Fetal cardiac bypass using an in-line axial flow pump to minimize extracorporeal surface and avoid priming volume
Fetal cardiac bypass using an in-line axial flow pump to minimize extracorporeal surface and avoid priming volume
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DOI：
10.1016/0003-4975(96)00243-3
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发表时间：
1996-08-01
影响因子：
4.6
通讯作者：
Hanley, FL
中科院分区：
文献类型：
--
作者：
Reddy, VM;Liddicoat, JR;Hanley, FL
背景。胎儿心脏搭桥术后迅速发生进行性代谢性酸中毒、缺氧和高碳酸血症，主要是由于胎盘血管阻力增加和胎盘血流减少所致。包括胎儿应激、启动物质和体外表面在内的许多因素已被确定为可能导致胎盘功能障碍的刺激因素。本研究的目的是检查避免预充量和最小化体外表面积对胎盘血流动力学和功能的影响。方法。妊娠 118 至 122 天的胎羊 (n = 16) 使用直列轴向泵（血泵组：n = 8，无灌注）或带有静脉储液器的滚子泵（对照组：n = 8，灌注体积 150 mL）进行心脏搭桥 30 分钟。搭桥后，观察胎儿90分钟。使用超声波探头连续测量胎盘血和合并心室输出量，并在特定时间间隔测量胎儿血气。结果。对照组中的 3 名胎儿在研究期间死亡，而血泵组中的所有 8 名胎儿在整个研究期间均保持稳定状态。在搭桥期间和之后，Hemopump 组的胎盘血液现在显着高于对照组 (p < 0.0001)，胎盘血管阻力显着低于对照组 (p < 0.0001)。与对照组相比，Hemopump 组的动脉 pH 值和动脉氧分压下降明显较少 (p < 0.0001)，动脉二氧化碳分压上升明显较少 (p = 0.0002)。结论。减少体外表面积并避免外部启动物质可在胎儿心脏搭桥术后保留胎盘血流动力学。直列轴流泵可用于小型化旁路回路，以便在胎儿心脏手术中使用。
Background. Progressive metabolic acidosis, hypoxia, and hypercarbia develop rapidly after fetal cardiac bypass mainly as a result of an increase in placental vascular resistance and a decrease in placental blood now. A number of factors including fetal stress, priming substances, and extracorporeal surfaces have been identified as possible stimuli causing this placental dysfunction. The purpose of this study was to examine the effects of avoiding priming volume and minimizing extracorporeal surface area on placental hemodynamics and function.Methods. Fetal sheep (n = 16) at 118 to 122 days of gestation were subjected to cardiac bypass for 30 minutes using either an in-line axial-now pump (Hemopump group: n = 8, no prime) or a roller pump with a venous reservoir (control group: n = 8, priming volume 150 mL). After bypass, the fetuses were observed for 90 minutes. Placental blood now and combined ventricular output were continuously measured with ultrasonic now probes, and fetal blood gases were measured at specific intervals.Results. Three fetuses in the control group died during the study, whereas all 8 fetuses in the Hemopump group remained in stable condition throughout the study period. During and after bypass, placental blood now was significantly higher (p < 0.0001) and placental vascular resistance was significantly lower (p < 0.0001) in the Hemopump group than in the control group. Arterial pH and partial pressure of arterial oxygen declined significantly less (p < 0.0001), and partial pressure of arterial carbon dioxide increased significantly less (p = 0.0002) in the Hemopump group than in the control group.Conclusions. Reducing the extracorporeal surface area and avoiding external priming substances preserves placental hemodynamics after fetal cardiac bypass. An inline axial-flow pump is useful in miniaturizing the bypass circuits for potential use in fetal cardiac surgery.