Kitamura Masaya, Hanzawa Kazuhiko, Takekubo Masaru, Aoki Kenji, Hayashi Jun-ichi
Division of Thoracic and Cardiovascular Surgery, Department of Cardiovascular and Vital Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Artif Organs. 2004 Mar;28(3):298-302. doi: 10.1111/j.1525-1594.2004.47036.x.
Left ventricular unloading and energy charge as effects of transaortic catheter venting (TACV) during venoarterial bypass (VAB) in normal and failing hearts has been reported previously. The aim of this study was to assess the effectiveness and safety of a special multipurpose catheter for TACV during percutaneous cardiopulmonary support (PCPS) in a preclinical setting. Six adult pigs underwent PCPS with or without the TACV. With standard hemodynamic monitoring, LV volume and function were assessed by direct ultrasonic cardiography (UCG) in each condition. PCPS was smoothly established and the TACV catheter was safely introduced in all cases. As compared with isolated PCPS, the TACV combined with PCPS maintained significant blood flow with LV venting and systemic perfusion: the heart rate of the native heart, systemic arterial pressure, and central venous pressure were stable. Also the additional TACV led to a significant reduction of LV preload during PCPS, and the reduction was 25-30% of LVDd and 20-35% of LVAd. The results of this investigation suggest that clinical application of the TACV technique with a clinical PCPS circuit would be feasible and additional TACV might be use-ful for LV recovery during PCPS in patients with severe heart failure.
先前已有报道，在正常心脏和衰竭心脏的静脉 - 动脉体外循环（VAB）期间，经主动脉导管排气（TACV）对左心室卸载和能量代谢的影响。本研究的目的是在临床前环境中评估一种用于经皮心肺支持（PCPS）期间TACV的特殊多功能导管的有效性和安全性。六只成年猪接受了有或没有TACV的PCPS。通过标准血流动力学监测，在每种情况下通过直接超声心动图（UCG）评估左心室容积和功能。所有病例均顺利建立PCPS并安全插入TACV导管。与单纯PCPS相比，TACV联合PCPS在左心室排气和全身灌注时维持了显著的血流：心脏自身的心率、体动脉压和中心静脉压均稳定。此外，额外的TACV导致PCPS期间左心室前负荷显著降低，左心室舒张末期内径（LVDd）降低25 - 30%，左心室舒张末期面积（LVAd）降低20 - 35%。本研究结果表明，将TACV技术应用于临床PCPS回路是可行的，额外的TACV可能有助于严重心力衰竭患者在PCPS期间左心室功能的恢复。
