HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen W. Downing Mario Llaneras Edward B. Savage Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Downing, S. W. Articles by Edmunds, L. H. Search for Related Content PubMed PubMed Citation Articles by Downing, S. W. Articles by Edmunds, L. H., Jr

Ann Thorac Surg 1992;53:132-138
© 1992 The Society of Thoracic Surgeons

---

Articles

Left ventricular assistance without thoracotomy: Mediastinal and transseptal approaches to the left heart

Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, and Medtronic-Biomedicus, Inc. Eden Prairie, Minnesota, USA

Accepted for publication September 6, 1991.

^_* Address reprint requests to Dr Edmunds, Department of Surgery, Hospital of the University of Pennsylvania. 3400 Spruce St, Philadelphia, PA 19104.

Two methods to cannulate the left atrium for initiating mechanical left ventricular circulatory assistance using a centrifugal pump were investigated in 25 sheep. A modified Dennis transatrial septal approach produced flow rates of 88.6 ± 14 mL · kg^–1 · min^–1 through 21F catheters inserted during fluoroscopy through the jugular vein. In 8 animals the septal perforation was plugged after decannulation with a modified Rashkind umbrella plug. Fibroendothelial tissue covered the plug by 4 weeks. In 7 other animals, the septal defect was not plugged. The septal defect reached pinpoint size by 2 weeks and was completely closed by 4 weeks. In 10 sheep, the left atrium was cannulated from the neck through the mediastinum. Left ventricular assistance flow averaged 71.6 ± 14 mL · kg^–1 · min^–1. Mean blood loss during 1 hour of left ventricular assistance was 47 mL. In 8 animals, the atrial perforation was plugged with a mean blood loss of 253 ± 194 mL. In 2 animals, the perforation was intentionally not plugged; mean blood loss was 700 mL. All animals survived. The modified Dennis transatrial method is recommended as a safe, expeditious, cost-effective method to implement left ventricular assistance without thoracotomy. The mediastinal approach, which is technically possible in humans, is more difficult but feasible. Left ventricular assistance has been proven to be the most effective way to rest the failing, ejecting left ventricle. Implementation without thoracotomy potentially expands applications of left ventricular assistance for temporary support of patients with severe manifestations of ischemic heart disease.

This article has been cited by other articles:

				M. Yano, T. Onitsuka, K. Shibata, and Y. Koga Efficacy and Safety of a Percutaneous Right Ventricular Assist System Ann. Thorac. Surg., April 1, 1996; 61(4): 1231 - 1235. [Abstract] [Full Text]

				L. H. Edmunds Jr, H. C. Herrmann, V. J. DiSesa, M. B. Ratcliffe, J. E. Bavaria, and D. M. McCarthy Left ventricular assist without thoracotomy: Clinical experience with the dennis method Ann. Thorac. Surg., April 1, 1994; 57(4): 880 - 885. [Abstract] [PDF]

				J. D. Fonger, Y. Zhou, H. Matsuura, G. S. Aldea, and R. J. Shemin Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist Ann. Thorac. Surg., March 1, 1994; 57(3): 570 - 575. [Abstract] [PDF]