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James P. Slater
Daniel J. Goldstein
Robert C. Ashton, Jr
Henry M. Spotnitz
Mehmet C. Oz
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Ann Thorac Surg 1995;60:978-985
© 1995 The Society of Thoracic Surgeons

Articles

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

MD James P. Slatera,b, MD Daniel J. Goldsteina,b, MD Robert C. Ashton, Jra,b, MD Howard R. Levina,b, MD Henry M. Spotnitza,b, MD Mehmet C. Oza,b,*

a Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
b Division of Circulatory Physiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA

* Address reprint requests to Dr Oz, Department of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center MHB-735, 177 Fort Washington, Ave, New York, NY 10032.

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.






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