Department of Surgery, University of Michigan Health System, Extracorporeal Life Support Laboratory, Ann Arbor, Michigan.
Michigan Critical Care Consultants, Inc, Ann Arbor, Michigan.
Ann Thorac Surg. 2014 Jul;98(1):97-102. doi: 10.1016/j.athoracsur.2014.04.027. Epub 2014 May 22.
Centrifugal pumps are used increasingly for temporary mechanical support for the treatment of cardiogenic shock. However, centrifugal pumps can generate excessive negative pressure and are afterload sensitive. A previously developed modified roller pump mitigates these limitations both in vitro and in preliminary animal experiments. We report the results of intermediate-term testing of our evolving pump technology, known as the BioVAD.
The BioVAD was implanted in 6 adult male sheep (62.5±3.9 kg), with drainage from the left atrium and reinfusion into the descending aorta. The sheep were monitored for 5 days. Heparin was given during the initial implantation, but no additional anticoagulants were given. Data collected included hemodynamic status, pump flow and pressures, laboratory values to monitor end-organ function and hemolysis, pathologic specimens to evaluate for thromboembolic events and organ ischemia, and explanted pump evaluation results.
All animals survived the planned experimental duration and there were no pump malfunctions. Mean BioVAD flow was 3.57±0.30 L/min (57.1 mL/kg/min) and mean inlet pressure was -30.51±4.25 mm Hg. Laboratory values, including plasma free hemoglobin, creatinine, lactate, and bilirubin levels, remained normal. Three animals had small renal cortical infarcts, but there were no additional thromboembolic events or other abnormalities seen on pathologic examination. No thrombus was identified in the BioVAD blood flow path.
The BioVAD performed well for 5 days in this animal model of temporary left ventricular assistance. Its potential advantages over centrifugal pumps may make it applicable for short-term mechanical circulatory support.
离心泵越来越多地用于治疗心源性休克的临时机械支持。然而,离心泵可能会产生过大的负压,并且对后负荷敏感。先前开发的改良滚柱泵在体外和初步动物实验中均减轻了这些限制。我们报告了我们不断发展的泵技术,即 BioVAD 的中期测试结果。
BioVAD 被植入 6 只成年雄性绵羊(62.5±3.9 千克),从左心房引流并重新注入降主动脉。对绵羊进行了 5 天的监测。在初始植入过程中给予肝素,但未给予其他抗凝剂。收集的数据包括血流动力学状态、泵流量和压力、实验室值以监测终末器官功能和溶血、病理标本以评估血栓栓塞事件和器官缺血以及体外泵评估结果。
所有动物均在计划的实验期间存活,且没有泵故障。平均 BioVAD 流量为 3.57±0.30 L/min(57.1 mL/kg/min),平均入口压力为-30.51±4.25 mm Hg。实验室值,包括血浆游离血红蛋白、肌酐、乳酸和胆红素水平,均保持正常。3 只动物有小的肾皮质梗死,但在病理检查中没有发现其他血栓栓塞事件或其他异常。在 BioVAD 血流路径中未发现血栓。
在这个临时左心室辅助的动物模型中,BioVAD 在 5 天内表现良好。与离心泵相比,它具有潜在的优势,可能适用于短期机械循环支持。