Peterss Sven, Guenther Sabina, Kellermann Kristina, Jungwirth Bettina, Lichtinghagen Ralf, Haverich Axel, Hagl Christian, Khaladj Nawid
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):561-6. doi: 10.1093/icvts/ivu187. Epub 2014 Jul 1.
Different revascularization strategies for patients with acute myocardial infarction (AMI) exist. It remains unclear whether ventricular unloading using cardiopulmonary bypass (CPB) or extracorporeal life support (ECLS) has an impact on early postischaemic ventricular function. Here, we report on the results of an approach using a miniaturized CPB in a well-established animal model of AMI.
In a randomized fashion, 30 male Wistar rats were assigned to temporary left anterior descending (LAD) ligation (30 min) followed by 180 min of reperfusion either with or without 60 min of CPB (70 ml/min, 36°C). The CPB circuit consisted of a venous reservoir, a peristaltic roller pump and a membrane oxygenator with heat exchanger. Cardiac function was measured at 60 and 120 min after reperfusion (F60, F120) using a conductance catheter.
The mortality rate was 37% (11/30). Thus, 19 animals could be included into the analysis (8 CPB). The mean cardiac output did not differ between the groups at F60 [63 ± 29 vs 54 ± 25 ml/min (CPB), P = 0.56] and F120 [73 ± 27 vs 53 ± 24 ml/min (CPB), P = 0.21]. During reperfusion, the mean left ventricular ejection fraction (LVEF) was stable in both the control (F60 37 ± 5% vs F120 33 ± 8%, P = 0.42) and the CPB groups (F60 52 ± 11% vs F120 51 ± 13%, P = 0.71). CPB animals had a significantly better LVEF after reperfusion (F60 P = 0.007, F120 P = 0.01).
In this animal model of AMI, the establishment of CPB resulted in a significantly better LVEF in comparison with conventional reperfusion only. This beneficial effect may have an impact on revascularization strategies and timing in patients presenting with AMI in the future.
急性心肌梗死（AMI）患者存在不同的血运重建策略。目前尚不清楚使用体外循环（CPB）或体外生命支持（ECLS）进行心室减负是否会对缺血后早期心室功能产生影响。在此，我们报告在一个成熟的AMI动物模型中使用小型化CPB的方法的结果。
以随机方式将30只雄性Wistar大鼠分配至临时左前降支（LAD）结扎（30分钟），然后在有或无60分钟CPB（70毫升/分钟，36°C）的情况下进行180分钟的再灌注。CPB回路由一个静脉储液器、一个蠕动泵和一个带有热交换器的膜式氧合器组成。使用电导导管在再灌注后60分钟和120分钟（F60、F120）测量心脏功能。
死亡率为37%（11/30）。因此，19只动物可纳入分析（8只接受CPB）。两组在F60时的心输出量均值无差异[63±29对54±25毫升/分钟（CPB），P = 0.56]，在F120时也无差异[73±27对53±24毫升/分钟（CPB），P = 0.21]。在再灌注期间，对照组（F60 37±5%对F120 33±8%，P = 0.42）和CPB组（F60 52±11%对F120 51±13%，P = 0.71）的平均左心室射血分数（LVEF）均保持稳定。CPB组动物再灌注后的LVEF明显更好（F60 P = 0.007，F120 P = 0.01）。
在这个AMI动物模型中，与仅进行传统再灌注相比，建立CPB可使LVEF明显更好。这种有益效果可能会对未来AMI患者的血运重建策略和时机产生影响。
