Clinical and experimental evaluation of left ventriculoiliac shunt bypass during repair of lesions of the descending thoracic aorta.

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.