Shibuya M, Kitamura M, Kurihara H, Kikuchi C, Endo M, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Artif Organs. 1997 Jul;21(7):789-92. doi: 10.1111/j.1525-1594.1997.tb03744.x.
Insufficient unloading of the left ventricle with blood stagnation is a main cause of unsuccessful left ventricular (LV) recovery during percutaneous cardiopulmonary support (PCPS). The purpose of this investigation was to evaluate the effectiveness of transaortic catheter venting (TACV) for LV unloading. Six adult mongrel dogs (mean weight 16.3 kg, range 14-20 kg) underwent venoarterial bypass (VAB) with TACV. Bypass flow ranged from 0.8-1.2 L/min, and TACV flow ranged from 160-240 ml/min. In addition to monitoring the standard hemodynamic parameters, the slope of the LV end-systolic pressure-volume relation (Emax) during transient occlusion of the inferior vena cava, the slope of the LV end-systolic pressure-stroke-volume relation (Ea), the stroke work (SW), the LV pressure-volume area (PVA), and the slope of the SW end-diastolic volume relation, the preload recruitable stroke work (PRSW) were assessed by means of a microtip manometer and a conductance catheter. The LV contractility (Emax) and aortic elastance (Ea) were equivalent in the 2 groups with or without TACV (7.7 +/- 1.1 versus 8.4 +/- 1.5 mm Hg/ml and 8.2 +/- 1.4 versus 7.6 +/- 1.3 mm Hg/ml). Comparing the measurements for the baseline to those for VAB with TACV, the SW was significantly reduced, and the PVA/SW was increased by TACV (1,685 +/- 309 versus 867 +/- 188 x 10(-4) J, p < 0.05 and 1.32 +/- 0.03 versus 1.58 +/- 0.11, p < 0.05, respectively). Furthermore, the PRSW was gradually decreased from the baseline value to the value resulting from VAB with TACV (75 +/- 8 versus 44 +/- 3 x 10(-4) J/ml, p < 0.01). In comparison, the percent reduction of SW between VAB and VAB with TACV tended to be increased by TACV (23.2 +/- 7.2% versus 46.9 +/- 7.7%, p = 0.05). These results suggest that TACV might reduce LV work (SW and PRSW) and might increase the LV energetic charge. In conclusion, TACV would be an adjunctive technique to VAB or PCPS for patients with LV failure.
左心室血液淤滞导致卸载不足是经皮心肺支持（PCPS）期间左心室（LV）恢复失败的主要原因。本研究的目的是评估经主动脉导管排气（TACV）对左心室卸载的有效性。六只成年杂种犬（平均体重16.3 kg，范围14 - 20 kg）接受了带TACV的静脉 - 动脉旁路（VAB）。旁路血流范围为0.8 - 1.2 L/分钟，TACV血流范围为160 - 240 ml/分钟。除了监测标准血流动力学参数外，在下腔静脉短暂闭塞期间左心室收缩末期压力 - 容积关系（Emax）的斜率、左心室收缩末期压力 - 搏出量关系（Ea）的斜率、搏功（SW）、左心室压力 - 容积面积（PVA）以及SW与舒张末期容积关系的斜率、可募集前负荷搏功（PRSW），通过微尖端压力计和电导导管进行评估。有或无TACV的两组左心室收缩性（Emax）和主动脉弹性（Ea）相当（7.7±1.1对8.4±1.5 mmHg/ml和8.2±1.4对7.6±1.3 mmHg/ml）。将基线测量值与带TACV的VAB测量值进行比较，TACV使SW显著降低，PVA/SW增加（1,685±309对867±188×10⁻⁴ J，p < 0.05；1.32±0.03对1.58±0.11，p < 0.05）。此外，PRSW从基线值逐渐降低至带TACV的VAB所得到的值（75±8对44±3×10⁻⁴ J/ml，p < 0.01）。相比之下，带TACV的VAB与VAB之间SW降低的百分比有增加的趋势（23.2±7.2%对46.9±7.7%，p = 0.05）。这些结果表明TACV可能降低左心室做功（SW和PRSW）并可能增加左心室能量负荷。总之，对于左心室衰竭患者，TACV将是VAB或PCPS的辅助技术。
