外置主动脉旁反搏装置对急性心衰的辅助效果

摘要

Objective An out-thoracic paraaortic counterpulsation device(PACD) developed in the Reseach Center of our hospital was evaluated for its hemodynamic effects in an animal model with induced acute heart failure.Methods Eight healthy adult sheep with a weight of 38.5 to 54.5 kg were used as models for acute heart failure by snaring branches of coronary arteries.Thoracotomy was performed through the space under the left 4th rib.A Satinski clamp was used for partially clamping the descending aorta, and the Dacron vascular graft of out-thoracic PACD was sutured end-to-side to the descending aorta.The out-thoracic PACD used in this study had a blood chamber that was separated from the gas chamber by a movable polyurethane membrane .A stroke volume of 60 ml could be pumped when it was fully inflated.A 4F multipurpose catheter was inserted through the left ventricular apex for measuring and recording left ventricular pressures.A standard 40-ml intraaortic balloon was inserted into the descending aorta via the surgically exposed left femoral artery.Baseline hemodynamic data were collected after the model for acute heart failure was created without mechanical support.Mechanical support was randomly initiated either by the IABP or by the out-thoracic PACD in each experimental phase.Both devices were driven by the same console and synchronization with electrocardiogram was performed.Hemodynamic indexes and left carotid artery flow were calculated at baseline (device off) and during the period of 1 : 2 support for the 60-ml out-thoracic PACD and 40-ml IABP in the same animal.Baseline and support modes for devices were maintained for 15 minutes individually to ensure that a steady-state was achieved.Results Both out-thoracic PACD and IABP resulted in a increase in the cardiac output (17.79％ with out-thoracic PACD vs.13.46％ with IABP, P =0.803) and the mean diastolic aortic pressure (29.48％ with out-thoracic PACD vs.15.01％ with IABP, P = 0.001).The use of out-thoracic PACD also led to a greater reduction in left ventricular end-diastolic pressure (35.09％ with out-thoracic PACD vs.15.79％ with IABP, P = 0.004).Meanwhile the out-thoracic PACD increased left carotid artery flow (14.52％ with out-thoracic PACD vs.6.70％ with IABP, P =0.006).No evidence of hemolysis, thrombus formation or major organ injury was identified during the experiment.Conclusion The study indicated that a 60-ml out-thoracic PACD, which providing an improved mechanical circulatory support, was superior to a 40-ml IABP in the setting of experimental acute heart failure.This device may be used as a desirable alternative for the long-term mechanical support in patients with severe heart failure or those waiting for a heart transplantation, owing to its properties of low cost,easily to be implanted and removed, as well as a high biocompatibility.%目的 探讨外置主动脉旁反搏装置(out-thoracic paraaortic counterpulsation device,OTPACD)对急性心衰的辅助效果。方法 选成年绵羊8只，将自制OTPACD(每搏量60 ml)的无瓣人工血管吻合于降主动脉，反搏泵放置于胸外。同时于降主动脉内置入IABP球囊(容量40ml)。结扎冠状动脉分支建立急性心衰动物模型，随机采用OTPACD或IABP进行反搏辅助。记录心衰前后和采用不同辅助方法后实验动物血流动力学指标。结果 IABP和OTPACD辅助后，实验动物心输出量增加13.46％(P=0.002)和17.79％ (P=0.000)，二者相比，P=0.803；舒张期平均动脉压分别增高为15.01％ (P =0.003)和29.48％ (P =0.000)，二者相比，P=0.001。IABP和OTPACD辅助后左室舒张末压分别降低为15.79％ (P =0.002)和35.09％ (P =0.001)，二者相比，P=0.004;左侧颈动脉流量分别增加6.70％ (P =0.003)和14.52％(P=0.001)，二者相比，P=0.006。结论 IABP对急性心衰动物有良好的辅助作用，而OTPACD进一步增加了心输出量，提高了舒张期平均动脉压，降低了左心室舒张末压，改善心脏功能，增加脑部灌注，对急性心衰辅助效果优于IABP。