Ambulatory oxygenator right ventricular assist device for total right heart and respiratory support
Ambulatory oxygenator right ventricular assist device for total right heart and respiratory support
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DOI：
10.1016/j.athoracsur.2007.03.068
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发表时间：
2007-11-01
影响因子：
4.6
通讯作者：
Zwischenberger, Joseph B.
中科院分区：
文献类型：
--
作者：
Wang, Dongfang;Lick, Scott D.;Zwischenberger, Joseph B.
背景我们的目标是提供非卧床全呼吸和右心辅助，从而实现肺移植。为此，我们将紧凑型旁路气体交换装置与右心室辅助装置（RVAD）结合，以创建“OxyRVAD”。“方法。在5只麻醉绵羊上，经左胸小切口暴露主肺动脉（PA）和右心房（RA）。全身肝素推注后，将粘在管路上的12 mm外径压接移植物固定（端对侧）到主PA上，并通过RA附件放置VAD心房插管。胸腔引流并闭合，然后PA移植物以1 - 2 L/min的流速作为RA的分流管过夜。第二天，对动物进行再抗凝，夹闭并分离分流插管。插入OxyRVAD装置，由市售组件组成，包括轴流泵和低阻力心肺旁路气体交换装置。从RA到PA的泵送维持在3 L/min。连续5只绵羊在植入后存活，并在开始OxyRVAD后正常站立和进食。三只在整个2周的研究中存活，第四只在第13天因风暴相关的停电而被处死。对于这4只绵羊，泵流量稳定在3 L/min。实验期间二氧化碳清除量恒定，总清除量为200 +/- 19 mL/min。氧输送量为144 +/- 44 mL/min。1只绵羊出现进行性血小板减少症，并在植入后第5天处死。我们的流动OxyRVAD可以为正常清醒绵羊的右心和肺提供14天的全面帮助。
Background. Our goal is ambulatory total respiratory and right heart assistance allowing a bridge to lung transplant. To that end, we have coupled a compact paracorporeal gas exchange device with a right ventricular assist device (RVAD) to create an "OxyRVAD."Methods. Through a limited left thoracotomy, the main pulmonary artery (PA) and right atrium (RA) were exposed in 5 anesthetized sheep. After a systemic heparin bolus, a 12-mm outer diameter crimped graft glued to tubing was anastomosed (end to side) to the main PA and a VAD atrial cannula was placed through the RA appendage. The chest was drained and closed, then the PA graft flowed at 1 to 2 L/min as a shunt to the RA overnight. The next day, the animal was reanticoagulated, and the shunt cannulae clamped and divided. The OxyRVAD unit, consisting of commercially available components including an axial flow pump and low-resistance cardiopulmonary bypass gas exchange device, was interposed. Pumping from RA to PA was maintained at 3 L/min.Results. Five consecutive sheep survived the implant, and stood and ate normally after initiation of the OxyRVAD. Three survived the full 2-week study, and a fourth was sacrificed on day 13 owing to a storm-related power failure. For these 4 sheep, pump flow was stable at 3 L/min. Carbon dioxide removal was constant and total during the experiment at 200 +/- 19 mL/min. Oxygen transfer was 144 +/- 44 mL/min. One sheep had progressive thrombocytopenia and was sacrificed on day 5 after implant.Conclusions. Our ambulatory OxyRVAD can provide total assistance for the right heart and lungs in normal awake sheep for 14 days.