A transapical-to-aorta double lumen cannula-based neonate left ventricular assist device efficiently unloads the left ventricle in neonate lambs.
A transapical-to-aorta double lumen cannula-based neonate left ventricular assist device efficiently unloads the left ventricle in neonate lambs.
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DOI：
10.1016/j.jtcvs.2016.08.041
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Zwischenberger J
中科院分区：
文献类型：
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作者：
Zhou C;Wang D;Ballard-Croft C;Zhao G;Reda HK;Topaz S;Zwischenberger J
我们正在开发一种经根尖至主动脉双腔插管（TAA DLC），作为一种微创/更可靠的新生儿左心室辅助装置。18-Fr TAA DLC原型在新生儿羔羊（n = 6, 7.7-10 kg）中进行了6小时的台架测试和评估。通过左前外侧开胸经第六肋间隙显露心尖。在压力波形引导下，TAA DLC在心尖处通过垫式缝线插入，穿过lv -主动脉瓣，进入升主动脉。DLC与血泵相连。用血管周围血流传感器测量心输出量和主动脉根部血流量。活化凝血时间维持在180-250秒。在台架测试中，DLC在63毫米汞柱引流压力和145毫米汞柱注入压力下可泵送高达1.8升/分钟的流量。在所有羔羊中，DLC在第一次尝试的1分钟内被正确插入/部署。泵送流量维持在1.2 ~ 1.3 L/min。收缩动脉压降低，舒张动脉压/平均动脉压升高，表明后负荷降低，灌注压升高。左室舒张末期压由13±1 mm Hg降至6±2 mm Hg，表明预负荷降低。无DLC时主动脉根部反流为2.4%±0.6%，有DLC时为3.5%±0.8%，表明无明显的DLC引起的主动脉瓣反流。6小时后，游离血红蛋白<5 mg/dL，血红蛋白/血小板不变。泵/ dlc未见明显血栓形成。左室、主动脉瓣、主动脉均未见外伤。我们的基于TAA dlc的新生儿左室辅助装置有效地卸载了羔羊的左室。经心尖至主动脉双腔插管从心尖插入左心室主动脉，是一种侵入性更小、更可靠的左心室辅助装置。
We are developing a transapical-to-aorta double lumen cannula (TAA DLC) for a less-invasive/more dependable neonatal left ventricular assist device. The 18-Fr TAA DLC prototypes were bench tested and evaluated for 6 hours in neonate lambs (n = 6, 7.7–10 kg). The cardiac apex was exposed through a left anterolateral thoracotomy through the sixth intercostal space. The TAA DLC was inserted through a mattress stitch on apex, passing LV-aortic valve, into the ascending aorta with insertion/deployment guided by pressure waveform. The DLC was connected to blood pump. Cardiac output and aortic root blood flow were measured with perivascular flow sensors. Activated clotting time was maintained at 180–250 seconds. The DLC pumped up to 1.8 L/min flow against 63 mm Hg drainage pressure and 145 mm Hg infusion pressure in bench testing. In all lambs, the DLC was inserted/deployed properly within 1 minute on the first attempt. Pumping flow was maintained at 1.2–1.3 L/min. Systolic arterial pressure decreased and diastolic arterial pressure/mean arterial pressure increased, indicating decreased afterload and increased perfusion pressure. Left ventricular end-diastolic pressure decreased from 13 ± 1 mm Hg to 6 ± 2 mm Hg, indicating decreased preload. Aortic root backward flow was 2.4% ± 0.6% without DLC and 3.5% ± 0.8% of cardiac output with DLC, indicating no significant DLC-induced aortic valve regurgitation. After 6 hours, free hemoglobin was <5 mg/dL with hemoglobin/platelets unchanged. No significant thrombus was found in pumps/DLCs. No trauma was found in LV, aortic valve, and aorta. Our TAA DLC-based neonate left ventricular assist device efficiently unloaded the LV in lambs. Transapical-to-aorta double lumen cannula inserted from apex into left ventricle-aorta for a less-invasive and more reliable left ventricular assist device.