Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Heart Lung Transplant. 2012 Nov;31(11):1223-9. doi: 10.1016/j.healun.2012.08.008. Epub 2012 Sep 12.
This study investigated the use of 2 Synergy Micro-Pumps for full biventricular assist device (BiVAD) support. We examined right-sided and left-sided hemodynamic parameters over a range of right-sided and left-sided pump speeds in an acute, fibrillating, non-beating-heart model in sheep.
Five juvenile sheep (43 ± 2 kg) were implanted with two Synergy Micro-Pumps (CircuLite Inc, Saddle Brook, NJ), 1 in the right (RV) and 1 in the left ventricle (LV), through a median sternotomy. The RVAD outflow graft was anastomosed end-to-side to the pulmonary artery and the LVAD outflow to the ascending aorta. After surgical implantation of both pumps, ventricular fibrillation was induced and hemodynamic parameters were measured at 9 different levels of RVAD pump speed (from 20,000 to 28,000 rpm at 1,000-rpm increments), while the speed of the LVAD was set constant at 24,000, then at 26,000, and finally, at 28,000 rpm.
At a fixed LVAD speed, RVAD and LVAD flow both increased identically as RVAD speed was increased. This was due to redistribution of blood volumes that resulted in resetting of pressure gradients across each pump and each vascular bed in a manner dictated by the pump pressure-flow characteristics. Results were similar with LVAD set at 24,000, 26,000, or 28,000 rpm. At the highest LVAD and RVAD speeds, flow averaged 3.1 ± 0.7 liters/min, and pressures in the right atrium, pulmonary artery, left atrium, and aorta averaged 2.2 ± 3.7, 24.4 ± 6.5, 22.4 ± 5.5, and 56.6 ± 8.5 mm Hg, respectively.
BiVAD support with the 2 Synergy Micro-Pumps is feasible and able to provide full hemodynamic support in sheep. This approach holds promise for providing biventricular partial support in humans and, in particular, for full support in small adults and children.
本研究旨在探讨使用 2 个 Synergy Micro-Pumps 实现全心辅助(BiVAD)。我们在绵羊的急性、颤动、非搏动心脏模型中,研究了不同右侧和左侧泵速下右侧和左侧血流动力学参数的变化。
5 只幼羊(43±2kg)通过正中开胸术植入 2 个 Synergy Micro-Pumps(CircuLite Inc,Saddle Brook,NJ),1 个在右心室(RV),1 个在左心室(LV)。RVAD 流出移植物端侧吻合于肺动脉,LVAD 流出吻合于升主动脉。在双泵植入手术后,诱发心室颤动,并在 9 个不同的 RVAD 泵速水平(以 1000rpm 的增量从 20000 到 28000rpm)下测量血流动力学参数,同时将 LVAD 速度设置为 24000rpm,然后是 26000rpm,最后是 28000rpm。
在固定的 LVAD 速度下,随着 RVAD 速度的增加,RVAD 和 LVAD 流量均相同地增加。这是由于血液体积的重新分布导致每个泵和每个血管床的压力梯度重置,方式由泵压流量特性决定。当 LVAD 设置为 24000、26000 或 28000rpm 时,结果相似。在最高的 LVAD 和 RVAD 速度下,平均流量为 3.1±0.7 升/分,右心房、肺动脉、左心房和主动脉的压力平均为 2.2±3.7、24.4±6.5、22.4±5.5 和 56.6±8.5mmHg。
使用 2 个 Synergy Micro-Pumps 进行全心辅助是可行的,能够为绵羊提供充分的血流动力学支持。这种方法有望为人类提供双心室部分支持,特别是为小成人和儿童提供完全支持。