Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden.
Eur J Cardiothorac Surg. 2013 Mar;43(3):612-8. doi: 10.1093/ejcts/ezs386. Epub 2012 Jul 3.
Right heart failure is a major cause of morbidity and mortality after left ventricular assist device implantation and is still hard to predict. This study investigated the haemodynamic effect of a modified Glenn shunt on induced right ventricular (RV) failure.
Isolated RV failure was induced by coronary ligation in 11 pigs. A modified Glenn shunt was established by a superior vena cava to pulmonary artery connection. Haemodynamic data were obtained at baseline, RV failure, and RV failure and open shunt. Myocardial biopsies were taken to ascertain established heart failure.
RV failure defined as right atrial pressure ≥20 mmHg was achieved in all 11 animals. A reduction in cardiac output (CO) from 3.7 (3.5-4.2) to 2.3 l/min (2.0-2.6) and mean arterial pressure (MAP) from median 72.7 (70.1-82.2) to 55.9 mmHg (52.6-59.8) was seen during heart failure. The median flow in the shunt was 681 ml. Right atrial pressures decreased from 20.3 (19.6-21.1) to 13.4 mmHg (12.7-14.0), and RV pressures decreased from 18.1 (16.4-20.1) to 13.6 mmHg (13.5-14.2) with open shunt (P = 0.001 for both). CO increased to 2.9 l/min (2.4-3.3) when the shunt was in use. Mixed venous oxygen saturation increased with the shunt from 32 (27-38) to 49% (45-56), P = 0.001. Genes associated with heart failure were upregulated during heart failure.
A modified Glenn shunt improved haemodynamics by reduced right atrial pressure, increased CO, MAP and mixed venous oxygen saturation in an experimental model of induced RV failure.
右心衰竭是左心室辅助装置植入后发病率和死亡率的主要原因，目前仍然难以预测。本研究探讨改良 Glenn 分流术对诱导性右心室（RV）衰竭的血流动力学影响。
在 11 头猪中通过冠状动脉结扎诱导 RV 衰竭。通过上腔静脉到肺动脉的连接建立改良 Glenn 分流术。在基线、RV 衰竭和 RV 衰竭及开放分流时获得血流动力学数据。取心肌活检以确定已建立的心力衰竭。
所有 11 只动物均成功达到右心房压力≥20mmHg 的 RV 衰竭。心输出量（CO）从 3.7（3.5-4.2）降至 2.3L/min（2.0-2.6），平均动脉压（MAP）从中位数 72.7（70.1-82.2）降至 55.9mmHg（52.6-59.8）mmHg，心力衰竭期间。分流中的中位流量为 681ml。右心房压力从 20.3（19.6-21.1）降至 13.4mmHg（12.7-14.0）mmHg，RV 压力从 18.1（16.4-20.1）降至 13.6mmHg（13.5-14.2）mmHg，分流开放（两者均 P=0.001）。分流器使用时 CO 增加至 2.9L/min（2.4-3.3）。分流器使混合静脉血氧饱和度从 32（27-38）增加到 49%（45-56），P=0.001。心力衰竭时与心力衰竭相关的基因上调。
改良 Glenn 分流术通过降低右心房压力、增加 CO、MAP 和混合静脉血氧饱和度，改善了实验性 RV 衰竭模型的血流动力学。
