Alternative Approach for Right Ventricular Failure after Left Ventricular Assist Device Placement in Animal Model
Alternative Approach for Right Ventricular Failure after Left Ventricular Assist Device Placement in Animal Model
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动物模型中左心室辅助装置放置后右心室衰竭的替代方法
DOI：
10.1093/ejcts/ezu364
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Yoshiyuki Taenaka and Eisuke Tatsumi
中科院分区：
文献类型：
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作者：
Tomohiro Saito;Koichi Toda;Yoshiaki Takewa;Tomonori Tsukiya;Toshihide Mizuno;Yoshiyuki Taenaka and Eisuke Tatsumi
目的：左心室辅助装置（LVAD）植入后的右心室衰竭与高死亡率相关。本研究旨在评估在LVAD内合并膜氧合器的房间隔造口术作为LVAD植入后右心室衰竭的新方法的有效性。方法将流出插管和流入插管分别置入颈动脉和左心室尖部。在7只麻醉山羊的流入和流出插管之间依次放置离心泵和氧合器。肺动脉束带导致右心衰，超声心动图引导下使用19mm球囊导管行房间隔球囊造口术。我们研究了房间分流对左室辅助血流和血流动力学的影响。结果右心衰使左室辅助血流降低（2.7±0.6 ~ 0.9±0.6 l/min），导致休克状态[平均动脉压（MAP） 41±12 mmHg]。球囊房间隔造口术后，左室血流和MAP分别显著改善至2.7±0.4 l/min （P< 0.001）和53±18 mmHg (P= 0.006)，右房压由18±5降至15±5 mmHg （P= 0.001）。此外，LVAD内的膜氧合器维持了动脉血氧合。结论在LVAD植入后右心衰竭模型中，在不影响全身氧合的情况下，通过在LVAD内植入心房分流器和膜氧合器，LVAD血流显著增加，血流动力学改善。我们的研究结果表明，这种新方法可能对LVAD植入后的右心室衰竭侵入性较小。
OBJECTIVESRight ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. This study was designed to evaluate the effectiveness of an atrial septostomy with a membrane oxygenator incorporated in an LVAD as a novel approach for right ventricular failure after LVAD implantation.METHODSThe outflow and inflow cannulae were placed in the carotid artery and left ventricular apex, respectively. A centrifugal pump and an oxygenator were sequentially placed between the inflow and outflow cannulae in seven anesthetized goats. While right ventricular failure was induced by pulmonary artery banding, a balloon atrial septostomy was performed using a 19-mm balloon catheter under echocardiographic guidance. We investigated the effects of the interatrial shunt on LVAD flow and haemodynamics.RESULTSDevelopment of right ventricular failure decreased LVAD flow (2.7 ± 0.6–0.9 ± 0.6 l/min), causing a state of shock [mean arterial pressure (MAP) of 41 ± 12 mmHg]. Following a balloon atrial septostomy, LVAD flow and MAP were significantly improved to 2.7 ± 0.4 l/min (P< 0.001) and 53 ± 18 mmHg (P= 0.006), respectively, while right atrial pressure decreased from 18 ± 5 to 15 ± 5 mmHg (P= 0.001). Furthermore, arterial blood oxygenation was maintained by the membrane oxygenator incorporated in the LVAD.CONCLUSIONSIn the present model of right ventricular failure after LVAD implantation, LVAD flow was significantly increased and haemodynamics improved without compromising systemic oxygenation by the use of an interatrial shunt and a membrane oxygenator incorporated in the LVAD. Our results indicate that this novel approach may be less invasive for a right ventricular failure after LVAD implantation.