR et al. Creation of a controlled venoarterial shunt: A surgical intervention for right-side circulatory failure. Circulation. 1995 Jan 1;92(9 SUPPL.).