Johnson Matthew D, Tchouta Lise, Spencer Brianna L, Langley Mark W, Urrea Kristopher A, Toomasian John M, Niman Joseph B, Bartlett Robert H, Rojas-Peña Alvaro, Drake Daniel H
Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
Perfusion. 2025 Sep;40(6):1317-1324. doi: 10.1177/02676591241309824. Epub 2024 Dec 17.
Sternotomy is rarely performed for veterinary therapeutic or recovery models in quadrupeds because of difficulties with breathing, ambulation, and pain control. Central cannulation for cardiopulmonary bypass (CPB) is infrequent and typically performed through full thoracotomies. Experienced clinical surgeons and perfusionists should provide guidance for new therapeutic interventions and translational research. We sought to develop, validate, and detail a contemporary model for minimally-invasive central cannulation, CPB, and cardioplegic arrest. After induction of anesthesia and sterile preparation, a right second-interspace parasternal mini-thoracotomy was performed, the ascending aorta was cannulated using Seldinger technique, and a cardioplegia needle was placed. A dual-stage cannula was introduced through the right atrial appendage and CPB commenced. The aorta was clamped and Buckberg 4:1 induction cardioplegia was administered. Arrest was maintained for 30 minutes. CPB was discontinued after 2 hours and the great vessels were decannulated. Hemostasis was achieved and the wound was closed. Initial recovery was accomplished in intensive care with subsequent transfer to the vivarium. Ten consecutive Yorkshire swine (45 ± 5 kg) were minimally invasively placed on CPB including cardioplegic arrest using central cannulation through a right parasternal mini-thoracotomy. There was no operative or late mortality. Morbidity appeared minimal. Planned euthanasia and scheduled necropsy were performed to exclude clinically-occult major complications. None were identified. Following initial supervision, veterinary and resident surgeons completed the procedures autonomously with excellent results. The described protocols should facilitate safe veterinary cardiac surgical care and humane translational research.
由于四足动物在呼吸、行走和疼痛控制方面存在困难，胸骨切开术很少用于兽医治疗或恢复模型。体外循环（CPB）的中心插管不常见，通常通过全胸廓切开术进行。经验丰富的临床外科医生和灌注师应为新的治疗干预措施和转化研究提供指导。我们试图开发、验证并详细描述一种用于微创中心插管、CPB和心脏停搏的当代模型。在诱导麻醉和进行无菌准备后，进行右第二肋间胸骨旁小切口胸廓切开术，采用Seldinger技术对升主动脉进行插管，并放置一根心脏停搏针。通过右心耳插入双腔插管并开始CPB。夹闭主动脉并给予Buckberg 4:1诱导心脏停搏液。心脏停搏维持30分钟。2小时后停止CPB，拔除大血管插管。实现止血并关闭伤口。最初在重症监护室进行恢复，随后转移到动物饲养室。连续10只约克郡猪（45±5千克）通过右胸骨旁小切口胸廓切开术进行中心插管，包括心脏停搏，以微创方式置于CPB上。无手术或晚期死亡病例。发病率似乎很低。计划实施安乐死并安排尸检以排除临床隐匿的主要并发症。未发现任何并发症。在最初的监督之后，兽医和住院外科医生自主完成了手术，效果良好。所描述的方案应有助于安全的兽医心脏手术护理和人道的转化研究。
