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J Thorac Cardiovasc Surg 2009;137:355-361
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Mechanical cavopulmonary assist maintains pulmonary and cerebral blood flow in a piglet model of a bidirectional cavopulmonary shunt with high pulmonary vascular resistance

^a The Labatt Family Heart Centre, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
^b Pediatric Critical Care Unit, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
^c Department of Artificial Organs, Institute of Biomaterial and Bioengineering, Tokyo Medical Dental University, Tokya, Japan

Received for publication May 3, 2008; revisions received August 3, 2008; accepted for publication September 16, 2008.

^_* Address for reprints: Glen S. Van Arsdell, MD, Division of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada, M5G 1X8. (Email: glen.vanarsdell{at}sickkids.ca).

Objectives: We tested mechanical cavopulmonary blood flow assist by incorporating a novel miniature centrifugal pump into a 1-ventricle type cavopulmonary connection in neonatal pigs.

Methods: Nine 3-week-old piglets (mean body weight, 10.2 kg) were used: mechanical cavopulmonary assist (n = 6) and controls (n = 3). A bidirectional cavopulmonary connection between the superior vena cava and the main pulmonary artery was created. The superior vena cava and pulmonary artery were also connected by cannulas with an interposed centrifugal pump. The cavoarterial mechanical cavopulmonary assist was performed at pump speeds of 1500, 2000, 2500, and 3000 rpm. Retrograde superior vena caval flow was limited by a band on the superior vena cava. A bidirectional cavopulmonary connection was created in the control animals, which then had a pure 1-ventricle repair physiology without mechanical support. Hemodynamics, blood gas, and cerebral blood flow measured by ultrasound were analyzed. Catheter-based dilatation of the surgically created superior vena cava obstruction was tested.

Results: Incremental increases in pump speed augmented bidirectional cavopulmonary shunt blood flow (P =.03) and diminished superior vena caval pressure (P =.03), thereby improving cerebral perfusion pressure. Pump flow of 3000 rpm was equivalent to baseline superior vena caval flow (before caval flow, 392 ± 48 mL/min vs MCPA, 371 ± 120 mL/min; mean ± SD; P = not significant). The mechanical cavopulmonary assist group had higher Doppler velocities of the middle cerebral artery and higher transcerebral oxygen difference(P < .05) than controls. Balloon dilatation of the superior vena cava band was successful.

Conclusions: Mechanical cavopulmonary assist maintained bidirectional cavopulmonary shunt flow, thereby sustaining primary bilateral cavopulmonary shunt physiology in a neonatal pig model of high pulmonary vascular resistance. The mechanical cavopulmonary assist maintained cerebral blood flow and metabolism with an adequate transcerebral pressure gradient.