Marinakis Sotirios, Niclauss Lars, Rolf Tanina, von Segesser Ludwig Karl
Department of Cardiovascular Surgery, CHUV, Lausanne, Switzerland.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):574-7. doi: 10.1093/icvts/ivs242. Epub 2012 Jul 9.
OBJECTIVES In extreme scenarios, such as hyperacute rejection of heart transplant, an urgent heart explantation might be necessary. The aim of this experimental study was to determine the feasibility and to improve the haemodynamics of a venoarterial cardiopulmonary bypass after cardiectomy. METHODS A venoarterial cardiopulmonary bypass was established in seven calves (56.4 ± 7 kg) by the transjugular insertion to the caval axis of a self-expanding cannula, with a carotid artery return. After baseline measurements (A), ventricular fibrillation was induced (B), great arteries were clamped (C), the heart was excised and the right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect over the cannula in the caval axis (D). Measurements were taken with the pulmonary artery clamped and declamped. RESULTS Initial pump flow was 4.16 ± 0.75 l/min dropping to 2.9 ± 0.63 l/min (P(AB )< 0.001) 10 min after induction of ventricular fibrillation. After cardiectomy with the pulmonary artery clamped, the pump flow increased non-significantly to 3.20 ± 0.78 l/min. After declamping, the flow significantly increased close to baseline levels (3.61 ± 0.73 l/min, P(DB )= 0.009, P(DC )= 0.017), supporting the notion that full cardiopulmonary bypass in acardia is feasible only if adequate drainage of pulmonary circulation is assured to avoid pulmonary congestion and loss of volume from the left-to-right shunt of bronchial vessels.
目的 在极端情况下，如心脏移植的超急性排斥反应，可能需要紧急心脏切除。本实验研究的目的是确定在心脏切除术后建立静脉 - 动脉体外循环的可行性，并改善其血流动力学。方法 通过经颈静脉将自膨胀插管插入腔静脉轴并经颈动脉回流，在7头小牛（56.4±7千克）中建立静脉 - 动脉体外循环。在进行基线测量（A）后，诱发心室颤动（B），钳夹大动脉（C），切除心脏，并将包含肺静脉的左右心房残余部分缝合在一起，在腔静脉轴上的插管上方留下房间隔缺损（D）。在肺动脉钳夹和松开时进行测量。结果 心室颤动诱发后10分钟，初始泵流量为4.16±0.75升/分钟，降至2.9±0.63升/分钟（P（AB）<0.001）。在钳夹肺动脉进行心脏切除术后，泵流量无显著增加，达到3.20±0.78升/分钟。松开后，流量显著增加，接近基线水平（3.61±0.73升/分钟，P（DB）=0.009，P（DC）=0.017），这支持了以下观点：只有确保肺循环有足够的引流以避免肺充血和支气管血管左向右分流导致的容量损失，无心心脏的完全体外循环才是可行的。
