PULMONARY CIRCULATORY SUPPORT - A QUANTITATIVE COMPARISON OF 4 METHODS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 88  (6) , 958-964
Abstract
Profound right ventricular failure was produced in 16 goats by inducing ventricular fibrillation after the systemic circulation was supported with a left atrial-aortic bypass pump. In each animal, 4 methods of providing pulmonary blood flow were compared quantitatively: passive flow through the pulmonary artery due to a right atrial to left atrial pressure gradient; pulmonary artery pulsation via a 40 ml intra-aortic type balloon within a 20 mm Dacron graft anastomosed to the main pulmonary artery; pulmonary artery pulsation via a 65 ml single-part, valveless, sac type pulsatile assist device; and right atrial-pulmonary arterial bypass via a valved pneumatic pulsatile pump. Average cardiac index of the 16 animals for each method was 31.1 .+-. 12.9, 44.4 .+-. 13.6, 64.3 .+-. 16.9, and 102.0 .+-. 20.7 ml/min per kg, respectively. Passive pulmonary artery flow alone provided inadequate pulmonary circulatory support. Addition of pulmonary artery pulsation via the intra-aortic balloon within a conduit increased cardiac index 13.3 ml/min per kg (43%) above passive pulmonary artery flow (P < 0.0005); the cardiac index remained inadequate. Increasing pulmonary artery pulsation volume with a 65 ml sac device provided a 32.2 ml/min per kg (106%) increase in cardiac index above passive flow (P < 0.0005) to a level that was marginally adequate. The valved right atrial-pulmonary arterial bypass pump increased cardiac index 70.9 ml/min per kg (228%) above passive pulmonary artery flow (P < 0.0005) to a satisfactory level and is the recommended method of pulmonary circulatory support in profound right ventricular failure.

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