Mechanically assisted bidirectional cavopulmonary shunt in neonates and infants: An acute human pilot study

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• 作者：Osami Honjo ; MD ; PhD^a ; Sandra L. Merklinger ; RN ; PhD^a ; John B. Poe ; MSc^a ; Anne-Marie Guerguerian ; MD ; PhD^b ; Hargen Zhang ; MD^a ; Katherine L. Taylor ; MD^c ; Glen S. Van Arsdell ; MD^d ; ^{glen.vanarsdell@sickkids.ca}
• 关键词：bidirectional cavopulmonary shunt ; in-series palliation ; mechanical circulatory assist ; single-ventricle physiology
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：153
• 期：2
• 页码：441-447
• 全文大小：813 K
• 卷排序：153

文摘

Poor survival following surgical palliation for hypoplastic left heart syndrome (HLHS) raises the question of the need for a paradigm shift. This is the first human study to investigate the possibility of primary “in-series” palliation in neonates and infants with HLHS in an acute setting with the aid of 2 types of mechanical assist: superior vena cava (SVC)–to–pulmonary artery (PA) pump assist and SVC–to–right atrium (RA) oxygenation assist.MethodsBy rearranging the cannula sites and flow rates for modified ultrafiltration, 2 types of mechanically assisted bidirectional cavopulmonary shunt (BCPS) circulation were simulated for 20 minutes. Three neonates undergoing a stage I Norwood procedure were assigned to SVC-PA pump assist, and 3 infants undergoing stage II BCPS were assigned to SVC-RA oxygenation assist. Hemodynamic parameters, blood gas values, and arterial (SaO2) and regional cerebral tissue (rCTO2) saturations were analyzed.ResultsAll 6 patients completed the study without hemodynamic compromise. In the SVC-PA pump assist group, a mean arterial pressure >40 mm Hg was maintained. SVC pressure was lower (P = .01) and cerebral perfusion pressure (CPP) was higher (P = .03) during the last 10 minutes of assist compared with Norwood physiology. SaO2 >80%, rCTO2 >60%, and mixed venous saturation ≥59% were maintained, comparable to values with Norwood physiology. In the SVC-RA oxygenation assist group, with full or 50% support, mean blood pressure >50 mm Hg, SVC pressure <15 mm Hg, mixed venous saturation >50%, and CPP >40 mm Hg were maintained, which were comparable to BCPS physiology.ConclusionsTwo types of mechanical assist to support primary in-series palliation are feasible in the acute setting. Both modes of mechanical assist maintained oxygenation, as well as systemic and cerebral perfusion.