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J Thorac Cardiovasc Surg 2001;122:1094-1100
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

An artificial lung reduces pulmonary impedance and improves right ventricular efficiency in pulmonary hypertension

From the Departments of Surgery and Biomedical Engineering, University of Michigan, and Michigan Critical Care Consultants, Ann Arbor, Mich.

Supported by a subcontract from Michigan Critical Care Consultants as a Small Business Innovation Research program from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Received for publication April 26, 2001. Revisions requested June 14, 2001. Accepted for publication June 14, 2001. Address for reprints: Ronald B. Hirschl, MD, 1500 E Medical Center Drive, Ann Arbor, MI 48105 (E-mail: rhirschl{at}umich.edu).

Abstract

Objective: Artificial lungs may have a role in supporting patients with end-stage lung disease as a bridge or alternative to lung transplantation. This investigation was performed to determine the effect of an artificial lung, perfused by the right ventricle in parallel with the pulmonary circulation, on indices of right ventricular load in a model of pulmonary hypertension.
Methods: Seven adult male sheep were connected to a low-resistance membrane oxygenator through conduits anastomosed end to side to the pulmonary artery and left atrium. Banding of the distal pulmonary artery generated acute pulmonary hypertension. Data were obtained with and without flow through the device conduits. Outcome measures of right ventricular load included hemodynamic parameters, as well as analysis of impedance, power consumption, wave reflections, cardiac efficiency, and the tension-time index.
Results: The model of pulmonary hypertension increased all indices of right ventricular load and decreased ventricular efficiency. Allowing flow through the artificial lung significantly reduced mean pulmonary artery pressure, zero harmonic impedance, right ventricular power consumption, amplitude of reflected waves, and the tension-time index. Cardiac efficiency was significantly increased.
Conclusions: An artificial lung perfused by the right ventricle and applied in parallel with the pulmonary circulation reduces ventricular load and improves cardiac efficiency in the setting of pulmonary hypertension. These data suggest that an artificial lung in this configuration may benefit patients with end-stage lung disease and pulmonary hypertension with right ventricular strain.

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