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. 2013 Jun;145(6):1660-6.
doi: 10.1016/j.jtcvs.2013.01.020. Epub 2013 Feb 10.

Use of a low-resistance compliant thoracic artificial lung in the pulmonary artery to pulmonary artery configuration

Christopher N Scipione  1 , Rebecca E Schewe, Kelly L Koch, Andrew W Shaffer, Amit Iyengar, Keith E Cook
Affiliations

Use of a low-resistance compliant thoracic artificial lung in the pulmonary artery to pulmonary artery configuration

Christopher N Scipione et al. J Thorac Cardiovasc Surg. 2013 Jun.

Abstract

Background: Thoracic artificial lungs have been proposed as a bridge to transplant in patients with end-stage lung disease. Systemic embolic complications can occur after thoracic artificial lung attachment in the pulmonary artery to left atrium configuration. Therefore, we evaluated the function of a compliant thoracic artificial lung attached via the proximal pulmonary artery to distal main pulmonary artery configuration.

Methods: The compliant thoracic artificial lung was attached to 5 sheep (63 ± 0.9 kg) in the proximal pulmonary artery to distal main pulmonary artery configuration. Device function and animal hemodynamics were assessed at baseline and with approximately 60%, 75%, and 90% of cardiac output diverted to the compliant thoracic artificial lung. At each condition, dobutamine (0 and 5 μg·kg(-1)·min(-1)) was used to simulate rest and exercise conditions.

Results: At rest, cardiac output decreased from 6.20 ± 0.53 L/min at baseline to 5.40 ± 0.43, 4.66 ± 0.31, and 4.05 ± 0.27 L/min with 60%, 75%, and 90% of cardiac output to the compliant thoracic artificial lung, respectively (P < .01 for each flow diversion vs baseline). During exercise, cardiac output decreased from 7.85 ± 0.70 L/min at baseline to 7.46 ± 0.55, 6.93 ± 0.51, and 5.96 ± 0.44 L/min (P = .82, P = .19, and P < .01 with respect to baseline) with 60%, 75%, and 90% of cardiac output to the compliant thoracic artificial lung, respectively. The artificial lung resistance averaged 0.46 ± 0.02 and did not vary significantly with blood flow rate.

Conclusions: Use of a compliant thoracic artificial lung may be feasible in the proximal pulmonary artery to distal main pulmonary artery setting if its blood flow is held at less than 75% of cardiac output. To ensure a decrease in cardiac output of less than 10%, a blood flow rate less than 60% of cardiac output is advised.

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Conflict of interest statement

Disclosures/Conflicts of Interest: None

Figures

Figure 1
Figure 1
The compliant thoracic artificial lung (cTAL) demonstrating the blood and gas flow paths
Figure 2
Figure 2
Experimental pulmonary system setup with all resistive elements. The shunt includes the anastomoses (Ain and Aout), the cTAL and the flow occluder.
Figure 3
Figure 3
Cardiac output (a) and mean arterial pressure (b) versus the percentage of cardiac output shunted to the compliant artificial lung for dobutamine doses of 0 mcg/kg/min and 5 mcg/kg/min (BL=baseline).
Figure 4
Figure 4
Total pulmonary system resistance, RT, pulmonary vascular resistance, PVR, and shunt resistance, Rs, at varying percentages of cardiac output diverted to the compliant artificial lung for dobutamine doses of (a) 0 mcg/kg/min and (b) 5 mcg/kg/min.
Figure 5
Figure 5
Mean proximal pulmonary artery pressure versus the percentage of cardiac output shunted to the compliant artificial lung for dobutamine doses of 0 mcg/kg/min and 5 mcg/kg/min (BL=baseline).
See this image and copyright information in PMC

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