Background: We are developing a total cavopulmonary support system for failing Fontan physiology using the percutaneous Wang-Zwische double-lumen cannula (DLC). Methods: We developed a sheep model of failing Fontan physiology through a right thoracotomy in 5 sheep. An extracardiac conduit was anastomosed to the inferior vena cava and superior vena cava, and a graft was applied to connect the conduit and the right pulmonary artery (PA) to create total vena cava-to-PA diversion, excluding the right heart. The DLC (commercialized as AvalonElite, Avalon Laboratories LLC, Rancho Dominguez, CA) was coupled with a CentriMag pump (Levitronix Waltham, MA) to form a cavopulmonary support system. The DLC was inserted through the right jugular vein and the superior vena cava into the extracardiac conduit with the infusion lumen opening aligned with the right PA bridge. Blood was withdrawn from the superior vena cava and the inferior vena cava through the drainage lumen and pumped into the right PA through the infusion lumen, with flow adjusted to 4.0 ± 0.5 L/min. Results: A successful Fontan model was created without cardiopulmonary bypass. After total venous blood diversion from the vena cava to the right PA artery, failing Fontan physiology developed, evidenced by elevated central venous pressure and dropping mean PA pressure and systolic arterial pressure. The DLC was successfully inserted, and hemodynamics were normalized in all 5 sheep for the duration of the 2-hour study. Conclusions: We created a model of failing Fontan circulation in sheep without cardiopulmonary bypass. The DLC system achieved total cavopulmonary support for 2 hours in our failing Fontan sheep model.
|Number of pages||5|
|Journal||Annals of Thoracic Surgery|
|State||Published - Jun 2011|
Bibliographical noteFunding Information:
All animal studies were approved by the University of Kentucky Institutional Animal Care and Use Committee and were conducted in accordance with the Principles of Laboratory Animal Care (National Society of Medical Research) and the Guide for the Care and Use of Laboratory Animals (National Institutes of Health publication 85-23, revised 1996). The CPAD was tested in our sheep model of failing Fontan physiology. The study used 5 adult female crossbred sheep (weight, 35–45 kg). After anesthesia induction with intravenous ketamine (5 mg/kg) and diazepam (0.25 mg/kg), the sheep were intubated with an endotracheal tube (Hudson RCI, Triangle Research Park, NC), transferred to the operating room, and connected to the anesthesia machine (Narkomed 2B North American DRAGER, Telford, PA). Prophylactic analgesia with buprenorphine (0.005 to 0.010mg/kg) was administered intramuscularly. Anesthesia was maintained by 1% to 3% isoflurane (Butler Animal Health Supply, Dublin, OH), with titration for a normal range of heart rate and arterial blood pressure. Femoral arterial and venous catheters (BD Intracath, Becton Dickinson Infusion Therapy Systems Inc, Sandy, UT) were placed by a cutdown in the right groin.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine