Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation.
Twenty-four hour cardiopulmonary stability in a model of assisted newborn Fontan circulation.
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DOI：
10.1016/j.athoracsur.2005.06.063
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
Cynthia D. Myers;Kelly D. Mattix;R. Presson;P. Vijay;Domingo Maynes;K. Litwak;John W. Brown;M. Rodefeld
中科院分区：
文献类型：
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作者：
Cynthia D. Myers;Kelly D. Mattix;R. Presson;P. Vijay;Domingo Maynes;K. Litwak;John W. Brown;M. Rodefeld
背景左心发育不全综合征1期姑息术后的发病率和死亡率很高，这是由于体动脉到肺动脉分流术造成的不良生理条件所致。转换为全身静脉来源的肺血流(Glenn/Fontan)大大降低了不稳定和死亡风险。腔肺辅助有可能消除对有问题的体动脉分流的严重依赖。在单室Fontan循环的新生动物模型中，我们研究了24小时内的这种支持方式。方法单抗(8.1±0.9 kg，8.3±2.1天，n=7)行全腔静脉-肺转流。采用微型离心泵辅助腔肺血流。对照组(6.6±1.0 kg，7.3±2.1天，n=11)仅放置监测线。测定血流动力学和气体交换数据。组内和组间比较采用双向重复测量方差分析。结果在反应初期，肺血管阻力恢复到低水平，13h后与基础值无显著差异，4h后与对照组无显著差异。氧合和换气保持正常，没有组织学证据表明实质肺损伤。结论在新生儿期，SPump辅助的腔-肺转流术可以耐受长达24小时。尽管最初有反应性，但肺血管阻力趋于正常并接近控制值。腔肺辅助有可能成为新生儿Fontan单心室修复术的桥梁。有必要进行长期研究，以确定向无辅助单室Fontan循环过渡的支持撤机的持续时间和比率。
BACKGROUNDMorbidity and mortality after stage-1 palliation of hypoplastic left heart syndrome is high as a result of adverse physiologic conditions imposed by the systemic-to-pulmonary arterial shunt. Conversion to a systemic venous source of pulmonary blood flow (Glenn/Fontan) substantially decreases instability and mortality risk. Cavopulmonary assist has the potential to eliminate critical dependence on the problematic systemic arterial shunt. We studied this support modality during a 24-hour period in a neonatal animal model of univentricular Fontan circulation.METHODSLambs (8.1 ± 0.9 kg, 8.3 ± 2.1 days, n = 7) underwent total cavopulmonary diversion. A miniature centrifugal pump was used to assist cavopulmonary flow. Control animals (6.6 ± 1.0 kg, 7.3 ± 2.1 days, n = 11) underwent placement of monitoring lines only. Hemodynamic and gas exchange data were measured. Within-group and between-group comparisons were made using two-way repeated measures analysis of variance.RESULTSAfter an initial phase of reactivity, pulmonary vascular resistance returned to low levels and was not significantly different from baseline values after hour 13 or significantly different from control values after hour 4. Systemic venous pressure remained low. Oxygenation and ventilation remained normal with no histologic evidence of parenchymal lung injury.CONCLUSIONSPump-assisted cavopulmonary diversion is well tolerated up to 24 hours in the neonatal period. Despite initial reactivity, pulmonary vascular resistance trended toward normal and approached control values. Cavopulmonary assist holds the potential to serve as a bridge to neonatal Fontan repair of single ventricle. Chronic studies are warranted to determine the duration and rate of weaning of support to transition to an unassisted univentricular Fontan circulation.