Ide H, Yamaguchi A, Ino T, Adachi H, Mizuhara A, Kawahito K, Matsumoto H, Fujimasa I
Department of Thoracic and Cardiovascular Surgery, Kyorin Medical School, Tokyo, Japan.
J Thorac Cardiovasc Surg. 1994 Feb;107(2):569-75.
A new pulsatile left ventricle-femoral artery bypass system (integrated cardioassist catheter system) has been developed for rapid, percutaneous insertion as a left ventricular assist device. Previous experiments revealed its superiority over the intraaortic balloon pump system in maintaining the peripheral circulation and in improving myocardial blood flow and afterload. Our objective was to determine whether the pulsatility of left ventricular bypass of this system would be preferable for maintaining the peripheral circulation and managing the ischemic myocardium as compared with nonpulsatile left ventricular bypass. Ten dogs with profound heart failure were supported by this system. Their hemodynamic status and myocardial blood flow were measured under control, nonpulsatile left ventricular bypass, or synchronous pulsatile left ventricular bypass. Significant differences between the nonpulsatile bypass group and the pulsatile bypass group were observed in the mean increase in aortic pressure (3.5% versus 22.2%, respectively; p < 0.001), total cardiac output (13.0% versus 21.7%; p = 0.004), and myocardial blood flow (9.5% versus 21.8%; p < 0.001). No differences were found between groups in the decrease in left atrial pressure (-20.2% versus -20.2%; p > 0.05). The ratio of diastolic time index/tension time index was shown to be improved significantly in the pulsatile bypass group compared with that of control and nonpulsatile bypass groups (p < 0.001). Thus, the pulsatility of the integrated cardioassist catheter system may support the peripheral circulation and improve the myocardial blood flow and oxygen supply/demand ratio.
一种新型搏动性左心室-股动脉旁路系统（集成心脏辅助导管系统）已被开发出来，用于快速经皮插入作为左心室辅助装置。先前的实验表明，在维持外周循环、改善心肌血流和后负荷方面，该系统优于主动脉内球囊泵系统。我们的目的是确定与非搏动性左心室旁路相比，该系统的左心室旁路搏动性在维持外周循环和处理缺血心肌方面是否更具优势。十只患有严重心力衰竭的狗接受了该系统的支持。在对照、非搏动性左心室旁路或同步搏动性左心室旁路情况下，测量了它们的血流动力学状态和心肌血流。非搏动性旁路组和搏动性旁路组在主动脉压平均升高（分别为3.5%对22.2%；p<0.001）、总心输出量（13.0%对21.7%；p = 0.004）和心肌血流（9.5%对21.8%；p<0.001）方面存在显著差异。各组之间左心房压降低情况无差异（-20.2%对-20.2%；p>0.05）。与对照和非搏动性旁路组相比，搏动性旁路组的舒张期时间指数/张力时间指数比值显著改善（p<0.001）。因此，集成心脏辅助导管系统的搏动性可能有助于维持外周循环，改善心肌血流和氧供需比。
