Clin Res Cardiol 96:Suppl 2 (2007)

P340 - A low-resistance lung assist in a pulmono-atrial shunt reverses right ventricular failure -An experimental study.
J. Spillner1, R. Autschbach1
1Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsklinikum Aachen, Aachen;
Background: In right ventricular failure (RVF) a decrease of right ventricular afterload and improvement of  left atrial filling could be achieved by a pulmonary artery-left atrial (PA)- shunt. To avoid cyanosis, artificial oxygenation of the shunted blood is necessary. This study investigated the use of a PA-shunt together with a low resistance lung assist device in RVF.
Methods: In 6 pigs a PA-shunt was created by a homograft. The lung assist device (Novalung; Germany) was integrated into the shunt with resulting parallel perfusion of the lungs and the lung assist. RVF was induced by pulmonary artery banding. Right ventricular performance and hemodynamics were determined by the use of pulse contour analysis (Pulsion, Germany) as well as direct pressure lines. Flows were monitored by ultrasonic flow probes; serial blood gas analyses were taken. The observation period was 90 minutes after declamping the shunt and the lung assist.
Results: A stable RVF could be generated with a significant decrease of cardiac output and right ventricular ejection fraction. After declamping the PA shunt and the lung assist cardiac output and arterial pressures increased significantly (p< 0,05; t- test) under a shuntflow of 2,3- 2,6 l/min.. Right ventricular ejection fraction increased  significantly, whereas right ventricular filling pressures remained unchanged. pO2 and mixed Svo2 significantly increased. Taken together the animals recoverd from cardiogenic shock over the observation period. These effects were immetiately reversed when the shunt was clamped again.
Conclusions: PA shunting  with a parallel lung assist can effecively reverse the deleterious effects of  RVF. This concept may be an option to treat RVF surgically.