Preliminary results of fetal cardiac bypass in nonhuman primates.
Preliminary results of fetal cardiac bypass in nonhuman primates.
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非人类灵长类动物胎儿心脏搭桥的初步结果。
DOI：
10.1016/j.jtcvs.2004.09.003
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Reddy,VMohan
中科院分区：
文献类型：
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作者：
Ikai,Akio;Riemer,RKirk;Ramamoorthy,Chandra;Malhotra,Sunil;Malhatra,Sunil;Cassorla,Lydia;Amir,Gabriel;Hanley,FrankL;Reddy,VMohan
胎儿心脏手术对某些先天性心脏病的治疗有潜在的益处。然而，胎盘功能障碍的结果，胎儿旁路，胎儿应激，胎儿暴露于外部环境需要克服，以优化胎儿心脏旁路的结果。在这项研究中，我们评估了心脏搭桥术在非人灵长类胎儿的技术可行性和不同的麻醉方法的有效性。方法5只狒狒胎儿，平均妊娠146 ± 8天，体重696 ± 184 g，被使用。3只胎仔因脐带绕颈先露而从研究中排除。动物分为两个麻醉组：异氟醚（n = 6）和芬太尼和咪达唑仑（n = 3）。使用不带氧合器的微型滚柱泵回路进行胎儿旁路30分钟。未进行输血。在转流前、转流过程中、转流后15分钟和60分钟采集胎儿血气样品。然而，芬太尼和咪达唑仑组中的2只动物由于母体子宫张力持续升高而未置于旁路回路上。所有的母狒狒都活了下来。异氟醚组的6只胎儿中，5只存活60分钟;然而，转流后胎盘功能继续恶化（转流前Pao 233 ± 3 mm Hg，转流后15分钟Pao 23 ± 6 mm Hg，转流后60分钟Pao 18 ± 9 mm Hg）。异氟醚麻醉似乎是上级芬太尼和咪达唑仑麻醉胎儿心脏手术，因为足够的子宫松弛。
OBJECTIVEFetal cardiac surgery has potential benefits for treatment of some congenital heart defects. However, placental dysfunction as a result of fetal bypass, fetal stress, and fetal exposure to external milieu needs to be overcome to optimize the outcomes of fetal cardiac bypass. In this study we evaluated the technical feasibility of cardiac bypass in the nonhuman primate fetus and the efficacy of different anesthetic approaches.METHODSTwelve baboon fetuses, average gestation 146 ± 8 days and weight 696 ± 184 g, were used. Three fetuses were excluded from the study because of nuchal cord presentations. The animals were separated into two anesthesia groups: isoflurane (n = 6) and fentanyl and midazolam (n = 3). A miniature roller pump circuit without oxygenator was used for fetal bypass for 30 minutes. No blood transfusion was performed. Fetal blood gas samples were collected before bypass, during bypass, and at 15 and 60 minutes after bypass.RESULTSAll fetuses in the isoflurane group were successfully placed on the cardiac bypass circuit. However, 2 animals in the fentanyl and midazolam group were not placed on the bypass circuit because of sustained elevation in maternal uterine tone. All maternal baboons survived. Of the 6 fetuses in the isoflurane group, 5 survived for 60 minutes; however, placental function continued to deteriorate after bypass (Pao233 ± 3 mm Hg before bypass, 23 ± 6 mm Hg 15 minutes after, and 18 ± 9 mm Hg 60 minutes after).CONCLUSIONThe technical feasibility of cardiac bypass in nonhuman primate fetuses weighing less than 1000 g was confirmed. Isoflurane anesthesia appears to be superior to fentanyl and midazolam anesthesia for fetal cardiac surgery because of adequate uterine relaxation.