A modified Glenn shunt reduces right ventricular stroke work during left ventricular assist device therapy
| Autor: | Per Vikholm, Petter Schiller, Laila Hellgren |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Swine Heart Ventricles Ventricular Dysfunction Right medicine.medical_treatment 030204 cardiovascular system & hematology Right ventricular Stroke work 03 medical and health sciences 0302 clinical medicine Right heart failure Internal medicine Animals Medicine cardiovascular diseases Cardiac Surgical Procedures business.industry Glenn shunt General Medicine Surgery Shunt (medical) 030228 respiratory system Ventricular assist device Ischemic stroke cardiovascular system Cardiology Heart-Assist Devices Cardiology and Cardiovascular Medicine business Medical science |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 49:795-801 |
| ISSN: | 1873-734X 1010-7940 |
| Popis: | Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) placement and remains hard to predict. We hypothesized that partial surgical exclusion of the RV with a modified Glenn shunt during LVAD treatment would reduce RV stroke work.An LVAD was implanted in eight pigs and a modified Glenn shunt was constructed. A conductance pressure-volume catheter was placed in the right ventricle through the apex. Haemodynamic data and pressure-volume loops were obtained at the following time periods: (i) baseline, (ii) open shunt, (iii) LVAD with closed shunt and (iii) LVAD and open shunt.During LVAD therapy, the right atrial (RA) pressure increased from 9 mmHg (9-9) to 15 mmHg (12-15), P = 0.01. RV stroke volume increased from 30 ml (29-40) to 51 ml (42-53), P0.01. Also, RV stroke work increased to 708 mmHg ml (654-1193) from 535 mmHg ml (424-717), P = 0.04, compared with baseline. During LVAD therapy in combination with a Glenn shunt, the RA pressure decreased from 15 mmHg (12-15) to 10 mmHg (7-11) when compared with LVAD therapy only, P = 0.01. A decrease in RV stroke work from 708 mmHg ml (654-1193) to 465 mmHg ml (366-711), P = 0.04, was seen when the LVAD was combined with a shunt, not significantly different from the baseline value (535 mmHg ml). The developed pressure in the right ventricle decreased from 29 mmHg (26-32) to 21 mmHg (20-24), P0.01. The pressure-volume loops of the RV show a significant reduction of RV stroke work during the use of the shunt with LVAD treatment.A modified Glenn shunt reduced RV volumes, RV stroke work and RA pressure during LVAD therapy in an experimental model of heart failure in pigs. |
| Databáze: | OpenAIRE |
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