EXTRACORPOREAL PERFUSION FOR ACUTE MYOCARDIAL INFARCTION

急性心肌梗死的体外灌注

• 批准号: 3351218
• 负责人: L HENRY EDMUNDS
• 金额: $ 23.74万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1986
• 资助国家: 美国
• 起止时间: 1986-04-01 至 1990-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3351218
• 关键词: acute disease /disorder; blood oxygenator; cardiovascular shunt surgery; coronary occlusion /thrombosis; disease /disorder model; extracorporeal circulation; heart failure; heart function; heart ventricle; myocardial infarct sizing; myocardial infarction; myocardial ischemia /hypoxia

This proposal will test the hypothesis that temporary extracorporeal circulatory assistance (TECA) can accelerate recovery of left ventricular function, reduce infarct size, and thereby improve survival by reducing circumferential and regional myocardial wall stresses after acute myocardial infarction (AMI) with or without reperfusion of the obstructed coronary artery. Centrifugal pump perfusion systems will be modified for use in AMI by developing techniques for peripheral, percutaneous cannulation, cannulation of the left atrium without thoracotomy, pulsatile perfusion, and perfusion with low dose or no heparin. Seven perfusion system combinations, suitable for use in AMI, will then be evaluated for their ability to reduce left ventricular wall stress in poorly contractile, pentobarbital-suppressed sheep hearts. Left atrial-to-femoral artery and veno-arterial bypass systems with both continuous and timed pulsatile flow with and without intra-aortic balloon counterpulsation will be studied. One system, which maximally reduces left ventricular wall stress and which is most practical for use in AMI, will be chosen for AMI studies. The ability of TECA to accelerate recovery of well-perfused, poorly contractile ventricular segments and to reduce infarct size will be evaluated in sheep with occlusion of the circumflex coronary artery. Myocardial regional wall shortening, wall thickness and short and long axis diameters will be measured by sonomicrometry in addition to aortic flow and cardiac chamber pressures. Awake sheep will be perfused for 96 hours using the chosen TECA system and compared to unperfused control animals. Calculated estimates of regional wall stresses will be made, and after euthanasia, size of the infarcted area will be determined. The effects of reperfusion of reversibly and irreversibly ischemic myocardium on regional wall motion, calculated estimates of regional wall stress, and overall ventricular function with and without TECA will be determined in the sheep model of circumflex coronary artery occlusion. The data obtained will define the role, if any, of TECA in AMI and will quantitate changes in regional wall motion, calculated estimates of regional wall stress, and overall ventricular performance after no, early, and late reperfusion of an obstructed coronary artery. This information may influence current management of patients with large acute myocardial infarctions.

本提案将检验临时体外循环 循环辅助（TECA）可加速左室功能恢复 功能，减少梗死面积，从而通过减少 急性心肌梗死后心肌壁周向和局部应力 心肌梗死（AMI）伴或不伴阻塞再灌注 冠状动脉 离心泵灌注系统将被修改用于AMI， 开发外周、经皮插管、插管 无开胸术、搏动灌注和灌注的左心房 低剂量或无肝素。 七种灌注系统组合，适用于 用于AMI，然后将评估其减少左心室功能的能力， 收缩不良、戊巴比妥抑制的 羊心 左心房-股动脉和静脉-动脉搭桥术 具有连续和定时脉动流的系统， 将研究主动脉内气囊反搏。 一个系统， 最大限度地降低左心室壁应力， 用于AMI研究。 TECA加速血流灌注良好、血流灌注差的 收缩心室节段和减少梗死面积将是 在冠状动脉回旋支闭塞的绵羊中进行评价。 心肌节段性室壁缩短、室壁厚度及短、长轴 除主动脉血流外，还将通过超声测微法测量直径， 心腔压 清醒的绵羊将被灌注96小时， 选择TECA系统并与未灌注的对照动物进行比较。 将对区域壁应力进行计算估计， 安乐死后，将确定梗死面积的大小。 可逆性和不可逆性缺血再灌注对脑缺血再灌注损伤的影响 局部室壁运动的心肌，计算局部室壁运动的估计值 压力和整体心室功能，有或没有TECA将是 在羊回旋冠状动脉闭塞模型中测定。 所获得的数据将确定TECA在AMI中的作用（如果有的话），并将 定量局部室壁运动的变化，计算 局部室壁应力和整体心室性能， 以及阻塞的冠状动脉的晚期再灌注。 这些信息 可能影响大面积急性心肌梗死患者的当前管理 梗塞