Surgical and Nonsurgical Complications of a Pig to Baboon Heterotopic Heart Transplantation Model
Surgical and Nonsurgical Complications of a Pig to Baboon Heterotopic Heart Transplantation Model
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DOI：
10.1016/j.transproceed.2010.05.116
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发表时间：
2010-07-01
影响因子：
0.9
通讯作者：
Mohiuddin, M. M.
中科院分区：
文献类型：
--
作者：
Corcoran, P. C.;Horvath, K. A.;Mohiuddin, M. M.
美国国立卫生研究院开发的一种改良的免疫抑制方案已用于异位心脏异种移植的大型动物模型。移植物的存活时间得到了延长，但尽管如此，我们的受者还是死于各种手术或非手术并发症。在此，我们描述了不同的并发症和管理策略。最常见的并发症是移植后高凝状态（HC），导致小脉管系统和大脉管系统血栓形成，最终导致移植物丢失。在处理这一并发症时，我们发现 HC 和消耗性凝血病 (CC) 之间存在微妙的平衡。一些受体狒狒遇到的CC无法通过停止抗凝治疗和多次输血来逆转。一些并发症具有医源性成分。为了监测动物，将固态左心室遥测探针通过心尖直接放入移植心脏中。通过连续输注肝素诱导低凝状态，导致 1 只狒狒从该顶端部位出现无法控制的腹内出血。这种情况需要使用多个荷包和 4 象限保证缝合线更紧密地固定探头。心脏破裂的一例源自侧壁梗塞部位。早期的研究表明，在这种移植模型中，感染都是致命的。然而，由于遥测放置，感染可以通过温度峰值早期发现，并立即用抗生素进行治疗。我们有几起因受者破坏缝合线而导致伤口裂开的病例。通过重新接近伤口或为狒狒寻找分散注意力的方法，这些并发症很快得到了解决。我们在早期实验中遇到的一些最常见的问题与护套、系绳和输液泵有关。给一些狒狒穿上夹克是很困难的，在我们确保长期成功之前，必须对系绳进行多次修改。输注导管更换导致移植心脏静脉阻塞和右股总静脉线血栓形成。 HC 和 CC 等稳态扰动以及狒狒引起的伤口并发症构成了大多数并发症。 2只狒狒因遥测植入和梗死破裂而发生大出血和死亡。尽管存在多种并发症，我们在该模型中实现了显着的移植物延长。
A modified immunosuppressive regimen, developed at the National Institutes of Health, has been employed in a large animal model of heterotopic cardiac xenotransplantation. Graft survival has been prolonged, but despite this, our recipients have succumbed to various surgical or nonsurgical complications. Herein, we have described different complications and management strategies. The most common complication was hypercoagulability (HC) after transplantation, causing thrombosis of both small and large vasculature, ultimately leading to graft loss. While managing this complication we discovered that there was a delicate balance between HC and consumptive coagulopathy (CC). CC encountered in some recipient baboons was not able to be reversed by stopping anticoagulation and administering multiple blood transfusions.Some complications had iatrogenic components. To monitor the animals, a solid state left ventricular telemetry probe was placed directly into the transplanted heart via the apex. Induction of hypocoagulable states by continuous heparin infusion led to uncontrollable intra-abdominal bleeding in 1 baboon from this apical site. This occurrence necessitated securing the probe more tightly with multiple purse strings and 4-quadrant pledgeted stay sutures. One instance of cardiac rupture originated from a lateral wall infarction site. Earlier studies have shown infections to be uniformly fatal in this transplant model. However, owing to the telemetry placement, infections were identified early by temperature spikes that were treated promptly with antibiotics.We had several cases of wound dehiscence due to recipients disrupting the suture line. These complications were promptly resolved by either re-approximating the wound or finding distractions for the baboon. A few of the most common problems we faced in our earlier experiments were related to the jacket, tether, and infusion pumps. It was difficult to keep the jackets on some baboons and the tether had to be modified several times before we assured long-term success. Infusion catheter replacement resulted in transplant heart venous obstruction and thrombosis from a right common femoral venous line. Homeostatic perturbations such as HC and CC and baboon-induced wound complications comprised most complications. Major bleeding and death due to telemetry implantation and infarct rupture occurred in 2 baboons. Despite the variety of complications, we achieved significant graft prolongation in this model.