Mechanically assisted bidirectional cavopulmonary shunt in neonates and infants: An acute human pilot study Osami Honjo, MD, PhD, Sandra L. Merklinger,

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Mechanically assisted bidirectional cavopulmonary shunt in neonates and infants: An acute human pilot study Osami Honjo, MD, PhD, Sandra L. Merklinger, RN, PhD, John B. Poe, MSc, Anne-Marie Guerguerian, MD, PhD, Hargen Zhang, MD, Katherine L. Taylor, MD, Glen S. Van Arsdell, MD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 2, Pages 441-447 (February 2017) DOI: 10.1016/j.jtcvs.2016.09.048 Copyright © 2016 Terms and Conditions

Figure 1 A, SVC-to-PA pump assist. Blood is removed from the SVC and passed through the MUF circuit. The pump returns the blood to the patient via the PA cannula. The pump flow rate is determined by the SVC flow measured before CPB. The BT shunt was temporarily clipped, making the simulated mechanically assisted BCPS flow the sole source of pulmonary blood. Additional blood volume can be sourced from the RA. Following the 20-minute study, the shunt clip was removed, and the neonate was returned to normal Norwood physiology. B, SVC-RA oxygenation assist. Blood is removed from the patient via the SVC cannula, passed through the MUF, circuit and returned to the patient via the RA or inferior vena cava. The initial pump flow rate is determined by the SVC flow measured before cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 441-447DOI: (10.1016/j.jtcvs.2016.09.048) Copyright © 2016 Terms and Conditions

Figure 2 Trends in hemodynamics and saturation during SVC-PA pump assist. A, Mean blood pressure >40 mm Hg was maintained. There was no difference in mean arterial pressure between the last 10 minutes of mechanical assist and Norwood physiology (P not significant). B, SVC pressure was lower and CPP was higher during the last 10 minutes of mechanical assist compared with Norwood physiology. C, SaO2 >80% and rCTO2 >60% were maintained throughout the study. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 441-447DOI: (10.1016/j.jtcvs.2016.09.048) Copyright © 2016 Terms and Conditions

Figure 3 Trends in hemodynamics and saturations during SVC-RA oxygenation assist. A, Mean blood pressure >50 mm Hg was maintained. B, SVC pressure tended to be lower and CPP tended to be higher during the last 10 minutes of mechanical assist compared with BCPS physiology. C, SaO2 >70% and rCTO2 >40% were maintained throughout the study at 25% assisted flow. It became apparent that maintenance of an SVC filling pressure in the range of 12 to 15 was needed so that the lung would also contribute to oxygenation; that is, there appeared to be a critical filling pressure required for the lung to contribute. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 441-447DOI: (10.1016/j.jtcvs.2016.09.048) Copyright © 2016 Terms and Conditions

Two types of mechanical assist systems to support primary in-series palliation. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 441-447DOI: (10.1016/j.jtcvs.2016.09.048) Copyright © 2016 Terms and Conditions