Kurihara H, Kitamura M, Shibuya M, Tsuda Y, Endo M, Koyangi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
ASAIO J. 1997 Sep-Oct;43(5):M838-41.
Although venoarterial bypass (VAB) or percutaneous cardiopulmonary support (PCPS) can improve hemodynamics in patients with serious cardiac decompression, some cannot be weaned from circulatory support. Insufficient unloading of the left ventricle (LV) with blood stagnation is a main cause of unsuccessful LV recovery during PCPS. This investigation was undertaken to evaluate the effectiveness of transaortic catheter venting (TACV) for LV unloading. Eight mongrel dogs (mean weight 16.3 kg, range 14-20 kg) underwent VAB with TACV. In addition to monitoring standard hemodynamic parameters, the slope of the LV end systolic pressure-volume relationship (Emax) during transient occlusion of the inferior vena cava, the slope of LV end systolic pressure-stroke-volume (Ea), external stroke work (SW), LV pressure-volume area (PVA), and slope of the SW-end diastolic volume relationship (preload recruitable stroke work: PRSW) were assessed by means of a micro-tip manometer and a conductance catheter. We measured data under the following four conditions; before circulatory support (baseline), during isolated VAB, VAB with TACV, and VAB with TACV plus intra-aortic balloon pumping (IABP). The LV contractility (Emax) and LV elastance (Ea) were equivalent for the four conditions. By comparison with baseline and VAB with TACV, LV energy (PVA) and work (SW, PRSW) were significantly reduced by TACV (1283.9 +/- 197.1 vs. 793.3 +/- 124.8 x 10(-4) J, 897.1 +/- 147.2 vs. 474.2 +/- 83.0 x 10(-4) J and 35.6 +/- 2.7 vs. 25.7 +/- 1.7 x 10(-4) J/ml, respectively), and the PE/PVA increased with TACV (30.4 +/- 2.6 vs. 40.8 +/- 1.8%). In contrast, there was no significant difference in PVA, SW, PRSW, and PE/PVA between baseline and isolated VAB. These results suggest that TACV might be an adjunctive technique to VAB or PCPS for patients with LV failure.
尽管静脉-动脉旁路（VAB）或经皮心肺支持（PCPS）可改善严重心脏减压患者的血流动力学，但部分患者无法脱离循环支持。左心室（LV）卸载不足伴血液淤滞是PCPS期间左心室恢复失败的主要原因。本研究旨在评估经主动脉导管排气（TACV）对左心室卸载的有效性。八只杂种犬（平均体重16.3kg，范围14 - 20kg）接受了带TACV的VAB。除监测标准血流动力学参数外，还通过微尖端压力计和电导导管评估了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-每搏量（Ea）的斜率、外在每搏功（SW）、左心室压力-容积面积（PVA）以及SW-舒张末期容积关系的斜率（可招募前负荷每搏功：PRSW）。我们在以下四种情况下测量数据：循环支持前（基线）、单纯VAB期间、带TACV的VAB期间以及带TACV加主动脉内球囊反搏（IABP）的VAB期间。四种情况下左心室收缩性（Emax）和左心室弹性（Ea）相当。与基线和带TACV的VAB相比，TACV使左心室能量（PVA）和功（SW、PRSW）显著降低（分别为1283.9±197.1对793.3±124.8×10⁻⁴J、897.1±147.2对474.2±83.0×10⁻⁴J以及35.6±2.7对25.7±1.7×10⁻⁴J/ml），且TACV时PE/PVA增加（30.4±2.6对40.8±1.8%）。相比之下，基线和单纯VAB之间PVA、SW、PRSW以及PE/PVA无显著差异。这些结果表明，对于左心室衰竭患者，TACV可能是VAB或PCPS的辅助技术。
