Pulmono-atrial shunt and lung assist to treat right ventricular failure

Spillner, Jan; Amerini, Andrea; Rex, Steffen; Pott, Frank Christian; Goetzenich, Andreas; Menon, Ares Krishna; Repas, T.; Steiner, Frederik; Autschbach, R.; Carpi, Angelo; Oster, O.

doi:10.2741/3857

Cited by 9 publications

(11 citation statements)

References 23 publications

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“…Τhere is statistical significant difference between groups concerning the percentage change from baseline to 10 minute of the SVR variable and a statistically significant difference between the two groups at 20 minute (p = 0.075). Our recordings of a low MAP and low SVR in both groups are consistent with the results described by other investigators [20-22]. …”

Section: Discussionsupporting

confidence: 93%

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Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Argiriou¹,

Mikroulis

Sakellaridis³

et al. 2011

J Cardiothorac Surg

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AbtractBackgroundIn right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery - left atrium shunt (PA-LA) is better than a right atrial - left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shunts.MethodsThirty, male Large White pigs weighting in average 21.3 kg ± 0.7 (SEM) were divided into two groups (15 pigs per group): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8 mm graft (PA-LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA-LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, half and one hour interval from the baseline (30 min from the banding). Cardiac output and flow of at the left anterior descending artery was also monitored.ResultsIn both groups, a stable RVF was generated. The PA-LA shunt compared to the RA-LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA-LA shunt is also the tendency - although not statistically significant - in relation to central venous pressure, left atrial filling and cardiac output.ConclusionThe PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt.

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Section: Discussionsupporting

confidence: 93%

“…Can be easily performed in conjunction with a pumpless lung assist device as Novalung in parallel with the PA shunt or in a serial setting [22]. …”

Section: Discussionmentioning

confidence: 99%

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Argiriou¹,

Mikroulis

Sakellaridis³

et al. 2011

J Cardiothorac Surg

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“…This can be accomplished via pulmonary artery-left atrial graft and has been shown to improve RV function. 29,30 Intraoperative echocardiography is used to assess biventricular and valvular function, presence of shunts, and detection of cardiac thrombi. Adequate pump function should be confirmed at this time, and if cardiac index is < 2.0 and central venous pressure is > 20, a temporary RVAD should be considered.…”

Section: Surgical Managementmentioning

confidence: 99%

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Fida¹,

Loebe²,

Estep³

et al. 2015

Methodist DeBakey Cardiovascular Journal

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Early recognition and improved outcomes of ischemic heart disease has resulted in an aging population and a global increase in the prevalence of heart failure (HF).1 Consequently, the burden of stage D heart failure (HF), which is unresponsive to conventional medical therapy, has surpassed the availability of the finite donor organ pool. 2 Significant advances in the field of mechanical circulatory support has made destination therapy (DT) with left ventricular assist devices (LVADs) a promising alternative to heart transplantation, with 1-year postimplant actuarial survival at about 80% with a continuous flow LVAD (CF-LVAD). 3However, despite newer technology and greater familiarity with patient management, physicians continue to be confronted by early and/or late right ventricular failure (RVF) that significantly impacts survival post-LVAD implantation. As none of the current mechanical circulatory support (MCS) devices are approved for DT for solitary right heart support or biventricular support, it is critical to identify preoperative predictors of right heart failure post-LVAD implant. Definition and Incidence of Right Ventricular Failure after LVAD PlacementIn the absence of a universally agreed-upon definition of RVF after LVAD placement, its reported incidence varies with the institutional practice, the United Network for Organ Sharing (UNOS) indication for MCS, the device type, and the criteria used to define failure. Additionally, it is now recognized that RVF is a progressive condition that can occur beyond the immediate postoperative period. However, this emerging concept of "late RVF" remains ill-defined and difficult to predict. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) defines RVF as persistent signs and symptoms of RV dysfunction evident by central venous pressure (CVP) > 18 mm Hg with a cardiac index (CI) < 2.0 L/min/m 2 in the absence of increased left atrial filling pressure/pulmonary capillary wedge pressure (PCWP) > 18 mm Hg, cardiac tamponade, ventricular arrhythmias, and/or pneumothorax requiring either right ventricular assist device (RVAD) implantation or inhaled nitric oxide or inotropic therapy for ≥ 14 days after LVAD implantation. 4 According to INTERMACS, RVF severity is described as follows:• Severe, when there is a need for RVAD; • Moderate, when inotropes or intravenous or inhaled pulmonary vasodilators are used; and • Mild, when a combination of ≥ 2 signs and symptoms are present but without the need for RVAD or inotropic and/ or vasodilator support. Signs and symptoms include CVP > 18 mm Hg, CI < 2.3 L/min/m 2 , ascites, moderate to severe peripheral edema, or evidence of high CVP on physical exam or transthoracic echocardiogram.The incidence of severe RVF necessitating RVAD placement after LVAD or preemptive BiVAD support is reported to be anywhere from 9.4% to 37.0%. [5][6][7][8][9] Most studies have reported the incidence encompassing the need for inotropic support with or without RVAD (≥ 14 days) after LVAD implant, with a range of b...

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“…Reverse Potts shunt circulation may be a therapeutic option for patients with systemic or suprasystemic PAH and RV dysfunction . We report the first successful interventional re‐opening of a PDA occluder (ADO I) to establish a reverse Potts shunt circulation in order to treat RV dysfunction refractory to maximal medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Interventional re‐opening of a PDA for reverse potts shunt circulation after ADO I implantation in a child

Schubert

Peters

Berger

2016

Cathet Cardio Intervent

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We report interventional re-opening of a PDA for reverse Potts shunt circulation 12 months after closure in a 3.8 year old child, suffering from right ventricular (RV) failure due to suprasystemic pulmonary artery hypertension (PAH) after ADO I implantation. After ex vivo simulation, perforation through the mesh of the ADO I with the use of transseptal needle, wire looping (AO-PA), balloon dilatation, stent implantation (Palmaz 6 mm) and post dilatation, a reverse Pott-shunt circulation was established. A follow-up period of 11 months was achieved with preserved RV function and reverse Pott shunt circulation maintained a post ductal saturation of 94-88%. © 2016 Wiley Periodicals, Inc.

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Pulmono-atrial shunt and lung assist to treat right ventricular failure

Cited by 9 publications

References 23 publications

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Interventional re‐opening of a PDA for reverse potts shunt circulation after ADO I implantation in a child

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