Neonatal cavopulmonary assist: Pulsatile versus steady-flow pulmonary perfusion

Cynthia D. Myers, Jack H. Boyd, Robert Presson, Palaniswamy Vijay, Aaron C. Coats, John Brown, Mark Rodefeld

Research output: Contribution to journalArticle

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Abstract

Background. Morbidity and mortality associated with single-ventricle physiology decrease substantially once a systemic venous, rather than systemic arterial, source of pulmonary blood flow is established. Cavopulmonary assist has potential to eliminate critical dependence on the problematic systemic-to-pulmonary shunt as a source of pulmonary blood flow in neonates. We have previously demonstrated feasibility of neonatal cavopulmonary assist under steady-flow conditions. We hypothesized that pulsatile pulmonary perfusion would further improve pulmonary hemodynamics. Methods. Lambs (weight 7.2 ± 1.1 kg, age 7.9 ± 1.5 days) underwent total cavopulmonary diversion using bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to augment cavopulmonary flow. Pulsatility was created with an intermittently compressed compliance chamber in the circuit. Hemodynamic and gas exchange data were measured for 8 hours. Pulsatile (n = 6), steady-flow (n = 13), and control (n = 6) groups were compared using two-way analysis of variance with repeated measures. Results. All animals remained physiologically stable with normal gas exchange function. Mean pulmonary arterial pressure was elevated in pulsatile and steady-flow groups compared with the control group and within-group baseline values. Pulmonary vascular resistance was elevated initially in both assist groups but decreased significantly over the last 4 hours of the study and normalized after hour 4 in the pulsatile perfusion group. Pulmonary vascular resistance also normalized to control in the steady-flow group after hour 7. Conclusions. Both steady-flow and pulsatile pulmonary perfusion demonstrated normalization of pulmonary vascular resistance to control in a neonatal model of univentricular Fontan circulation. These results suggest that there is no benefit to pulsatile flow in this model.

Original languageEnglish
Pages (from-to)257-263
Number of pages7
JournalAnnals of Thoracic Surgery
Volume81
Issue number1
DOIs
StatePublished - Jan 2006

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Pulsatile Flow
Perfusion
Lung
Vascular Resistance
Gases
Hemodynamics
Catheterization
Pulmonary Artery
Compliance
Analysis of Variance
Arterial Pressure
Morbidity
Weights and Measures
Control Groups
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Neonatal cavopulmonary assist : Pulsatile versus steady-flow pulmonary perfusion. / Myers, Cynthia D.; Boyd, Jack H.; Presson, Robert; Vijay, Palaniswamy; Coats, Aaron C.; Brown, John; Rodefeld, Mark.

In: Annals of Thoracic Surgery, Vol. 81, No. 1, 01.2006, p. 257-263.

Research output: Contribution to journalArticle

Myers, Cynthia D. ; Boyd, Jack H. ; Presson, Robert ; Vijay, Palaniswamy ; Coats, Aaron C. ; Brown, John ; Rodefeld, Mark. / Neonatal cavopulmonary assist : Pulsatile versus steady-flow pulmonary perfusion. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 1. pp. 257-263.
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N2 - Background. Morbidity and mortality associated with single-ventricle physiology decrease substantially once a systemic venous, rather than systemic arterial, source of pulmonary blood flow is established. Cavopulmonary assist has potential to eliminate critical dependence on the problematic systemic-to-pulmonary shunt as a source of pulmonary blood flow in neonates. We have previously demonstrated feasibility of neonatal cavopulmonary assist under steady-flow conditions. We hypothesized that pulsatile pulmonary perfusion would further improve pulmonary hemodynamics. Methods. Lambs (weight 7.2 ± 1.1 kg, age 7.9 ± 1.5 days) underwent total cavopulmonary diversion using bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to augment cavopulmonary flow. Pulsatility was created with an intermittently compressed compliance chamber in the circuit. Hemodynamic and gas exchange data were measured for 8 hours. Pulsatile (n = 6), steady-flow (n = 13), and control (n = 6) groups were compared using two-way analysis of variance with repeated measures. Results. All animals remained physiologically stable with normal gas exchange function. Mean pulmonary arterial pressure was elevated in pulsatile and steady-flow groups compared with the control group and within-group baseline values. Pulmonary vascular resistance was elevated initially in both assist groups but decreased significantly over the last 4 hours of the study and normalized after hour 4 in the pulsatile perfusion group. Pulmonary vascular resistance also normalized to control in the steady-flow group after hour 7. Conclusions. Both steady-flow and pulsatile pulmonary perfusion demonstrated normalization of pulmonary vascular resistance to control in a neonatal model of univentricular Fontan circulation. These results suggest that there is no benefit to pulsatile flow in this model.

AB - Background. Morbidity and mortality associated with single-ventricle physiology decrease substantially once a systemic venous, rather than systemic arterial, source of pulmonary blood flow is established. Cavopulmonary assist has potential to eliminate critical dependence on the problematic systemic-to-pulmonary shunt as a source of pulmonary blood flow in neonates. We have previously demonstrated feasibility of neonatal cavopulmonary assist under steady-flow conditions. We hypothesized that pulsatile pulmonary perfusion would further improve pulmonary hemodynamics. Methods. Lambs (weight 7.2 ± 1.1 kg, age 7.9 ± 1.5 days) underwent total cavopulmonary diversion using bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to augment cavopulmonary flow. Pulsatility was created with an intermittently compressed compliance chamber in the circuit. Hemodynamic and gas exchange data were measured for 8 hours. Pulsatile (n = 6), steady-flow (n = 13), and control (n = 6) groups were compared using two-way analysis of variance with repeated measures. Results. All animals remained physiologically stable with normal gas exchange function. Mean pulmonary arterial pressure was elevated in pulsatile and steady-flow groups compared with the control group and within-group baseline values. Pulmonary vascular resistance was elevated initially in both assist groups but decreased significantly over the last 4 hours of the study and normalized after hour 4 in the pulsatile perfusion group. Pulmonary vascular resistance also normalized to control in the steady-flow group after hour 7. Conclusions. Both steady-flow and pulsatile pulmonary perfusion demonstrated normalization of pulmonary vascular resistance to control in a neonatal model of univentricular Fontan circulation. These results suggest that there is no benefit to pulsatile flow in this model.

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