Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement

Daniel J. Goldstein, Robert C. Ashton, James P. Slater, Marc Pearson, J. Alex Seldomridge, David A. D'Alessandro, Desmond A. Jordan, Mehmet C. Oz

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Right sided circulatory failure (RSCF), a common complication after left ventricular assist device (LVAD) implantation, results in decreased systemic output due to diminished blood flow across the pulmonary vasculature. The authors hypothesized that creation of a venoarterial shunt (VAS) would decompress the right-sided circulation and improve systemic pressure and perfusion without significant arterial desaturation. An experimental model was created in which RSCF was induced acutely in a large animal (n = 6) by β-blockade after LVAD placement. After VAS creation, hemodynamic and blood gas determinations were performed to compare non shunt and shunt states. After induction of heart failure after LVAD placement, VAS resulted in a 22% elevation in systemic blood pressure (p < 0.0001), a 36% elevation in cerebral blood flow (p = 0.02), and an 18% decrease in right sided filling pressures (p = 0.08). Systemic pH and aortic oxygen saturation remained unchanged from baseline. In a large animal model of RCSF after LVAD implantation, VAS improves systemic hemodynamics without a significant cost in arterial oxygenation to critical organs and without creating acid-base imbalance. Bedside implementation, adjustable capabilities, easy removal and salutatory hemodynamic effects suggest that VAS may serve as a first line, short-term therapy for LVAD recipients who develop perioperative RSCF.

Original languageEnglish (US)
Pages (from-to)171-176
Number of pages6
JournalASAIO Journal
Volume43
Issue number3
StatePublished - Jun 1997
Externally publishedYes

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Shock
Hemodynamics
Blood
Cerebrovascular Circulation
Acid-Base Imbalance
Animals
Pressure
Oxygenation
Blood pressure
Theoretical Models
Animal Models
Heart Failure
Perfusion
Gases
Oxygen
Blood Pressure
Costs and Cost Analysis
Lung

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering

Cite this

Goldstein, D. J., Ashton, R. C., Slater, J. P., Pearson, M., Seldomridge, J. A., D'Alessandro, D. A., ... Oz, M. C. (1997). Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement. ASAIO Journal, 43(3), 171-176.

Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement. / Goldstein, Daniel J.; Ashton, Robert C.; Slater, James P.; Pearson, Marc; Seldomridge, J. Alex; D'Alessandro, David A.; Jordan, Desmond A.; Oz, Mehmet C.

In: ASAIO Journal, Vol. 43, No. 3, 06.1997, p. 171-176.

Research output: Contribution to journalArticle

Goldstein, DJ, Ashton, RC, Slater, JP, Pearson, M, Seldomridge, JA, D'Alessandro, DA, Jordan, DA & Oz, MC 1997, 'Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement', ASAIO Journal, vol. 43, no. 3, pp. 171-176.
Goldstein DJ, Ashton RC, Slater JP, Pearson M, Seldomridge JA, D'Alessandro DA et al. Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement. ASAIO Journal. 1997 Jun;43(3):171-176.
Goldstein, Daniel J. ; Ashton, Robert C. ; Slater, James P. ; Pearson, Marc ; Seldomridge, J. Alex ; D'Alessandro, David A. ; Jordan, Desmond A. ; Oz, Mehmet C. / Venoarterial shunting for the treatment of right sided circulatory failure after left ventricular assist device placement. In: ASAIO Journal. 1997 ; Vol. 43, No. 3. pp. 171-176.
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