Bierbach Benjamin, Pieterek Luca, Dauvergne Jan, Scholl Carolin, Oetzmann von Sochaczewski Christina, Breuer Johannes, Asfour Boulos, Vergnat Mathieu, Kratz Tobias
Department of Pediatric Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany.
Department of Pediatric Cardiology, University Hospital Bonn, 53127 Bonn, Germany.
Biomedicines. 2025 Apr 9;13(4):918. doi: 10.3390/biomedicines13040918.
: Palliative surgery for the treatment of functionally univentricular heart malformations consists of a staged approach to separation of the pulmonary and systemic circulation, including the creation of a superior cavopulmonary connection. Literature on the superior cavopulmonary connection in porcine models lacks information on details of the procedure as well as data on its acute hemodynamic effects. In preliminary experiments, we were unable to reproduce an already published porcine model. Therefore, we used a conduit extension and cardiopulmonary bypass in order to achieve hemodynamic stability and still employ the commonly used straight downward pathway for the superior caval vein onto the right pulmonary artery, as in the human clinical setting. This model of a univentricular circulation utilising the superior cavopulmonary anastomosis is intended to be applied in the setting of unilateral diaphragmatic palsy. Hence, we aim to investigate the effect of unilateral diaphragmatic pacing in a reproducible model of univentricular physiology. : Therefore, we constructed an anastomosis between the superior caval vein and the right pulmonary artery (RPA) in 14 pigs on cardiopulmonary bypass using a 12 mm expanded polytetrafluorethylene interposition graft. Six pigs received a bidirectional cavopulmonary connection with unrestricted atrial septal communication (BDCPC), while eight pigs received a unidirectional cavopulmonary connection (UDCPC) to the excluded RPA. : The BDCPC resulted in an impaired cardiopulmonary state (cardiac output dropped from 3.15 ± 0.21 to 2.17 ± 0.19 L/min; < 0.01), mean arterial pressure plummeted (from 80.8 ± 3.7 to 49.3 ± 7.3 mmHg; = 0.02), arterial lactate concentration rose (from 0.82 ± 0.09 to 4.36 ± 0.96 mmol/L; = 0.01), arterial oxygen saturation dropped (from 95.8 ± 1.1 to 60.9 ± 10.4%; < 0.01), and right ventricular function deteriorated (tricuspid annular plane systolic excursion decreased from 12 ± 0.7 to 5 ± 0.7 mm; < 0.01). In contrast, in the UDCPC group, the cardiopulmonary parameters indicated a stable condition. Consequently, a UDCPC is a more suitable acute model in pigs for a univentricular circulation. The model's reproducibility may aid in future research on partial cavopulmonary connection.
用于治疗功能性单心室心脏畸形的姑息性手术包括一种分阶段分离肺循环和体循环的方法，其中包括建立上腔静脉-肺动脉连接。关于猪模型中上腔静脉-肺动脉连接的文献缺乏该手术细节的信息以及其急性血流动力学效应的数据。在初步实验中，我们无法复制已发表的猪模型。因此，我们使用了管道延长和体外循环，以实现血流动力学稳定，并且仍采用与人类临床情况相同的上腔静脉直接向下至右肺动脉的常用路径。这种利用上腔静脉-肺动脉吻合术的单心室循环模型旨在应用于单侧膈肌麻痹的情况。因此，我们旨在研究在可重复的单心室生理学模型中单侧膈肌起搏的效果。
因此，我们在体外循环下，使用12毫米的膨体聚四氟乙烯插入移植物，在14头猪的上腔静脉和右肺动脉（RPA）之间构建了吻合术。6头猪接受了具有无限制房间隔交通的双向腔肺连接（BDCPC），而8头猪接受了与被排除的RPA的单向腔肺连接（UDCPC）。
BDCPC导致心肺状态受损（心输出量从3.15±0.21降至2.17±0.19升/分钟；P<0.01），平均动脉压大幅下降（从80.8±3.7降至49.3±7.3毫米汞柱；P = 0.02），动脉乳酸浓度升高（从0.82±0.09升至4.36±0.96毫摩尔/升；P = 0.01），动脉血氧饱和度下降（从95.8±1.1降至60.9±10.4%；P<0.01），并且右心室功能恶化（三尖瓣环平面收缩期位移从12±0.7降至5±0.7毫米；P<0.01）。相比之下，在UDCPC组中，心肺参数表明情况稳定。因此，UDCPC是猪单心室循环更合适的急性模型。该模型的可重复性可能有助于未来关于部分腔肺连接的研究。
