Spillner Jan, Stoppe Christian, Hatam Nima, Amerini Andrea, Menon Ares, Nix Christoph, Steinseifer Ulrich, Abusabha Yousef, Giessen Hanna, Autschbach Rüdiger, Haushofer Marcus
Department for Cardiothoracic- and Vascular Surgery, University Hospital RWTH Aachen, Pauwelsstr, 30, D-52074 Aachen.
J Cardiothorac Surg. 2012 Feb 6;7:15. doi: 10.1186/1749-8090-7-15.
Right ventricular failure (RVF) and -support is associated with poor results. We aimed for a new approach of right - sided assistance bypassing the right ventricle and pulmonary circulation in order to better decompress the right ventricle and optimize left ventricular filling.
From a microaxial pump (Abiomed), a low resistance oxygenator (Maquet and Novalung) and two cannulas (28 and 27 Fr) a system was set up and evaluated in an ovine model (n = 7). Connection with the heart was the right and left atrium. One hour the system was operated without RVF and turned of again. Then a RVF was induced and the course with the system running was evaluated. Complete hemodynamic monitoring was performed as well as echocardiography, flow measurement and blood gas analysis.
The overall performance of the system was reliable. Without RVF no relevant changes of hemodynamics occurred; blood gases were supra normal. In RVF a cardiogenic shock developed (MAP 35 ± 13 mmHg, CO 1,1 ± 0,7 l/min). Immediately after starting the system the circulation normalized (significant increase of MAP to 85 ± 13 mmHg, of CO to 4,5 ± 1,9). Echocardiography also revealed right ventricular recovery. After stopping the system, RVF returned.
Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed.
右心室衰竭（RVF）及支持治疗效果不佳。我们旨在采用一种绕过右心室和肺循环的右侧辅助新方法，以便更好地减轻右心室压力并优化左心室充盈。
利用一台微型轴流泵（Abiomed）、一个低阻力氧合器（Maquet和Novalung）以及两根插管（28和27 Fr）建立了一个系统，并在绵羊模型（n = 7）中进行评估。与心脏的连接部位是右心房和左心房。该系统在无右心室衰竭的情况下运行1小时，然后关闭。接着诱发右心室衰竭，并评估系统运行时的情况。进行了全面的血流动力学监测以及超声心动图、流量测量和血气分析。
该系统的整体性能可靠。在无右心室衰竭时，血流动力学无相关变化；血气指标高于正常水平。在右心室衰竭时，发生了心源性休克（平均动脉压35±13 mmHg，心输出量1.1±0.7升/分钟）。启动系统后，循环立即恢复正常（平均动脉压显著升至85±13 mmHg，心输出量升至4.5±1.9）。超声心动图也显示右心室恢复。停止系统后，右心室衰竭又复发。
使用一种氧合辅助装置绕过右心室和肺循环，可能具有增强右心室减压和增加左心房充盈的优势，在治疗急性右心室衰竭方面是可行且有效的。还需要进行长时间实验。
