The Annals of Thoracic Surgery, Vol 31, 551-557, Copyright © 1981 by The Society of Thoracic Surgeons
Clinical and experimental evaluation of left ventriculoiliac shunt bypass during repair of lesions of the descending thoracic aorta
PT Frantz, GF Murray, JA Shallal and CL Lucas
Temporary ventriculoiliac bypass with a tridodecylmethylammonium
chloride-coated shunt has been used routinely at the University of North
Carolina for the past seven years for repair of lesions of the descending
thoracic aorta. Although the technic appears to be safe and reliable, the
hemodynamic effects of prolonged nonvalved apical diversion on left
ventricular function are not defined. To evaluate left ventricular
performance during ventriculoiliac shunt bypass, the procedure was
investigated in adult sheep. Systolic flow through the shunt was pulsatile
and accounted for approximately 35% of the total cardiac output. Reversed
flow was minimal. No significant change occurred in cardiac output, left
ventricular end-diastolic pressure, or left atrial pressure. Perfusion of
the abdominal viscera through the shunt was sufficient to prevent
intestinal and renal ischemia. Our results indicate that the shunt provides
left ventricular decompression without evidence of deterioration in left
ventricular performance for up to three hours of apical bypass and aortic
occlusion. It is included that bypass with a left ventriculoiliac shunt
provides safe and effective diversion during repair of lesions of the
descending thoracic aorta and offers and excellent alternative to methods
involving greater technical hazard or requiring systemic anticoagulation.
