Left ventricular assist via percutaneous transhepatic transseptal cannulation in swine.

Objective: To report the in vivo testing of transhepatic, transseptal cannula insertion to support the left ventricle.

Background: Percutaneous cannulation for circulatory assist poses particular challenges in pediatrics. We utilized a strategy using a transhepatic, transseptal venous cannula inserted into the left atrium, a centrifugal pump, and arterial cannula.

Methods: Yorkshire swine of 5-20 kg (n = 6) were anesthetized for the procedure. After hepatic venous angiography, percutaneous puncture of the hepatic vein was performed, followed by transseptal puncture with echocardiographic guidance. A 10-14 Fr 26-cm venous inflow cannula was placed in the left atrium via hepatic approach. The femoral artery was cannulated with a 6-10 Fr femoral cannula, and the circuit completed with the TandemHeart centrifugal pump.

Results: Implantation of the system utilizing the transhepatic approach was successful in all experiments. The pump delivered flows ranging from 0.8 to 1.4 L/min, which corresponded to 40-86% of the baseline systemic outputs. Decannulation and occlusion of the hepatic tract was successful utilizing transcatheter vascular occlusion plugs.

Conclusions: The transhepatic, transseptal insertion of the inflow cannula, coupled with the TandemHeart centrifugal pump and femoral arterial cannulation allows percutaneous circulatory support in 5- to 20-kg models.