Use of a venous assist device after repair of complex lesions of the right heart

• Published in: Journal of the American College of Cardiology 1986-10, Vol.8 (4), p.922-929
• Main Authors: Milliken, Jeffrey C., Laks, Hillel, George, Barbara
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Assisted Circulation; Biological and medical sciences; Blood Pressure; Cardiology. Vascular system; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart; Heart Defects, Congenital - therapy; Heart Rate; Heart-Assist Devices; Humans; Infant; Intensive care medicine; Lower Body Negative Pressure; Male; Medical sciences; Oxygen - blood; Postoperative Care
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(86)80436-3

Sixteen patients underwent hemodynamic evaluation of a venous assist device after complex operations on the right side of the heart. The device consists of an inflatable abdominal binder attached to a Jobst extremity pump causing intermittent external compression of the abdomen. In addition, six of these patients were evaluated using total lower body compression for comparison. Modifications of the Fontan procedure were performed in 14 patients, mitral valve anuloplasty and tricuspid valve replacement in 1 patient and reconstruction of the right ventricular outflow tract for treatment of pulmonary atresia with intact septum in 1 patient. The patients' ages ranged from 23 months to 31 years (mean 10.7 ± 1.8 years). Systemic blood pressure, right and left atrial pressures, heart rate and arterial-mixed venous oxygen saturation difference were recorded in each patient with and without the device in place. With the venous assist device, mean systolic pressure increased from 95 ± 4 to 122 ± 3 mm Hg (p < 0.05) and diastolic pressure rose from 57 ± 3 to 70 ± 3 mm Hg (p < 0.05). Left atrial pressure increased from 7 ± 1 to 15 ± 1 mm Hg and right atrial pressure from 15 ± 1 to 23 ± 1 mm Hg (both p < 0.05). In addition, arterial-mixed venous oxygen saturation difference decreased from 29% without the device to 23% with the device in place (p < 0.05). Total lower body compression gave similar results to intermittent abdominal compression alone. Use of the venous assist device improves postoperative circulatory performance in patients after complex procedures on the right side of the heart. Cardiac filling pressures and systemic blood pressure rose while peripheral perfusion was improved. The ease and effectiveness of application of abdominal compression alone offer some advantage over the previously described technique of total lower body compression.