Document Detail

Biventricular cannulation is superior regarding hemodynamics and organ recovery in patients on biventricular assist device support.
MedLine Citation:
PMID:  21489816     Owner:  NLM     Status:  Publisher    
BACKGROUND: Adequate pump flow is a prerequisite for recovery of end-organ failure and outcome in patients treated with a biventricular assist device (BiVAD). We hypothesized that hemodynamics and organ recovery would improve after biventricular, apical cannulation compared with right atrial cannulation. METHODS: Between 2003 and 2009, we treated 31 patients (21 men, 10 women; mean age, of 43 ± 15 years) with a paracorporeal BiVAD (Thoratec BVAD, Pleasanton, CA). In 15 of 31 patients, the inflow cannula of the right VAD (RVAD) was positioned inside the right ventricle (RV) through the RV apex (biapical) instead of the right atrium (conventional). We analyzed pump flow, driving pressure, and vacuum of the Thoratec driving console and recovery of kidney (creatinine, blood urea nitrogen) and liver function (bilirubin). RESULTS: Mean duration of BiVAD support was 84 ± 72 days. BiVAD weaning was successful in 4 of 31 patients (13%), 12 underwent cardiac transplantation (39%), and 15 (48%) died. We observed significantly higher pump flow of the LVAD and RVAD in patients after biapical cannulation compared with those with conventional cannulation (LVAD, 5.6 ± 0.4 vs 5.1 ± 0.3 liters/min, p = 0.002; and RVAD: 4.9 ± 0.3 vs 4.2 ± 0.3 liters/min, p < 0.001). This superior circulatory support correlated with faster recovery of kidney function. CONCLUSION: Cardiac support with a BiVAD is hemodynamically more effective after biventricular apical cannulation compared with conventional right atrial cannulation. Consequently, higher pump flow results in better end-organ recovery using biapical cannulation.
Christian Schlensak; David Schibilsky; Matthias Siepe; Kerstin Brehm; Rolf Klemm; Robert von Wattenwyl; Michael Berchthold-Herz; Christoph Benk; Friedhelm Beyersdorf
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-12
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  -     ISSN:  1557-3117     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Department of Cardiovascular Surgery, University Medical Center, Freiburg, Germany.
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