• L K von Segesser, K Kwang, P Tozzi, J Horisberger, and W Dembitsky.
• Cardiovascular Surgery, CHUV, Lausanne, Switzerland. ludwig.von-segesser@chuv.ch
• Thorac Cardiovasc Surg. 2008 Sep 1; 56 (6): 337-41.

ObjectiveThe aim of this investigation was to improve the hemodynamics during venoarterial bypass by remote decompression of the left ventricle (LV).MethodsVenoarterial bypass was established in 5 bovine experiments (69+/-10 kg) by the transjugular insertion of a self-expanding cannula (smartcanula) with return through a carotid artery. Cardiogenic shock was simulated with ventricular fibrillation induced by an external stimulator. Left ventricular decompression was achieved by switching to transfemoral drainage of the pulmonary artery (PA) with a long self-expanding cannula.ResultsInitial pump flow was 4.7+/-0.9 l/min and the aortic pressure accounted for 75+/-21 mmHg. After induction of ventricular fibrillation, the pump flow dropped after 11+/-8 min to 2.5+/-0.1 l/min. Transfemoral decompression increased the pump flow to 5.6+/-0.7 l/min, while the RV pressure decreased from 27+/-9 to 3+/-5 mmHg, the PA pressure decreased from 29+/-7 to 5+/-4 mmHg, the LV pressure decreased from 29+/-6 to 7+/-2 mmHg, and the aortic pressure increased from 31+/-3 to 47+/-11 mmHg.ConclusionsRemote drainage of the pulmonary artery during venoarterial bypass allows for effective decompression of the left ventricle and provides superior hemodynamics.

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