Slater J P, Yamada A, Yano O J, Stennet R, Goldstein D J, Levin H R, Spotnitz H M, Oz M C
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Circulation. 1995 Nov 1;92(9 Suppl):II467-71. doi: 10.1161/01.cir.92.9.467.
Right-side circulatory failure (RSCF), a common complication of heart transplant and left ventricular assist device recipients, results in decreased cardiac output because of diminished flow across the pulmonary circuit. We hypothesized that creation of a controlled venoarterial shunt would result in decompression of the right ventricle and improved systemic cardiac output at tolerable oxygen saturations.
A venoarterial shunt was created in a large-animal model (calf, n = 6). RSCF was induced by banding the pulmonary artery. Hemodynamic measures and blood gas determinations were obtained during nonshunted and shunted states. Pulmonary artery banding increased mean right ventricular systolic pressure from 44.9 +/- 2.1 mm Hg (mean +/- SEM) to 85.9 +/- 6.9 mm Hg (P < .05, paired t test) and decreased mean aortic flow from 7.8 +/- 1.0 to 4.2 +/- 1.1 L/min (P < .05). Flow through a venoarterial shunt at approximately 40% of cardiac output resulted in a decrease in right ventricular end-systolic pressure from 85.9 +/- 6.9 to 72.1 +/- 5.6 mm Hg (P < .01, ANOVA), a decrease in mean pulmonary artery pressure from 42.9 +/- 5.0 to 37.2 +/- 3.8 mm Hg (P < .01), and an increase in aortic flow from 4.2 +/- .05 to 5.1 L/min (P < .01). Left ventricular stroke work decreased from 2.22 +/- 0.28 to 1.55 +/- 0.88 (P < .05). Carotid artery oxygen saturation did not change significantly (99.9 +/- .02 to 97.6 +/- 1.7) during shunting.
A controlled venoarterial shunt improved hemodynamics and cardiac output in a large animal model with RSCF. This strategy may be useful in the management of transplant and left ventricular assist device recipients with perioperative RSCF.
右侧循环衰竭（RSCF）是心脏移植和左心室辅助装置接受者的常见并发症，由于肺循环血流量减少导致心输出量降低。我们推测，建立可控的静脉动脉分流可使右心室减压，并在可耐受的氧饱和度下改善全身心输出量。
在大型动物模型（小牛，n = 6）中建立静脉动脉分流。通过结扎肺动脉诱导RSCF。在未分流和分流状态下进行血流动力学测量和血气测定。肺动脉结扎使平均右心室收缩压从44.9±2.1 mmHg（平均值±标准误）升高至85.9±6.9 mmHg（P < 0.05，配对t检验），并使平均主动脉血流量从7.8±1.0降至4.2±1.1 L/min（P < 0.05）。以约心输出量40%的流量通过静脉动脉分流，导致右心室收缩末期压力从85.9±6.9降至72.1±5.6 mmHg（P < 0.01，方差分析），平均肺动脉压力从42.9±5.0降至37.2±3.8 mmHg（P < 0.01），主动脉血流量从4.2±0.05增至5.1 L/min（P < 0.01）。左心室每搏功从2.22±0.28降至1.55±0.88（P < 0.05）。分流期间颈动脉血氧饱和度无显著变化（从99.9±0.02降至97.
