Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation

Cynthia D. Myers, Kelly Mattix, Robert Presson, Palaniswamy Vijay, Domingo Maynes, Kenneth N. Litwak, John Brown, Mark Rodefeld

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background. Morbidity and mortality after stage-1 palliation of hypoplastic left heart syndrome is high as a result of adverse physiologic conditions imposed by the systemic-to-pulmonary arterial shunt. Conversion to a systemic venous source of pulmonary blood flow (Glenn/Fontan) substantially decreases instability and mortality risk. Cavopulmonary assist has the potential to eliminate critical dependence on the problematic systemic arterial shunt. We studied this support modality during a 24-hour period in a neonatal animal model of univentricular Fontan circulation. Methods. Lambs (8.1 ± 0.9 kg, 8.3 ± 2.1 days, n = 7) underwent total cavopulmonary diversion. A miniature centrifugal pump was used to assist cavopulmonary flow. Control animals (6.6 ± 1.0 kg, 7.3 ± 2.1 days, n = 11) underwent placement of monitoring lines only. Hemodynamic and gas exchange data were measured. Within-group and between-group comparisons were made using two-way repeated measures analysis of variance. Results. After an initial phase of reactivity, pulmonary vascular resistance returned to low levels and was not significantly different from baseline values after hour 13 or significantly different from control values after hour 4. Systemic venous pressure remained low. Oxygenation and ventilation remained normal with no histologic evidence of parenchymal lung injury. Conclusions. Pump-assisted cavopulmonary diversion is well tolerated up to 24 hours in the neonatal period. Despite initial reactivity, pulmonary vascular resistance trended toward normal and approached control values. Cavopulmonary assist holds the potential to serve as a bridge to neonatal Fontan repair of single ventricle. Chronic studies are warranted to determine the duration and rate of weaning of support to transition to an unassisted univentricular Fontan circulation.

Original languageEnglish
Pages (from-to)264-271
Number of pages8
JournalAnnals of Thoracic Surgery
Volume81
Issue number1
DOIs
StatePublished - Jan 2006

Fingerprint

Vascular Resistance
Hypoplastic Left Heart Syndrome
Newborn Animals
Lung
Venous Pressure
Mortality
Lung Injury
Weaning
Ventilation
Analysis of Variance
Animal Models
Gases
Hemodynamics
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation. / Myers, Cynthia D.; Mattix, Kelly; Presson, Robert; Vijay, Palaniswamy; Maynes, Domingo; Litwak, Kenneth N.; Brown, John; Rodefeld, Mark.

In: Annals of Thoracic Surgery, Vol. 81, No. 1, 01.2006, p. 264-271.

Research output: Contribution to journalArticle

Myers, Cynthia D. ; Mattix, Kelly ; Presson, Robert ; Vijay, Palaniswamy ; Maynes, Domingo ; Litwak, Kenneth N. ; Brown, John ; Rodefeld, Mark. / Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 1. pp. 264-271.
@article{3754dc92b86043099d3c032ad58afdb1,
title = "Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation",
abstract = "Background. Morbidity and mortality after stage-1 palliation of hypoplastic left heart syndrome is high as a result of adverse physiologic conditions imposed by the systemic-to-pulmonary arterial shunt. Conversion to a systemic venous source of pulmonary blood flow (Glenn/Fontan) substantially decreases instability and mortality risk. Cavopulmonary assist has the potential to eliminate critical dependence on the problematic systemic arterial shunt. We studied this support modality during a 24-hour period in a neonatal animal model of univentricular Fontan circulation. Methods. Lambs (8.1 ± 0.9 kg, 8.3 ± 2.1 days, n = 7) underwent total cavopulmonary diversion. A miniature centrifugal pump was used to assist cavopulmonary flow. Control animals (6.6 ± 1.0 kg, 7.3 ± 2.1 days, n = 11) underwent placement of monitoring lines only. Hemodynamic and gas exchange data were measured. Within-group and between-group comparisons were made using two-way repeated measures analysis of variance. Results. After an initial phase of reactivity, pulmonary vascular resistance returned to low levels and was not significantly different from baseline values after hour 13 or significantly different from control values after hour 4. Systemic venous pressure remained low. Oxygenation and ventilation remained normal with no histologic evidence of parenchymal lung injury. Conclusions. Pump-assisted cavopulmonary diversion is well tolerated up to 24 hours in the neonatal period. Despite initial reactivity, pulmonary vascular resistance trended toward normal and approached control values. Cavopulmonary assist holds the potential to serve as a bridge to neonatal Fontan repair of single ventricle. Chronic studies are warranted to determine the duration and rate of weaning of support to transition to an unassisted univentricular Fontan circulation.",
author = "Myers, {Cynthia D.} and Kelly Mattix and Robert Presson and Palaniswamy Vijay and Domingo Maynes and Litwak, {Kenneth N.} and John Brown and Mark Rodefeld",
year = "2006",
month = "1",
doi = "10.1016/j.athoracsur.2005.06.063",
language = "English",
volume = "81",
pages = "264--271",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation

AU - Myers, Cynthia D.

AU - Mattix, Kelly

AU - Presson, Robert

AU - Vijay, Palaniswamy

AU - Maynes, Domingo

AU - Litwak, Kenneth N.

AU - Brown, John

AU - Rodefeld, Mark

PY - 2006/1

Y1 - 2006/1

N2 - Background. Morbidity and mortality after stage-1 palliation of hypoplastic left heart syndrome is high as a result of adverse physiologic conditions imposed by the systemic-to-pulmonary arterial shunt. Conversion to a systemic venous source of pulmonary blood flow (Glenn/Fontan) substantially decreases instability and mortality risk. Cavopulmonary assist has the potential to eliminate critical dependence on the problematic systemic arterial shunt. We studied this support modality during a 24-hour period in a neonatal animal model of univentricular Fontan circulation. Methods. Lambs (8.1 ± 0.9 kg, 8.3 ± 2.1 days, n = 7) underwent total cavopulmonary diversion. A miniature centrifugal pump was used to assist cavopulmonary flow. Control animals (6.6 ± 1.0 kg, 7.3 ± 2.1 days, n = 11) underwent placement of monitoring lines only. Hemodynamic and gas exchange data were measured. Within-group and between-group comparisons were made using two-way repeated measures analysis of variance. Results. After an initial phase of reactivity, pulmonary vascular resistance returned to low levels and was not significantly different from baseline values after hour 13 or significantly different from control values after hour 4. Systemic venous pressure remained low. Oxygenation and ventilation remained normal with no histologic evidence of parenchymal lung injury. Conclusions. Pump-assisted cavopulmonary diversion is well tolerated up to 24 hours in the neonatal period. Despite initial reactivity, pulmonary vascular resistance trended toward normal and approached control values. Cavopulmonary assist holds the potential to serve as a bridge to neonatal Fontan repair of single ventricle. Chronic studies are warranted to determine the duration and rate of weaning of support to transition to an unassisted univentricular Fontan circulation.

AB - Background. Morbidity and mortality after stage-1 palliation of hypoplastic left heart syndrome is high as a result of adverse physiologic conditions imposed by the systemic-to-pulmonary arterial shunt. Conversion to a systemic venous source of pulmonary blood flow (Glenn/Fontan) substantially decreases instability and mortality risk. Cavopulmonary assist has the potential to eliminate critical dependence on the problematic systemic arterial shunt. We studied this support modality during a 24-hour period in a neonatal animal model of univentricular Fontan circulation. Methods. Lambs (8.1 ± 0.9 kg, 8.3 ± 2.1 days, n = 7) underwent total cavopulmonary diversion. A miniature centrifugal pump was used to assist cavopulmonary flow. Control animals (6.6 ± 1.0 kg, 7.3 ± 2.1 days, n = 11) underwent placement of monitoring lines only. Hemodynamic and gas exchange data were measured. Within-group and between-group comparisons were made using two-way repeated measures analysis of variance. Results. After an initial phase of reactivity, pulmonary vascular resistance returned to low levels and was not significantly different from baseline values after hour 13 or significantly different from control values after hour 4. Systemic venous pressure remained low. Oxygenation and ventilation remained normal with no histologic evidence of parenchymal lung injury. Conclusions. Pump-assisted cavopulmonary diversion is well tolerated up to 24 hours in the neonatal period. Despite initial reactivity, pulmonary vascular resistance trended toward normal and approached control values. Cavopulmonary assist holds the potential to serve as a bridge to neonatal Fontan repair of single ventricle. Chronic studies are warranted to determine the duration and rate of weaning of support to transition to an unassisted univentricular Fontan circulation.

UR - http://www.scopus.com/inward/record.url?scp=29144506917&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=29144506917&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2005.06.063

DO - 10.1016/j.athoracsur.2005.06.063

M3 - Article

C2 - 16368378

AN - SCOPUS:29144506917

VL - 81

SP - 264

EP - 271

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -