Brann S H, Thomas C N, Rose S S, Harper T, Chen D, Ezeokoli C, Cummings P, Daniel S
Cardiopulmonary Research Unit, Eric Williams Medical Sciences Complex, University of the West Indies, St Augustine, Trinidad and Tobago.
West Indian Med J. 2000 Dec;49(4):271-5.
We developed an open-chest porcine model of acute coronary occlusion and surgical reperfusion, and attempted to prevent intra-operative ischaemic ventricular fibrillation (VF) by a Retrograde Intracoronary Glyceryl trinitrate (RIG) infusion into the occluded vessel. Five Yorkshire pigs (weight 50 +/- 1.1 kg), randomized into 3 groups, underwent median sternotomy under general anaesthesia. One pig (Group 1, control) underwent sternotomy and pericardiotomy only. Four pigs underwent acute left anterior descending (LAD) coronary occlusion. Two pigs were not reperfused (Group 2). Two pigs underwent surgical reperfusion (Group 3) via left internal mammary artery (LIMA) grafting to the LAD using the Off-Pump Coronary Artery Bypass (OPCAB) technique. Ischaemic injury was assessed using 7-lead electrocardiography (ECG) and transthoracic/epimyocardial echocardiography (ECHO). Group 1: transient intraoperative hypotension and VF occurred. Successful resuscitation and 10-week survival (until sacrifice) with normal left ventricular (LV) function was achieved. Group 2: there were ECG and ECHO evidence of acute LV ischaemic dysfunction in both pigs. The surviving pig had persistent anterior hypokinesis at 8 1/2 months. The other died intra-operatively following progressive ischaemic LV dysfunction despite resuscitative attempts. Group 3: the surviving pig had normal LV function at 8 months. Initial anterior LV akinesis normalized within 7 days. The other developed post-occlusion haemodynamic instability and died intra-operatively despite reperfusion. In this porcine model, acute LAD artery occlusion modified by the novel RIG infusion technique, followed by surgical reperfusion (OPCAB) is feasible. This model would facilitate further development of OPCAB surgical expertise and understanding of the pathophysiology of ischaemia-reperfusion injury.
我们建立了一种急性冠状动脉闭塞和手术再灌注的开胸猪模型，并试图通过向闭塞血管逆行冠状动脉内输注硝酸甘油（RIG）来预防术中缺血性心室颤动（VF）。将5只约克夏猪（体重50±1.1千克）随机分为3组，在全身麻醉下进行正中胸骨切开术。1只猪（第1组，对照组）仅接受胸骨切开术和心包切开术。4只猪接受急性左前降支（LAD）冠状动脉闭塞。2只猪未进行再灌注（第2组）。2只猪通过非体外循环冠状动脉搭桥术（OPCAB）技术将左乳内动脉（LIMA）移植到LAD进行手术再灌注（第3组）。使用7导联心电图（ECG）和经胸/心外膜超声心动图（ECHO）评估缺血性损伤。第1组：术中出现短暂性低血压和VF。成功复苏并存活10周（直至处死），左心室（LV）功能正常。第2组：两只猪均有ECG和ECHO证据表明存在急性LV缺血性功能障碍。存活的猪在8个半月时持续存在前壁运动减弱。另一只猪尽管进行了复苏尝试，但在术中因进行性LV缺血性功能障碍死亡。第3组：存活的猪在8个月时LV功能正常。最初的LV前壁运动减弱在7天内恢复正常。另一只猪在闭塞后出现血流动力学不稳定，尽管进行了再灌注，但仍在术中死亡。在这种猪模型中，采用新型RIG输注技术改良的急性LAD动脉闭塞，随后进行手术再灌注（OPCAB）是可行的。该模型将有助于进一步发展OPCAB手术技术，并加深对缺血再灌注损伤病理生理学的理解。
