Department of Vascular Medicine, University Heart Center Hamburg, Germany.
J Endovasc Ther. 2012 Oct;19(5):679-88. doi: 10.1583/JEVT-12-3899R.1.
To evaluate the hemodynamic impact of transseptal sheath access to the ascending aorta using increasing sheath diameters.
Transseptal puncture was performed in 6 pigs (62±9 kg) facilitating guidewire passage across the left heart to the descending aorta to establish transseptal through-and-through access into the ascending aorta. Hemodynamic parameters were evaluated during 6- to 16-F sheath deployments and after sheath retraction according to a standardized protocol. Fluorescent microspheres were injected for quantitative assessment of myocardial and cerebral perfusion and left-right shunting volume.
Cardiac output, heart rate, and central venous pressure (CVP) were stable throughout the study in all animals. The ratio between pulmonary artery pressure and mean arterial pressure was significantly higher during sheath deployment compared to after retraction (p<0.01), indicating transient mitral valve insufficiency. The ratio between left atrial pressure and CVP was significantly higher with the sheath in place (p<0.01), signaling transient left-right shunting; the hemodynamic alteration disappeared after sheath retraction. Myocardial perfusion (p=0.224), cerebral perfusion (p=0.209), and left-right shunting volume (p=0.111) were not significantly affected by the transseptal access.
Transseptal access to the ascending aorta in a porcine model is feasible without persisting hemodynamic impairment or severe influence on myocardial or cerebral perfusion even with up to 16-F sheaths. Potential adverse effects need to be addressed before clinical use of this alternative access to the ascending aorta, aortic arch, and its side branches.
评估使用逐渐增大的鞘管直径经房间隔穿刺进入升主动脉对血流动力学的影响。
在 6 头（62±9kg）猪中进行经房间隔穿刺，以引导导丝穿过左心进入降主动脉，从而建立经房间隔贯穿性穿刺进入升主动脉的通道。根据标准化方案，在 6-16F 鞘管扩张和鞘管回缩期间评估血流动力学参数。注射荧光微球进行心肌和脑灌注及左右分流体积的定量评估。
所有动物在整个研究过程中心输出量、心率和中心静脉压（CVP）均保持稳定。与回缩后相比，鞘管扩张期间肺动脉压与平均动脉压的比值显著升高（p<0.01），表明存在短暂性二尖瓣关闭不全。鞘管在位时左心房压与 CVP 的比值显著升高（p<0.01），提示存在短暂性左右分流；鞘管回缩后这种血流动力学改变消失。心肌灌注（p=0.224）、脑灌注（p=0.209）和左右分流体积（p=0.111）不受经房间隔穿刺的影响。
在猪模型中，经房间隔穿刺进入升主动脉是可行的，不会导致持续的血流动力学损害，也不会对心肌或脑灌注产生严重影响，即使使用最大 16F 鞘管也是如此。在将这种替代升主动脉、主动脉弓及其分支的进入途径用于临床之前，需要解决潜在的不良影响。
