Bolotin Gil, van der Veen Frederik H, Lorusso Roberto, Wolf Tamir, Sachner Robert, Shofti Rona, Shreuder Jan J, Uretzky Gideon
The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Israel.
Eur J Cardiothorac Surg. 2002 Jun;21(6):975-80. doi: 10.1016/s1010-7940(02)00051-9.
Descending and ascending aortomyoplasty are two surgical procedures intended to induce hemodynamic benefits similar to those of the intra-aortic-balloon-pump (IABP). To date, there have been no studies comparing the two surgical techniques. The objective of this study was to compare coronary blood flow augmentation and afterload reduction as produced by descending and ascending aortomyoplasty counterpulsation
Twenty-two mongrel dogs (18-35 kg) underwent IABP application (n=7), descending (n=8), or ascending (n=7) aortomyoplasty. Left anterior descending (LAD) coronary artery blood flow was measured using a Transonic Doppler flow probe. Left ventricular pressure as well as aortic pressures proximal and distal to either the aortomyoplasty site or the IABP position were monitored continuously.
Descending aortomyoplasty induced higher elevation in the LAD blood flow during assisted beats (27% from 10.8+/-4 to 13.8+/-6 ml/min, P<0.001) than that induced by either ascending aortomyoplasty (19% from 11.7+/-5 to 14+/-5 ml/min, P<0.001) or IABP counterpulsation (18% from 8.6+/-3 to 10.2+/-4 ml/min, P<0.001). Conversely, while ascending aortomyoplasty reduced the left ventricular end-diastolic pressure by 16% (from 60+/-18 to 50+/-22 mmHg, P<0.001), similar to the 16% after load reduction achieved by the IABP counterpulsation, descending aortomyoplasty failed to induce afterload reduction.
Descending aortomyoplasty produces higher coronary blood flow augmentation than either ascending aortomyoplasty or IABP. However, afterload reduction comparable to that achieved by IABP was observed only with ascending aortomyoplasty and not with descending aortomyoplasty.
降主动脉成形术和升主动脉成形术是两种旨在产生与主动脉内球囊泵（IABP）类似血流动力学益处的外科手术。迄今为止，尚无比较这两种外科技术的研究。本研究的目的是比较降主动脉成形术和升主动脉成形术反搏所产生的冠状动脉血流增加和后负荷降低情况。
22只杂种犬（18 - 35千克）接受了IABP应用（n = 7）、降主动脉成形术（n = 8）或升主动脉成形术（n = 7）。使用Transonic多普勒血流探头测量左前降支（LAD）冠状动脉血流。连续监测左心室压力以及主动脉成形术部位或IABP位置近端和远端的主动脉压力。
在辅助搏动期间，降主动脉成形术使LAD血流升高幅度更高（从10.8±4增加到13.8±6毫升/分钟，增加27%，P < 0.001），高于升主动脉成形术（从11.7±5增加到14±5毫升/分钟，增加19%，P < 0.001）或IABP反搏（从8.6±3增加到10.2±4毫升/分钟，增加18%，P < 0.001）。相反，升主动脉成形术使左心室舒张末期压力降低了16%（从60±18降至50±22毫米汞柱，P < 0.001），与IABP反搏实现的16%后负荷降低相似，而降主动脉成形术未能降低后负荷。
降主动脉成形术比升主动脉成形术或IABP产生更高的冠状动脉血流增加。然而，仅升主动脉成形术观察到与IABP相当的后负荷降低，而降主动脉成形术未观察到。
