Impact of Subxiphoid Video Pericardioscopy with a Rigid Shaft on Cardiac Hemodynamics in a Porcine Model.
Impact of Subxiphoid Video Pericardioscopy with a Rigid Shaft on Cardiac Hemodynamics in a Porcine Model.
复制标题
剑突下视频心包镜检查与刚性轴对猪模型心脏血流动力学的影响。
DOI：
10.1097/imi.0b013e3181ceef8a
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Zenati,MarcoA
中科院分区：
文献类型：
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作者：
Yokota,Takenori;Ota,Takeyoshi;Schwartzman,David;Zenati,MarcoA
带刚性轴杆的单端口剑突下视频心包镜可用于左心房隔离、左心室（LV）起搏电极导线植入和心外膜标测，但可能干扰心律并对血流动力学产生不利影响。我们研究了这种技术对血液动力学指标的影响，在猪model.MethodsThe videopericardioscopy设备被引入到五只猪（35-45公斤）的心包空间，通过剑突下的方法和导航到六个解剖目标[右心耳，上级腔静脉，升主动脉，左心耳（前和后的方法），横窦，和房室（AV）沟]。成功采集目标后，通过剑突下端口撤回器械。当血流动力学稳定时，将器械导航至另一个靶点。在每个预靶点（剑突下切口）和靶点测量心率（HR）、动脉血压（BP）、中心静脉压（CVP）、肺动脉压和混合静脉血氧饱和度（SvO 2）。导航试验后，动物被杀死，纵隔空间进行了检查程序相关injuries.ResultsThe设备提供了一个很好的看法，并成功地进行了心脏跳动的导航试验。四只动物耐受了手术，而一只动物在试验后死于设备诱导的心室颤动。血流动力学严重受损，在所有解剖目标，除了左心耳（前的方法）。ConclusionsSubxiphoid videopericardioscopy显着干扰心脏节律，造成危及生命的心律失常和血流动力学的妥协，当目标位于深，远离心包切开术。柔性或高度铰接的器械可实现心包内导航，而不会影响血流动力学。
ObjectiveSingle-port subxiphoid videopericardioscopy with a rigid shaft is useful for left atrial exclusion, left ventricular (LV) pacing lead implantation, and epicardial mapping, but it may interfere with the cardiac rhythm and adversely alter hemodynamics. We examined the impact of this technique on hemodynamic indices in a porcine model.MethodsThe videopericardioscopy device was introduced into the pericardial space of five pigs (35–45 kg) via a subxiphoid approach and navigated to six anatomic targets [right atrial appendage, superior vena cava, ascending aorta, left atrial appendage (anterior and posterior approaches), transverse sinus, and atrioventricular (AV) groove]. After successful target acquisition, the device was withdrawn through the subxiphoid port. When the hemodynamics stabilized, the device was navigated to another target. The heart rate (HR), arterial blood pressure (BP), central venous pressure (CVP), pulmonary arterial pressure, and mixed venous oxygen saturation (SvO2) were measured at every pretarget (subxiphoid incision) and target point. After the navigation trials, the animals were killed and the mediastinum space was examined for procedure-related injuries.ResultsThe device afforded a good view, and the navigation trials were successfully performed on the beating heart. Four animals tolerated the procedures, whereas one died of device-induced ventricular fibrillation after the trials. Hemodynamics was severely compromised at all anatomic targets except the left atrial appendage (anterior approach).ConclusionsSubxiphoid videopericardioscopy significantly interferes with the cardiac rhythm, causing life-threatening arrhythmia and hemodynamic compromise, when the target is located deep and far from the pericardiotomy. A flexible or highly articulated device would enable intrapericardial navigation without hemodynamic compromise.