Effects of intraluminal and extracorporeal inferior vena caval bypass on canine hemodynamics
作者:
Thomas R. MD Howdieshell,
Morgan MD Wood,
Michael CCP Swayne,
Ron CCP Duvall,
Sam CCP Mooney,
Nancy MSN Stark,
期刊:
Critical Care Medicine
(OVID Available online 1996)
卷期:
Volume 24,
issue 4
页码: 631-634
ISSN:0090-3493
年代: 1996
出版商: OVID
数据来源: OVID
摘要:
ObjectiveTo compare inferior vena cava-right atrial extracorporeal bypass with intraluminal atriocaval shunting during hepatic vascular isolation.DesignProspective, randomized, controlled animal study.SettingUniversity research laboratory.SubjectsAdult mongrel dogs (n equals 5) weighing 20 to 27 kg.InterventionsAnesthetized dogs underwent laparotomy and sternotomy for vascular isolation. For atriocaval shunting, 20- and 24-Fr intraluminal shunts were inserted into the inferior vena cava via right atriotomy. For extracorporeal bypass, each animal underwent inferior vena cava, portal vein, and right atrial cannulation for venovenous bypass, utilizing a centrifugal pump. Hemodynamic data were recorded at baseline and at intervals after caval occlusion, Pringle maneuver, and caval occlusion with Pringle maneuver.Measurements and Main ResultsIsolated Pringle maneuver and caval occlusion with Pringle maneuver produced significant reductions in mean arterial pressure (MAP) and cardiac output, irrespective of pulmonary artery occlusion pressure. Extracorporeal bypass, including both caval and portal venous return, produced significant increases in MAP and cardiac output during caval occlusion with Pringle maneuver, while atriocaval shunting and extracorporeal bypass without portal venous return did not improve MAP or cardiac output.ConclusionVenovenous extracorporeal bypass with portal return, acting as a right ventricular assist device, is superior to intraluminal atriocaval shunting in maintaining hemodynamic stability during hepatic vascular isolation.(Crit Care Med 1996; 24:631-634)
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