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肺动脉高压和右心衰竭绵羊模型的 7 天门诊机械循环支持。

Ambulatory 7-day mechanical circulatory support in sheep model of pulmonary hypertension and right heart failure.

机构信息

Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA.

Auburn University, Auburn, AL, USA.

出版信息

J Heart Lung Transplant. 2024 Feb;43(2):293-302. doi: 10.1016/j.healun.2023.10.017. Epub 2023 Oct 29.

DOI:10.1016/j.healun.2023.10.017
PMID:37907183
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10842834/
Abstract

BACKGROUND

Right heart failure is the major cause of death in pulmonary hypertension. Lung transplantation is the only long-term treatment option for patients who fail medical therapy. Due to the scarcity of donor lungs, there is a critical need to develop durable mechanical support for the failing right heart. A major design goal for durable support is to reduce the size and complexity of devices to facilitate ambulation. Toward this end, we sought to deploy wearable mechanical support technology in a sheep disease model of chronic right heart failure.

METHODS

In 6 sheep with chronic right heart failure, a mechanical support system consisting of an extracorporeal blood pump coupled with a gas exchange unit was attached in a right atrium-to-left atrium configuration for up to 7 days. Circuit performance, hematologic parameters, and animal hemodynamics were analyzed.

RESULTS

Six subjects underwent the chronic disease model for 56 to 71 days. Three of the subjects survived to the 7-day end-point for circulatory support. The circuit provided 2.8 (0.5) liter/min of flow compared to the native pulmonary blood flow of 3.5 (1.1) liter/min. The animals maintained physiologically balanced blood gas profile with a sweep flow of 1.2 (1.0) liter/min. Two animals freely ambulated while wearing the circuit.

CONCLUSIONS

Our novel mechanical support system provided physiologic support for a large animal model of pulmonary hypertension with right heart failure. The small footprint of the circuit and the low sweep requirement demonstrate the feasibility of this technology to enable mobile ambulatory applications.

摘要

背景

右心衰竭是肺动脉高压患者死亡的主要原因。肺移植是对药物治疗失败的患者唯一的长期治疗选择。由于供体肺的稀缺，迫切需要开发耐用的机械支持来治疗衰竭的右心。耐用支持的一个主要设计目标是减小设备的尺寸和复杂性，以方便移动。为此，我们试图在慢性右心衰竭的绵羊疾病模型中部署可穿戴机械支持技术。

方法

在 6 只患有慢性右心衰竭的绵羊中，一个由体外血液泵与气体交换单元组成的机械支持系统以右心房到左心房的构型连接，持续长达 7 天。分析了回路性能、血液参数和动物血液动力学。

结果

6 只动物接受慢性疾病模型治疗 56 至 71 天。其中 3 只动物存活至 7 天的循环支持终点。该回路提供了 2.8（0.5）升/分钟的流量，而原生肺血流量为 3.5（1.1）升/分钟。动物通过 1.2（1.0）升/分钟的扫流保持生理平衡的血气谱。两只动物在佩戴回路的同时自由行走。

结论

我们的新型机械支持系统为肺动脉高压伴右心衰竭的大型动物模型提供了生理支持。该回路的小占地面积和低扫流要求证明了这项技术的可行性，可实现移动可穿戴应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/66628b23aaec/nihms-1943642-f0007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/fec47f937ba2/nihms-1943642-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/91fc22598ab3/nihms-1943642-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/02fd2c1f0883/nihms-1943642-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/da8deb862916/nihms-1943642-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/4a4eb239ed1b/nihms-1943642-f0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/4bcce62f1fd2/nihms-1943642-f0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/66628b23aaec/nihms-1943642-f0007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/fec47f937ba2/nihms-1943642-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/91fc22598ab3/nihms-1943642-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/02fd2c1f0883/nihms-1943642-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/da8deb862916/nihms-1943642-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/4a4eb239ed1b/nihms-1943642-f0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/4bcce62f1fd2/nihms-1943642-f0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bdf/10842834/66628b23aaec/nihms-1943642-f0007.jpg

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