From the Mechanics and High Performance Computing Group, Technical University of Munich, Garching, Germany.
Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm, Ulm, Germany.
ASAIO J. 2018 Jul/Aug;64(4):480-488. doi: 10.1097/MAT.0000000000000686.
For treatment of advanced heart failure, current strategies include cardiac transplantation or blood-contacting pump technology associated with complications, including stroke and bleeding. This study investigated an individualized biventricular epicardial augmentation technology in a drug-induced porcine failing heart model. A total of 11 pigs were used, for the assessment of hemodynamics and cardiac function under various conditions of support pressures and support durations (n = 4), to assess device positioning and function by in vivo computer tomographic imaging (n = 3) and to investigate a minimally invasive implantation on the beating heart (n = 4). Support pressures of 20-80 mm Hg gradually augmented cardiac function parameters in this animal model as indicated by increased left ventricular stroke volume, end-systolic pressures, and decreased end-diastolic pressures. Strong evidence was found regarding the necessity of mechanical synchronization of support end with the isovolumetric relaxation phase of the heart. In addition, the customized, self-expandable implant enabled a marker-guided minimally invasive implantation through a 4 cm skin incision using fluoroscopy. Correct positioning was confirmed in computer tomographic images. Continued long-term survival investigations will deliver preclinical evidence for further development of this concept.
对于晚期心力衰竭的治疗，目前的策略包括心脏移植或与并发症相关的血接触泵技术，包括中风和出血。本研究在药物诱导的猪衰竭心脏模型中研究了一种个体化的双心室心外膜增强技术。总共使用了 11 头猪，以评估在不同的支撑压力和支撑时间条件下的血流动力学和心功能（n = 4），通过体内计算机断层扫描成像评估设备定位和功能（n = 3），并研究在跳动心脏上进行微创植入（n = 4）。随着支撑压力从 20-80mmHg 的逐渐增加，该动物模型的心脏功能参数逐渐增加，表现为左心室每搏量增加、收缩末期压力增加和舒张末期压力降低。有力的证据表明，支撑的机械同步性与心脏等容松弛阶段的同步性是必要的。此外，定制的自扩张植入物使我们能够通过透视引导使用 4cm 的皮肤切口进行标记引导的微创植入。在计算机断层扫描图像中确认了正确的定位。持续的长期生存研究将为这一概念的进一步发展提供临床前证据。
