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J Thorac Cardiovasc Surg 2004;127:705-711
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Cavopulmonary assist in the neonate: an alternative strategy for single-ventricle palliation

^a Department of Surgery, Section of Cardiothoracic Surgery, Indiana University School of Medicine and James Whitcomb Riley Hospital for Children, Indianapolis, Ind, USA
^b Department of Anesthesiology, Indiana University School of Medicine and James Whitcomb Riley Hospital for Children, Indianapolis, Ind, USA
^c Department of Cellular and Integrative Physiology, Indiana University School of Medicine and James Whitcomb Riley Hospital for Children, Indianapolis, Ind, USA

Read at the Twenty-ninth Annual Meeting of The Western Thoracic Surgical Association, Carlsbad, Calif, June 18-21, 2003.

Received for publication June 17, 2003; revisions received August 22, 2003; revisions received November 5, 2003; accepted for publication November 12, 2003.

^* Address for reprints: Mark D. Rodefeld, MD, Department of Surgery, Section of Cardiothoracic Surgery, Indiana University School of Medicine, Emerson Hall 215, 545 Barnhill Dr, Indianapolis, IN 46202, USA
rodefeld{at}iupui.edu

BACKGROUND: Cavopulmonary blood flow, rather than a systemic arterial source of pulmonary blood flow, stabilizes Norwood physiology. We hypothesized that pump-assisted cavopulmonary diversion would yield stable pulmonary and systemic hemodynamics in the neonate. This was tested in a newborn animal model of total cavopulmonary diversion and univentricular Fontan circulation.

METHODS: Lambs (n = 13; mean weight, 5.6 ± 1.5 kg; mean age, 6.8 ± 4.0 days) were anesthetized and mechanically ventilated. Baseline hemodynamic parameters were measured. Total cavopulmonary diversion was performed with bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to assist cavopulmonary flow. Support was titrated to normal physiologic parameters. Hemodynamic data, arterial blood gases, and lactate values were measured for 8 hours. Baseline, 1-hour, and 8-hour time points were compared by using analysis of variance.

RESULTS: All animals remained stable without the use of volume loading, inotropic support, or pulmonary vasodilator therapy. Cardiac index, systemic arterial pressure, left atrial pressure, and lactate values were similar to baseline values 8 hours after surgery. Mean pulmonary arterial pressure and pulmonary vascular resistance were modestly increased 8 hours after surgery. Mean arterial pH, PO₂, and PCO₂ values remained stable throughout the study.

CONCLUSIONS: Cavopulmonary assist is feasible in a neonatal animal model of total cavopulmonary diversion and univentricular Fontan circulation with acceptable pulmonary arterial pressures and without altering regional volume distribution or cardiac output. Pump-assisted cavopulmonary diversion, in combination with Norwood aortic arch reconstruction, could solve several major problems associated with a systemic shunt–dependent univentricular circulation, including hypoxemia, impaired diastolic coronary perfusion, and ventricular volume overload.

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				A. L. Throckmorton, K. K. Ballman, C. D. Myers, S. H. Frankel, J. W. Brown, and M. D. Rodefeld Performance of a 3-Bladed Propeller Pump to Provide Cavopulmonary Assist in the Failing Fontan Circulation Ann. Thorac. Surg., October 1, 2008; 86(4): 1343 - 1347. [Abstract] [Full Text] [PDF]

				C. D. Myers, J. H. Boyd, R. G. Presson Jr, P. Vijay, A. C. Coats, J. W. Brown, and M. D. Rodefeld Neonatal Cavopulmonary Assist: Pulsatile Versus Steady-Flow Pulmonary Perfusion Ann. Thorac. Surg., January 1, 2006; 81(1): 257 - 263. [Abstract] [Full Text] [PDF]

				C. D. Myers, K. Mattix, R. G. Presson Jr, P. Vijay, D. Maynes, K. N. Litwak, J. W. Brown, and M. D. Rodefeld Twenty-Four Hour Cardiopulmonary Stability in a Model of Assisted Newborn Fontan Circulation Ann. Thorac. Surg., January 1, 2006; 81(1): 264 - 271. [Abstract] [Full Text] [PDF]