Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif 94305, USA.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1460-4. doi: 10.1016/j.jtcvs.2012.08.014. Epub 2012 Aug 31.
Fetal cardiac surgery is a potential innovative treatment for certain congenital heart defects that have significant mortality and morbidity in utero or after birth, but it has been limited by placental dysfunction after fetal cardiac bypass. We have used the TinyPump device for fetal cardiac bypass in sheep fetuses at 90 to 110 days gestation.
Ten mixed-breed pregnant ewes were used over a period of 6 months, and 10 fetuses were placed on bypass for 30 minutes. Five fetuses with a mean gestational age of 104 ± 4.5 days and mean weight of 1.4 ± 0.4 kg were placed on bypass using the TinyPump device, and 5 fetuses with a mean gestational age of 119 ± 4.5 days and mean weight of 3.4 ± 0.4 kg were placed on bypass using the roller head pump. The fetuses were monitored for up to 3 hours after bypass or until earlier demise.
Progressive respiratory and metabolic acidosis developed in all fetuses. The TinyPump group had a lower gestational age and weight compared with the roller head pump group. However, the rate of postbypass deterioration in the TinyPump group, as measured with blood gases, was noted to be significantly slower compared with the roller head pump group.
We demonstrate the feasibility of the TinyPump device for fetal cardiac bypass in a fetal sheep model. The TinyPump group showed improved results compared with the roller head group despite more immature fetuses. The TinyPump device seems to be a promising device for future studies of fetal cardiac bypass in immature fetal sheep and in primates.
胎儿心脏手术是一种有潜力的创新性治疗方法，适用于某些在子宫内或出生后具有高死亡率和发病率的先天性心脏缺陷，但它受到胎儿心脏旁路后胎盘功能障碍的限制。我们已经在 90 至 110 天妊娠的绵羊胎儿中使用 TinyPump 装置进行胎儿心脏旁路。
在 6 个月的时间内使用了 10 只杂种怀孕母羊，并对 10 只胎儿进行了 30 分钟的旁路处理。5 只胎儿的平均胎龄为 104 ± 4.5 天，平均体重为 1.4 ± 0.4kg，使用 TinyPump 装置进行旁路处理，5 只胎儿的平均胎龄为 119 ± 4.5 天，平均体重为 3.4 ± 0.4kg，使用滚子头泵进行旁路处理。在旁路处理后，对胎儿进行了长达 3 小时的监测，或直到更早的死亡。
所有胎儿均出现进行性呼吸和代谢性酸中毒。与滚子头泵组相比，TinyPump 组的胎龄和体重较低。然而，与滚子头泵组相比，TinyPump 组的旁路后恶化速度明显较慢，这可以通过血气来衡量。
我们在绵羊胎儿模型中证明了 TinyPump 装置用于胎儿心脏旁路的可行性。尽管胎儿更不成熟，但 TinyPump 组的结果优于滚子头组。TinyPump 装置似乎是未来对不成熟胎儿和灵长类动物进行胎儿心脏旁路研究的有前途的装置。
