Novel Left Atrial Cannulation Technique for Attachment of a Pumpless Artificial Lung.
Novel Left Atrial Cannulation Technique for Attachment of a Pumpless Artificial Lung.
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DOI：
10.1097/mat.0000000000001693
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发表时间：
2022-08-01
期刊：
影响因子：
4.2
通讯作者：
Rojas-Pena, Alvaro
中科院分区：
文献类型：
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作者：
Prater, Aaron R.;Fallon, Brian P.;Hirschl, Ronald B.;Drake, Daniel H.;Rojas-Pena, Alvaro
无泵人工肺有可能为呼吸衰竭儿童的康复或移植提供桥梁。肺动脉流入和左心房流出对于低梯度、无泵系统是必要的;然而，脆弱的左心房的长期插管仍然存在问题。在该技术中，通过左前胸廓切开术暴露左心房和肺动脉。使用与肺动脉的端侧吻合术创建人工肺的流入。通过左心房建立器械流出。将单级静脉插管穿过游离PTFE移植物。使用带垫片的聚丙烯，将两条同心荷包缝合线放置在左心房的圆顶中。插入静脉插管。将移植物沿套管滑下，并沿周向固定到相邻左心房组织和垫片上。用丝线将移植物的另一端固定在套管上。该手术在10只羊中获得成功。初始器械血流量为969±222 mL/min，保持稳定长达7天，无吻合口并发症。这是一种在低阻力、无泵人工肺中实现安全、长期左心房插管的有效方法，无需体外循环。最重要的是，当不再需要AL支持时，可以提高套管更换和最终拔管的简便性和安全性。
A pumpless artificial lung has the potential to provide a bridge to recovery or transplantation in children with respiratory failure. Pulmonary artery inflow and left atrial outflow is necessary for low-gradient, pumpless systems; however, long-term cannulation of the fragile left atrium remains problematic. In this technique, the left atrium and pulmonary artery were exposed through a left anterior thoracotomy. Inflow to the artificial lung was created using an end-to-side anastomosis with the pulmonary artery. Device outflow was established through the left atrium. A single-stage venous cannula was passed through a free PTFE graft. Using polypropylene with pledgets, two concentric purse-string sutures were placed in the dome of the left atrium. The venous cannula was inserted. The graft was slid down the cannula and circumferentially secured to the adjacent left atrial tissue and pledgets. The other end of the graft was secured to the cannula with silk ties. The procedure was successful in 10 sheep. Initial device blood flow was 969±222 mL/min, which remained stable for up to 7 days with no anastomotic complications. This is an effective method of achieving secure, long-term left atrial cannulation without cardiopulmonary bypass for use in a low-resistance, pumpless artificial lung. And, most importantly, improves the ease and safety of cannula replacement and final decannulation when AL support is no longer required.