Naito Noritsugu, Nishimura Takashi, Iizuka Kei, Fujii Yutaka, Takewa Yoshiaki, Umeki Akihide, Ando Masahiko, Ono Minoru, Tatsumi Eisuke
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Ann Thorac Surg. 2017 Nov;104(5):1488-1495. doi: 10.1016/j.athoracsur.2017.04.045. Epub 2017 Jul 12.
Femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to maintain blood flow in patients with cardiogenic shock. However, retrograde blood flow increases left ventricular (LV) afterload during femoral VA-ECMO. Additional support by means of an intraaortic balloon pump (IABP) alleviates LV afterload but is associated with significant adverse events. We previously developed a system for rotational speed modulation in synchrony with the native cardiac cycle, for use with implantable continuous-flow LV assist devices. Here, we aimed to evaluate whether our novel rotation speed modulation system can improve coronary artery flow and reduce LV during femoral VA-ECMO.
VA-ECMO was installed by means of right atrial drainage and distal abdominal aortic perfusion in six adult goats. Cardiogenic shock was induced with β-adrenergic antagonist infusion. An IABP was placed in the descending aorta. LV stroke work, LV end-systolic pressure, and coronary arterial flow were evaluated. Data were collected under five conditions (modes): baseline, circuit-clamp (cardiogenic shock), continuous mode (constant rotational speed), counterpulse mode (increasing rotational speed during diastole), and continuous mode with IABP support.
LV stroke work and LV end-systolic pressure tended to be lower in the counterpulse mode, indicating decreased LV work load and afterload in this mode. Furthermore, coronary arterial flow tended to be higher in the counterpulse mode.
Our system enabled an increase in coronary arterial flow and a decrease in LV work load and afterload during VA-ECMO. The system offers the effects of VA-ECMO and an IABP in a single device.
股静脉-动脉体外膜肺氧合（VA-ECMO）被广泛用于维持心源性休克患者的血流。然而，在股动脉-静脉体外膜肺氧合期间，逆向血流会增加左心室（LV）后负荷。通过主动脉内球囊泵（IABP）提供额外支持可减轻左心室后负荷，但会伴有严重不良事件。我们之前开发了一种与天然心动周期同步进行转速调制的系统，用于植入式连续流左心室辅助装置。在此，我们旨在评估我们的新型转速调制系统是否能在股动脉-静脉体外膜肺氧合期间改善冠状动脉血流并减轻左心室负荷。
通过右心房引流和腹主动脉远端灌注，在6只成年山羊身上安装VA-ECMO。通过输注β-肾上腺素能拮抗剂诱导心源性休克。将一个主动脉内球囊泵置于降主动脉。评估左心室每搏功、左心室收缩末期压力和冠状动脉血流。在五种情况下（模式）收集数据：基线、回路钳夹（心源性休克）、连续模式（恒定转速）、反搏模式（舒张期增加转速）以及主动脉内球囊泵支持下的连续模式。
反搏模式下左心室每搏功和左心室收缩末期压力往往较低，表明该模式下左心室工作负荷和后负荷降低。此外，反搏模式下冠状动脉血流往往较高。
我们的系统能够在VA-ECMO期间增加冠状动脉血流，并降低左心室工作负荷和后负荷。该系统在单一装置中兼具VA-ECMO和主动脉内球囊泵的效果。
