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当无法进行经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)时,对心肌进行选择性逆行静脉血管重建:在猪模型中的研究。

Selective retrograde venous revascularization of the myocardium when PCI or CABG is impossible: investigation in a porcine model.

作者信息

Møller Christian H, Nørgaard Martin A, Gøtze Jens P, Andersen Claus B, Olsen Niels V, Steinbrüchel Daniel A

机构信息

Departments of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.

出版信息

Heart Surg Forum. 2008;11(2):E99-104. doi: 10.1532/HSF98.20071219.

Abstract

We investigated the possibility of nourishing the myocardium through selective retrograde coronary venous bypass grafting (CVBG) with an off-pump technique and evaluated various methods of monitoring the physiological effects of this procedure. In a porcine model, the left internal mammary artery (LIMA) was anastomosed to the left anterior descending coronary vein (LAD vein) in an off-pump procedure. The LAD vein was ligated proximal to the anastomosis. The LAD artery was ligated proximally. The physiological effects were monitored using microdialysis, tissue oxygen tension, blood flow in LIMA, blood samples, and hemodynamic and histological analyses. As controls, 5 pigs underwent surgery involving only LAD artery ligation without CVBG. CVBG with LAD ligation was performed in 16 pigs; 12 survived CVBG and were monitored for 2-2.5 hours while in sinus rhythm, a 75% salvage rate after an otherwise lethal LAD artery occlusion. Immediately after LAD artery ligation, the anterior wall of the left ventricle became cyanotic and hypokinetic. Over time it regained color and contractility as flow in the LIMA increased. Microdialysis showed a significant increase in lactate. Initially tissue oxygen tension decreased, but with time some recovery was seen. Cardiac troponin T was elevated. Histological analysis showed ischemic changes. In control pigs, microdialysis was performed for 1.5 hours up to LAD artery ligation, after which all pigs died in ventricular fibrillation arrest. No increase in lactate was observed. These results indicate that after LAD artery occlusion, CVBG can nourish the myocardium to a certain extent and prevent death in the majority of cases, although varying degrees of ischemia remain.

摘要

我们研究了采用非体外循环技术通过选择性逆行冠状动脉静脉搭桥术(CVBG)滋养心肌的可能性,并评估了监测该手术生理效应的各种方法。在猪模型中,采用非体外循环技术将左乳内动脉(LIMA)吻合至左前降支冠状动脉静脉(LAD静脉)。在吻合口近端结扎LAD静脉。在近端结扎LAD动脉。使用微透析、组织氧张力、LIMA血流量、血样以及血流动力学和组织学分析来监测生理效应。作为对照,5头猪仅接受了LAD动脉结扎而未进行CVBG的手术。16头猪进行了LAD结扎的CVBG手术;12头在CVBG术后存活,并在窦性心律下监测2 - 2.5小时,在LAD动脉闭塞本应致死的情况下挽救率达75%。LAD动脉结扎后即刻,左心室前壁变青紫且运动减弱。随着LIMA血流量增加,其颜色和收缩力逐渐恢复。微透析显示乳酸显著增加。最初组织氧张力下降,但随着时间推移有所恢复。心肌肌钙蛋白T升高。组织学分析显示有缺血改变。在对照猪中,在LAD动脉结扎前进行了1.5小时的微透析,之后所有猪均死于心室颤动骤停。未观察到乳酸增加。这些结果表明,LAD动脉闭塞后,CVBG可在一定程度上滋养心肌并在大多数情况下预防死亡,尽管仍存在不同程度的缺血。

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