Estudo experimental comparativo entre a derivação cavo-pulmonar associada ao suporte circulatório esquerdo e o suporte circulatório biventricular na falência aguda biventricular / Comparative experimental study between cavopulmonary anastomosis associated with left ventricular assist device support and biventricular circulatory assistance in acute biventricular failure

Luis Alberto Saraiva Santos

Background Right ventricular (RV) failure durinq left ventricular assist device (LVAD) support can result in severe hernodynarnic cornpromise with hiqh mortality. Objective: This study investiqated the acute effects of cavopulmonary anastomosis on L VAD performance and riqht ventricular myocardial compromise in comparison with isolated LVAD support and biventricular circulatory support in a model of severe cardiac failure. Methods: LVAD support was performed by means of centrituqa pump implantation in 21 anesthetized guinea piqs (25-32 kg) with severe biventricular failure achieved by ventricular fibrillation (VF) induction. Animais were randomized in three groups In the Control group, isolated LVAD support was performed In the Cavopulmonary group, cavopulmonary anastomosis was established by connecting the superior vena cava ano pulmonary main artery with a short segment of expanded politrafluorotylen no. 16 (rnodified Glenn shunt). In the Biventricular group, biventricular assist device support was established by means of two parallel centrifugal: pumps, one of them on the riqht-hand side of the heart and the other on the left-hand side. They were maintened under circulatory support and hemodynamic monitoring for 3h. Blood sample was collected before VF and in intervals of 30 minutes until the end of the surgery. Venous lactate and cytokines serum levels derterminations were also obtained, before VF and each hour. Endocardium samples of the septum and two ventricles were collected and analyzed by optics and electronic in microscopy. Results: Ventricular fibrillation maintenance was responsible for acute LVAD performance impairment after mino in the Control and Cavopulmonary groups. Cavopulmonary anastomosis resulted in non-significant improvement of LVAD pump flow in relation to control group (+55±14 ml/kg/min, p=0.072), while animais under biventricular support maintained higher LVAD flow performance (+93±17 ml/kg/min, p=0.012). Mean arterial pressure remained constant only in biventricular group (p<0.001), which also presented significant decrease of right atrial pressure (p=0,043). Similar increases in cytokine levels were observed in the three groups while the serum lactate presented lower level only in the Biventricular group (p=0,014). Ultrastructural analysis documented the presence of lower levels of myocardial cellular swelling in right ventricle in the Biventricular group . (p=0.017). Conclusion: The concomitant use of cavopulmonary anastomosis during LVAD support in a pig model of severe biventricular failure resulted in non-siqnificant improvement of hemodynamic performance and it did not effectively replace the use of biventricular support. Cytokine levels were similar in three groups. The Biventricular group showed lower levei of cellular swelling in the right ventricle.

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