Right-to-left veno-arterial shunting for right-sided circulatory failure

James Slater, Daniel J. Goldstein, Robert C. Ashton, Howard R. Levin, Henry M. Spotnitz, Mehmet C. Oz

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background.: Right-sided circulatory failure, a complication of heart transplantation and left ventricular assist device use, results in decreased cardiac output due to diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled right-to-left shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations. We also hypothesized that a peripheral veno-arterial shunt is physiologically superior to a central shunt. Methods.: Right atrial-femoral artery and right atrial-left atrial shunts were created in a large animal model (calf). Right-sided circulatory failure was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Results.: Peripheral and central shunts resulted in decreased right-sided pressures and increased cardiac output. Arterial oxygen saturation remained greater than 90% during shunting. The peripheral shunt had the added advantage of decreasing left ventricular end-diastolic pressure and left ventricular stroke work. Conclusions.: A controlled right-to-left shunt improved hemodynamics and cardiac output in a large animal model with right-sided circulatory failure. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative right-sided circulatory failure. Our studies also indicate that creation of a peripheral shunt has both physiologic and technical advantages over a central shunt.

Original languageEnglish (US)
Pages (from-to)978-985
Number of pages8
JournalThe Annals of Thoracic Surgery
Volume60
Issue number4
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Cardiac Output
Shock
Heart-Assist Devices
Animal Models
Hemodynamics
Oxygen
Femoral Artery
Heart Transplantation
Decompression
Pulmonary Artery
Heart Ventricles
Gases
Stroke
Blood Pressure
Transplants
Pressure
Lung

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Slater, J., Goldstein, D. J., Ashton, R. C., Levin, H. R., Spotnitz, H. M., & Oz, M. C. (1995). Right-to-left veno-arterial shunting for right-sided circulatory failure. The Annals of Thoracic Surgery, 60(4), 978-985. https://doi.org/10.1016/0003-4975(95)00670-G
Slater, James ; Goldstein, Daniel J. ; Ashton, Robert C. ; Levin, Howard R. ; Spotnitz, Henry M. ; Oz, Mehmet C. / Right-to-left veno-arterial shunting for right-sided circulatory failure. In: The Annals of Thoracic Surgery. 1995 ; Vol. 60, No. 4. pp. 978-985.
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Right-to-left veno-arterial shunting for right-sided circulatory failure. / Slater, James; Goldstein, Daniel J.; Ashton, Robert C.; Levin, Howard R.; Spotnitz, Henry M.; Oz, Mehmet C.

In: The Annals of Thoracic Surgery, Vol. 60, No. 4, 01.01.1995, p. 978-985.

Research output: Contribution to journalArticle

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