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Experimental, Clinical Research of The Ventricular Assist Device in Combined Use with IABP and in Its Weaning Method.

心室辅助装置与IABP联合使用及其脱机方法的实验、临床研究。

基本信息

批准号：
61480294
负责人：
SAKAMOTO Tohru
金额：
$ 3.71万
依托单位：
TOKYO MEDICAL AND DENTAL UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1986
资助国家：
日本
起止时间：
1986 至 1987
项目状态：
已结题

项目摘要

Simultaneous drive of left ventricular assist device (LVAD) and intraaortic balloon pumping (IABP) is needed frequently but infration of intraaortic balloon affects as a resistance against counterpulsed LVAD flow and reduces renal blood flow (BF), resulted in renal dysfunction. To resolve this disadvantage, a new sequential method, Bisected Diastolic Driving (BDD) is devised. After bisecting the aortic diastole, LVAD ejects on early half of the diastole and subsequently intraaortic balloon is inflated on the remained late one, On BDD, two devices act ad counterpulsation (CP) to failing heart (FH) generating high aortic pressure (AP) with non-disturbed distribution of systemic BF, and deflation of balloon produces systolic unloading to FH. Exparimentally, decrease of renal BF and fraction on BDD was smaller then on usual combination which widely used. Two surgical cases with FH revealed impaired renal function under conventional LVAD- IABP drive up to 48 hours, but progressive improvement of renal function was observed 12 hours after BDD use. Case 1 showed s-cr 4.5 - 1.4mg/dl,BUN 60 - 38mg/dl and case 2, s-cr 3.4 - 1.4mg/dl, BUN 57 - 38mg/dl and they weaned fron LVAD within 5 days after surgery maintaining normal renal function. Determination of left ventricular function curve is very easy and accuarte method to dicise the timing of the weaning from LVAD, and inlet-outlet canula with pressure senser was devised to obtain accurate left atrial and aortic pressures from the chamber of LVAD.

左心室辅助装置（LVAD）和主动脉内球囊反搏（IABP）常需要同时驱动，但主动脉内球囊扩张对LVAD反搏血流产生阻力，减少肾血流量，导致肾功能不全。为了解决这个问题，一个新的顺序方法，二分舒张驱动（BDD）的设计。在主动脉瓣口二等分后，LVAD在瓣口的前半部分展开，随后主动脉内球囊在剩余的后半部分膨胀，在BDD时，两个装置对衰竭心脏（FH）起反搏（CP）作用，产生高主动脉压（AP），全身BF分布不受干扰，球囊放气对FH产生收缩期卸载。实验结果表明，BDD组的肾BF和肾功能分数下降幅度均小于目前广泛应用的常规联合用药组。2例FH手术病例在常规LVAD-IABP驱动下显示肾功能受损长达48小时，但在使用BDD后12小时观察到肾功能逐渐改善。例1术后s-cr 4.5 ~ 1.4mg/dl，BUN 60 ~ 38 mg/dl;例2术后s-cr 3.4 ~ 1.4mg/dl，BUN 57 ~ 38 mg/dl，术后5天内脱离LVAD，肾功能正常。测定左心室功能曲线是判断LVAD撤机时机的简便而准确的方法，并设计了带压力传感器的进、出口套管，以获得LVAD腔内准确的左房压和主动脉压。