Department of Pediatric Cardiac Surgery, Medical Faculty, Helmholtz Institute, RWTH Aachen University, Aachen, Germany.
Artif Organs. 2010 Nov;34(11):911-7. doi: 10.1111/j.1525-1594.2010.01146.x.
Cardiopulmonary bypass may cause severe inflammatory reactions and multiorgan failure, especially in premature and low-weight infants. This is due in part to the large area of contact with extrinsic surfaces and the essential addition of foreign blood. Thus, we developed a new miniaturized heart-lung machine (MiniHLM) with a total static priming volume of 102mL (including arterial and venous lines) and tested it in a small animal model. Seven Chinchilla Bastard rabbits were perfused with the MiniHLM (dynamic priming volume 127mL). Seven animals serving as a control were perfused using Dideco Kids and a Stöckert roller pump (modified dynamic priming volume 149mL). The rabbits were anesthetized and sternotomized, followed by cannulation of the aorta and the right atrium. The aorta was clamped for 1h. Blood for examination of inflammation (TNF-α, IL-1β, IL-6, IL-8, and IL-10) and blood gas analysis were taken before skin incision, 5min before opening of the aorta, 15min after opening of the aorta, and 4 h after the initiation of cardiopulmonary bypass. The parameters of inflammation were expressed by means of the comparative C(T) method (ΔΔC(T) method). After gradual reduction of perfusion with the HLM, the heart was decannulated, and the sternum was closed. All rabbits were successfully weaned from cardiopulmonary bypass. Blood gas analysis was unremarkable in all cases. Foreign blood was not administered. Although statistical significance was not achieved, there was a reduced expression of inflammatory markers in the MiniHLM group. The newly developed MiniHLM prototype was tested successfully in a small animal model in terms of technical function and expression of inflammation. Upcoming tests with the industrially manufactured MiniHLM may reveal the advantages of the MiniHLM in comparison with the conventional HLM.
体外循环可能会引起严重的炎症反应和多器官衰竭，尤其是在早产儿和低体重儿中。这部分是由于与外表面的大面积接触以及必须添加外来血液。因此，我们开发了一种新的小型化心肺机（MiniHLM），其总静态预充体积为 102mL（包括动脉和静脉管路），并在小动物模型中进行了测试。7 只奇努克杂种兔用 MiniHLM 进行灌注（动态预充体积 127mL）。7 只作为对照的动物使用 Dideco Kids 和 Stöckert 滚压泵（改良的动态预充体积 149mL）进行灌注。兔子被麻醉并开胸，随后进行主动脉和右心房插管。主动脉夹闭 1 小时。在皮肤切开前、主动脉开放前 5 分钟、主动脉开放后 15 分钟和体外循环开始后 4 小时采集血液以检查炎症（TNF-α、IL-1β、IL-6、IL-8 和 IL-10）和血气分析。炎症参数通过比较 C(T) 法（ΔΔC(T) 法）表示。随着心肺机的逐渐减少灌注，心脏被拔管，胸骨关闭。所有兔子均成功从体外循环中脱机。所有病例的血气分析均无异常。未输入异体血。虽然未达到统计学意义，但 MiniHLM 组的炎症标志物表达减少。新型 MiniHLM 原型在小动物模型中的技术功能和炎症表达方面均成功进行了测试。即将进行的具有工业制造的 MiniHLM 的测试可能会揭示与传统 HLM 相比 MiniHLM 的优势。
