EXTRACORPOREAL PERFUSION FOR ACUTE MYOCARDIAL INFARCTION

急性心肌梗死的体外灌注

• 批准号: 3351222
• 负责人: L HENRY EDMUNDS
• 金额: $ 22.28万
• 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/3351222
• 关键词: acute disease /disorder; blood oxygenator; cardiovascular shunt surgery; coronary occlusion /thrombosis; disease /disorder model; dogs; extracorporeal circulation; heart failure; heart function; heart ventricle; myocardial infarct sizing; myocardial infarction; myocardial ischemia /hypoxia; sheep

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.

该提案将检验以下假设：临时体外 循环辅助（TECA）可以加速左心室的恢复 功能，减少梗塞面积，从而通过减少 急性发作后周向和局部心肌壁应力 伴有或不伴有梗阻再灌注的心肌梗死 (AMI) 冠状动脉。 离心泵灌注系统将经过改造以用于 AMI 开发外周、经皮插管、插管技术 左心房无需开胸、脉动灌注和灌注 低剂量或无肝素。 七种灌注系统组合，适合 用于 AMI，然后将评估其减少左心室的能力 收缩不良、戊巴比妥抑制的心室壁应力 羊心。 左心房至股动脉和静脉动脉旁路 具有连续和定时脉动流的系统，有或没有 将研究主动脉内球囊反搏。 一个系统，其中 最大限度地减少左心室壁应力，这是最实用的 用于 AMI，将被选择用于 AMI 研究。 TECA 能够加速灌注良好、灌注不良的患者的恢复 收缩心室节段并减少梗塞面积 在回旋冠状动脉闭塞的绵羊身上进行了评估。 心肌局部壁缩短、壁厚以及短轴和长轴 除了主动脉流量之外，还将通过声测微法测量直径 心室压力。 清醒的羊将被灌注 96 小时 选择的 TECA 系统并与未灌注的对照动物进行比较。 将计算出区域壁应力的估计值，然后 安乐死后，将确定梗塞区域的大小。 可逆性和不可逆性缺血再灌注的影响 心肌对局部室壁运动的影响，局部室壁的计算估计 使用和不使用 TECA 时的压力和整体心室功能将 在绵羊回旋支冠状动脉闭塞模型中测定。 获得的数据将定义 TECA 在 AMI 中的作用（如果有的话），并将 量化区域壁运动的变化，计算出估计值 区域壁应力和整体心室表现后没有，早期， 以及阻塞的冠状动脉的晚期再灌注。 此信息 可能会影响大急性心肌病患者的当前治疗 梗塞。