A simple way to decompress the left ventricle during venoarterial bypass

Objective: The aim of this investigation was to improve the hemodynamics during venoarterial bypass by remote decompression of the left ventricle (LV). Methods: Venoarterial bypass was established in 9 bovine experiments (69 +/- 10 kg) by the transjugular insertion of a self-expanding cannula (smartcanula((R))) 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. Results: Initial pump flow was 4.7 +/- 0.91/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 +/- 0.11/min. Transfemoral decompression increased the pump flow to 5.6 +/- 0.71/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 front 31 +/- 3 to 47 +/- 11 mmHg. Conclusions: Remote drainage of the pulmonary artery during venoarterial bypass allows for effective decompression of the left ventricle and provides superior hermodynamics.