Desaturated venous-to-arterial shunting reduces right-sided heart failure after cardiopulmonary bypass.

BACKGROUND

Right-sided circulatory failure is a major cause of morbidity in heart transplant and ventricular assist device recipients.

METHODS

Several systems for managing right-sided circulatory failure with use of a right-to-left shunt without need for an oxygenator or systemic heparinization were designed and used clinically.

RESULTS

A right-to-left shunt was successfully used to treat severe right-sided circulatory failure in both a transplant and a left ventricular assist device recipient.

CONCLUSIONS

If constructed between the femoral vein and artery, such a shunt could (1) be easily inserted and removed, (2) selectively infuse the lower extremities with desaturated blood while maintaining cerebral and cardiac perfusion with saturated blood, (3) selectively reduce the risk of paradoxical emboli to the head and heart, and (4) provide a known and adjustable degree of shunting depending on the condition of the patient, a major advantage of this system compared with creation of an atrial septal defect.