Ditmarsch M, Yilmaz E N, Vahl A C, van Genderingen H R, van Rij G l, Rauwerda J A
Institute of Cardiovascular Researchm Vrije University, Amsterdam, The Netherlands.
Cardiovasc Surg. 2003 Aug;11(4):287-93. doi: 10.1016/S0967-2109(03)00061-9.
To investigate the haemodynamic properties of a direct endovascular aortic shunt to maintain distal aortic perfusion as an alternative of a distal shunt (left-left-, Gott shunt) in thoracic aortic aneurysm repair.
A shunt was developed and tested in an in vitro model which should be capable of transporting a flow of 3-4 L/min with a decrease in blood pressure < 20 mmHg. Thereupon the shunt was tested in an in vivo experiment in six pigs to assess the possibility of its use with normal distal blood pressure. The shunt was inserted in the thoracic aorta and stayed in place for 1.5 h. Parameters were measured at six time intervals to assess organ perfusion, -function, cardiac output, proximal- and distal blood pressure and aortic- and shunt flow.
The mean blood flow through the shunt was 2.5 L/min. The difference of the mean blood pressure over the shunt was on average 14.20 mmHg. Parameters for coagulation disturbance and organ ischaemia were tested. The decrease in mean thrombocyte count was 299-158 (p<0.02). The venous lactate and the venous mesenteric lactate as parameters for intestinal ischemia did not increase significantly. No significant changes occurred in angiotensin II levels. Pulsatile flow was maintained but significantly suppressed (60%) distal from the shunt. The clamp time needed to insert the shunt and the venous mesenteric lactate, as well as the venous lactate, showed high correlation, r(s) = 0.9 (p<0.05) and r(s) = 0.94 (p<0.01). This also accounted for the 2nd clamp time, both r(s) = 0.95 (p<0.05).
The shunt is capable of transporting a blood flow of 2-4 L/min with an acceptable decrease in distal blood pressure. However, the time, needed to insert the shunt, was significantly associated with parameters of organ ischaemia.
研究一种直接血管内主动脉分流装置的血流动力学特性，以在胸主动脉瘤修复术中维持主动脉远端灌注，作为远端分流（左-左分流、戈特分流）的替代方法。
研发了一种分流装置，并在体外模型中进行测试，该装置应能够输送3-4升/分钟的血流量，同时血压下降<20毫米汞柱。随后，在六头猪身上进行体内实验，以评估在正常远端血压下使用该分流装置的可能性。将分流装置插入胸主动脉并保持在位1.5小时。在六个时间间隔测量参数，以评估器官灌注、功能、心输出量、近端和远端血压以及主动脉和分流血流量。
通过分流装置的平均血流量为2.5升/分钟。分流装置两端的平均血压差平均为14.20毫米汞柱。测试了凝血紊乱和器官缺血的参数。平均血小板计数从299降至158（p<0.02）。作为肠道缺血参数的静脉乳酸和肠系膜静脉乳酸没有显著增加。血管紧张素II水平没有显著变化。维持了脉动血流，但在分流装置远端显著受到抑制（60%）。插入分流装置所需的钳夹时间与肠系膜静脉乳酸以及静脉乳酸显示出高度相关性，r(s)=0.9（p<0.05）和r(s)=0.94（p<0.01）。这也适用于第二次钳夹时间，两者r(s)=0.95（p<0.05）。
该分流装置能够输送2-4升/分钟的血流量，同时远端血压下降可接受。然而，插入分流装置所需的时间与器官缺血参数显著相关。
