Morishita A, Kitamura M, Shibuya M, Kurihara H, Koyanagi H
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University.
ASAIO J. 1999 Jan-Feb;45(1):69-73. doi: 10.1097/00002480-199901000-00016.
Insufficient unloading of the left ventricle (LV) is a limitation of percutaneous cardiopulumonary support (PCPS). We previously reported the unloading effect of transaortic catheter venting (TACV) during venoarterial bypass (VAB) in normal hearts. The aim of this study was to assess the effectiveness of TACV with VAB in a heart failure (HF) model. Seven adult mongrel dogs underwent TACV with VAB, and isolated LV failure was induced by multiple ligation of left coronary arteries. With standard hemodynamic monitoring, slope of the LV end-systolic pressure-volume relationship (Emax; mm Hg/ml), aortic elastance (Ea; mm Hg/ml), LV stroke work (SW; 10(-4)J), preload recruitable stroke work (PRSW; 10(-4)J/ ml), LV pressure-volume area (PVA; 10(-4)J), and potential energy (PE; 10(-4)J) were assessed using a micro-tip manometer and a conductance catheter. In addition to evaluation of LV function, myocardial adenosine 5'-triphosphate (ATP) was measured in each condition. The TACV combined support significantly reduced LV total energy (PVA) and LV work (SW). The LV energetic charge (PE/PVA, myocardial ATP) was significantly increased by TACV. These results suggest that TACV might be an effective technique for LV recovery during VAB or PCPS in patients with severe heart failure.
左心室（LV）卸载不足是经皮心肺支持（PCPS）的一个局限性。我们之前报道了在正常心脏的静脉-动脉旁路（VAB）过程中经主动脉导管排气（TACV）的卸载效果。本研究的目的是评估在心力衰竭（HF）模型中TACV联合VAB的有效性。七只成年杂种犬接受了TACV联合VAB，并通过多次结扎左冠状动脉诱导孤立性左心室衰竭。采用标准血流动力学监测，使用微尖端压力计和电导导管评估左心室收缩末期压力-容积关系斜率（Emax；mmHg/ml）、主动脉弹性（Ea；mmHg/ml）、左心室每搏功（SW；10^(-4)J）、可招募前负荷每搏功（PRSW；10^(-4)J/ml）、左心室压力-容积面积（PVA；10^(-4)J）和势能（PE；10^(-4)J）。除了评估左心室功能外，还在每种情况下测量心肌三磷酸腺苷（ATP）。TACV联合支持显著降低了左心室总能量（PVA）和左心室功（SW）。TACV显著增加了左心室能量电荷（PE/PVA，心肌ATP）。这些结果表明，TACV可能是严重心力衰竭患者在VAB或PCPS期间左心室恢复的有效技术。
