CARDIOPULMONARY BYPASS THROUGH PERIPHERAL CANNULATION WITH PERCUTANEOUS DECOMPRESSION OF THE LEFT-HEART IN A MODEL OF SEVERE MYOCARDIAL FAILURE

Prolonged closed chest cardiopulmonary bypass for severe total biventr icular myocardial dysfunction requires invasive decompression of the l eft heart. The authors have developed an elongated helical coil that i s permanently attached to the distal 8-10 cm of a flow directed Swan-C ant catheter. When properly positioned, the helical coil kept the pulm onary artery (PA) and the tricuspid valves open, and allowed closed ch est retrograde decompression of the left heart. The authors have evalu ated the merits of closed chest cardiopulmonary bypass with decompress ion of the left heart in this manner in four sheep subjected to 30 min of warm global myocardial ischemia, along with induced ventricular fi brillation. All sheep developed severe global myocardial failure, with no left ventricular (LV) ejection. The authors have shown that pulmon ary blood flow during cardiopulmonary bypass was reversed from the lef t heart, across the lungs, and into the right heart. The wedge pressur e never exceeded 12 mmHg at any time, attesting to good decompression during periods of total ventricular failure, during partial recovery w ith some LV ejection, and after good recovery of LV function, followed by weaning from bypass after 44, 67, and 78 h of such support. One sh eep could not be weaned from bypass, even after 5 days of CPBP. Lung f unction in all sheep remained unimpaired throughout, and there was no wound bleeding. The authors conclude that in this model of total myoca rdial failure, and while on closed chest CPBP, at all times and with a ll degrees of myocardial dysfunction, excellent LV decompression with the helical coil catheter was attained.