Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model
<b>Background</b>: Palliative surgery for the treatment of functionally univentricular heart malformations consists of a staged approach to separation of the pulmonary and systemic circulation, including the creation of a superior cavopulmonary connection. Literature on the superior cavo...
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2025-04-01
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| author | Benjamin Bierbach Luca Pieterek Jan Dauvergne Carolin Scholl Christina Oetzmann von Sochaczewski Johannes Breuer Boulos Asfour Mathieu Vergnat Tobias Kratz |
| author_facet | Benjamin Bierbach Luca Pieterek Jan Dauvergne Carolin Scholl Christina Oetzmann von Sochaczewski Johannes Breuer Boulos Asfour Mathieu Vergnat Tobias Kratz |
| author_sort | Benjamin Bierbach |
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| description | <b>Background</b>: Palliative surgery for the treatment of functionally univentricular heart malformations consists of a staged approach to separation of the pulmonary and systemic circulation, including the creation of a superior cavopulmonary connection. Literature on the superior cavopulmonary connection in porcine models lacks information on details of the procedure as well as data on its acute hemodynamic effects. In preliminary experiments, we were unable to reproduce an already published porcine model. Therefore, we used a conduit extension and cardiopulmonary bypass in order to achieve hemodynamic stability and still employ the commonly used straight downward pathway for the superior caval vein onto the right pulmonary artery, as in the human clinical setting. This model of a univentricular circulation utilising the superior cavopulmonary anastomosis is intended to be applied in the setting of unilateral diaphragmatic palsy. Hence, we aim to investigate the effect of unilateral diaphragmatic pacing in a reproducible model of univentricular physiology. <b>Methods</b>: Therefore, we constructed an anastomosis between the superior caval vein and the right pulmonary artery (RPA) in 14 pigs on cardiopulmonary bypass using a 12 mm expanded polytetrafluorethylene interposition graft. Six pigs received a bidirectional cavopulmonary connection with unrestricted atrial septal communication (BDCPC), while eight pigs received a unidirectional cavopulmonary connection (UDCPC) to the excluded RPA. <b>Results</b>: The BDCPC resulted in an impaired cardiopulmonary state (cardiac output dropped from 3.15 ± 0.21 to 2.17 ± 0.19 L/min; <i>p</i> < 0.01), mean arterial pressure plummeted (from 80.8 ± 3.7 to 49.3 ± 7.3 mmHg; <i>p</i> = 0.02), arterial lactate concentration rose (from 0.82 ± 0.09 to 4.36 ± 0.96 mmol/L; <i>p</i> = 0.01), arterial oxygen saturation dropped (from 95.8 ± 1.1 to 60.9 ± 10.4%; <i>p</i> < 0.01), and right ventricular function deteriorated (tricuspid annular plane systolic excursion decreased from 12 ± 0.7 to 5 ± 0.7 mm; <i>p</i> < 0.01). In contrast, in the UDCPC group, the cardiopulmonary parameters indicated a stable condition. <b>Conclusions:</b> Consequently, a UDCPC is a more suitable acute model in pigs for a univentricular circulation. The model’s reproducibility may aid in future research on partial cavopulmonary connection. |
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| spelling | doaj-art-67e47281050e46f090e3f4c6c3f6bfb02025-08-20T02:24:39ZengMDPI AGBiomedicines2227-90592025-04-0113491810.3390/biomedicines13040918Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine ModelBenjamin Bierbach0Luca Pieterek1Jan Dauvergne2Carolin Scholl3Christina Oetzmann von Sochaczewski4Johannes Breuer5Boulos Asfour6Mathieu Vergnat7Tobias Kratz8Department of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiology, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, GermanySection of Pediatric Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiology, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Pediatric Cardiology, University Hospital Bonn, 53127 Bonn, Germany<b>Background</b>: Palliative surgery for the treatment of functionally univentricular heart malformations consists of a staged approach to separation of the pulmonary and systemic circulation, including the creation of a superior cavopulmonary connection. Literature on the superior cavopulmonary connection in porcine models lacks information on details of the procedure as well as data on its acute hemodynamic effects. In preliminary experiments, we were unable to reproduce an already published porcine model. Therefore, we used a conduit extension and cardiopulmonary bypass in order to achieve hemodynamic stability and still employ the commonly used straight downward pathway for the superior caval vein onto the right pulmonary artery, as in the human clinical setting. This model of a univentricular circulation utilising the superior cavopulmonary anastomosis is intended to be applied in the setting of unilateral diaphragmatic palsy. Hence, we aim to investigate the effect of unilateral diaphragmatic pacing in a reproducible model of univentricular physiology. <b>Methods</b>: Therefore, we constructed an anastomosis between the superior caval vein and the right pulmonary artery (RPA) in 14 pigs on cardiopulmonary bypass using a 12 mm expanded polytetrafluorethylene interposition graft. Six pigs received a bidirectional cavopulmonary connection with unrestricted atrial septal communication (BDCPC), while eight pigs received a unidirectional cavopulmonary connection (UDCPC) to the excluded RPA. <b>Results</b>: The BDCPC resulted in an impaired cardiopulmonary state (cardiac output dropped from 3.15 ± 0.21 to 2.17 ± 0.19 L/min; <i>p</i> < 0.01), mean arterial pressure plummeted (from 80.8 ± 3.7 to 49.3 ± 7.3 mmHg; <i>p</i> = 0.02), arterial lactate concentration rose (from 0.82 ± 0.09 to 4.36 ± 0.96 mmol/L; <i>p</i> = 0.01), arterial oxygen saturation dropped (from 95.8 ± 1.1 to 60.9 ± 10.4%; <i>p</i> < 0.01), and right ventricular function deteriorated (tricuspid annular plane systolic excursion decreased from 12 ± 0.7 to 5 ± 0.7 mm; <i>p</i> < 0.01). In contrast, in the UDCPC group, the cardiopulmonary parameters indicated a stable condition. <b>Conclusions:</b> Consequently, a UDCPC is a more suitable acute model in pigs for a univentricular circulation. The model’s reproducibility may aid in future research on partial cavopulmonary connection.https://www.mdpi.com/2227-9059/13/4/918Glennporcine modeluniventricular circulationcavopulmonary connectionbidirectional cavopulmonary connectionright ventricular failure |
| spellingShingle | Benjamin Bierbach Luca Pieterek Jan Dauvergne Carolin Scholl Christina Oetzmann von Sochaczewski Johannes Breuer Boulos Asfour Mathieu Vergnat Tobias Kratz Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model Biomedicines Glenn porcine model univentricular circulation cavopulmonary connection bidirectional cavopulmonary connection right ventricular failure |
| title | Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model |
| title_full | Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model |
| title_fullStr | Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model |
| title_full_unstemmed | Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model |
| title_short | Establishment and Hemodynamic Assessment of the Superior Cavopulmonary Anastomosis in a Reproducible Porcine Model |
| title_sort | establishment and hemodynamic assessment of the superior cavopulmonary anastomosis in a reproducible porcine model |
| topic | Glenn porcine model univentricular circulation cavopulmonary connection bidirectional cavopulmonary connection right ventricular failure |
| url | https://www.mdpi.com/2227-9059/13/4/918 |
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