Açık kalp cerrahisinde pompa sisteminden oksijenatörün çıkarılması: deneysel hayvan çalışması

Amaç: Koyun kullanılan bu deneysel çalışmada, pompa ile yapılan rutin açık kalp cerrahisi yönteminde, oksijenatör yerine pulmoner sistemin kullanılabileceği hipotezinin teknik olarak mümkün olup olmadığı araştırılmıştır.Gereç ve Yöntem: Beş adet dişi Ankara koyunu kullanılan çalışmada hayvanlara pompa ile açık kalp ameliyatı uygulanmıştır. Temel fark venöz kanülasyon sağ atriyum yerine sol atriyuma yapılmış, oksijenatör sistemden çıkarılmıştır. Kardiyak arrest için 2 denekte ventriküler fibrilasyon, 2 denekte kros klemp-potasyum kardiyoplejisi tekniği kullanılmıştır. 30 dakika boyunca sürüdülen kardiyak arrest boyunca debiler, tansiyonlar, arter kan gazı değerleri gibi hemodinamik parametreler kaydedilmiştir. İlk denek tekniğin gerekli şekilde uygulanması sonucu pompa aşamasında ölmüştür. Diğer hayvanların hayatı test sonuçları elde edildikten sonra sonlandırılmıştır. Sonuç: İn vivo olarak, tamamen hidrodinamik bir test şeklinde yürütülen çalışmada tekniğin en azından bu testte mümkün olabildiği görülmüştür. Hemodinaminin sıkı takibi ve santral venöz basıncın 18 mmHg civarında tutulmasıyla, ek bir pompaya gerek kalmadan sağ atriyum kanı spontan olarak sol atriyuma geçebilmiştir. Geçen kan miktarı 30dk boyunca, hedef kardiyak indeksin üzerinde stabil olarak sağlanabilmiştir. Çalışmanın düşündürdüğü bir başka sonuç da; akut miyokard infarktüsü gibi bir nedenle kalbin ventriküler fibrilasyona girdiği veya elektriksel iletinin bozularak kalbin kasılmadığı durumlarda sadece sol atriyum-aort arasına perkütan olarak yerleştirilecek bir pompa sistemiyle kardiyak ve sistemik dolaşımda perfüzyon sağlanabileceği şeklindedir.

Anahtar Kelimeler:

Oksijenatör, pompa ile açık kalp cerrahisi, akut miyokard infarktüsü, ventriküler fibrilasyon

Removal of oxygenator from pump system in open heart surgery: experimental animal study

Aim: In this experimental study using sheep, it has been investigated whether the hypothesis that the pulmonary system can be used instead of the oxygenator is technically possible in routine open heart surgery method.Material and Method: In this study, 5 female Ankara sheep were used. The main difference was that the venous cannulation was made to the left atrium instead of the right atrium and the oxygenator was removed from the system. Ventricular fibrillation was performed in 2 subjects for cardiac arrest and cross clamp-potassium cardioplegia was used in 2 subjects. Hemodynamic parameters such as flow rates, blood pressure, arterial blood gas values were recorded during 30 minutes of cardiac arrest. The first subject died in the pump stage due to the wrong application of the technique. The life of the other animals was terminated after the test results were obtained. Results: In this in vivo study, which was conducted in the form of a fully hydrodynamic test, it has seen at least possible for this test. With a strict follow-up of hemodynamic parameters and provide central venous pressure as 18mmHg, the right atrial blood could spontaneously pass into the left atrium without the need for an additional pump. The amount of blood passed was stable over the target cardiac index for 30 min. Another result of the study gave rise to a thought that, in case such as heart attack, cardiac and systemic circulation and perfusion may be provided by a pump system which will be placed percutaneously between the left atrial and aorta when the heartbeat is ended due to VF or the electrical conduction fails.

Keywords:

Oxygenator, on-pump heart surgery, acute myocardial infarction, ventricular fibrillation,

PDF

___

1. Zakkar M, Guida G, Suleiman M, Angelini GD. Cardiopulmonary bypass and oxidative stress. Oxidative medicine and cellular longevity, 2015.2. Ricci M, Karamanukian HL, Abraham R, Von Fricken K, D’Ancona G, Choi S. Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass. Ann Thorac Surg 2000;69:1471-5.3. Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993;55:552-9.4. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002;21:232-44.5. Wagner R, Piler P, Uchytil B, Halouzka R, Kovaru H, Bobkova M, Nemec P. Systemic inflammatory response syndrome is reduced by preoperative plasma-thrombo-leukocyte aphaeresis in a pig model of cardiopulmonary bypass. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc, 2016;160.6. Hirai S. Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass. Ann Thorac Cardiovasc Surg 2003;9:365-70.7. Parikh CR, Schaub JA. Acute kidney injury: Steroids for prevention of AKI after cardiopulmonary bypass. Nature Reviews Nephrology, 2015;11:509-10.8. Nee L, Giorgi R, Garibaldi V, Bruzzese L, Blayac D, Fromonot J. Ischemia-modified albumin and adenosine plasma concentrations are associated with severe systemic inflammatory response syndrome after cardiopulmonary bypass. J Crit Care. 2013;28:747-55.9. Axelrod DM, Sutherland SM, Anglemyer A, Grimm PC, Roth SJ. A double-blinded, randomized, placebo-controlled clinical trial of aminophylline to prevent acute kidney injury in children following congenital heart surgery with cardiopulmonary bypass. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2016;17:135.10. Hosoyama K, Ito K, Kawamoto S, Kumagai K, Akiyama M, Adachi O, Shimizu Y. Poly-2-methoxyethylacrylate-coated cardiopulmonary bypass circuit can reduce transfusion of platelet products compared to heparin-coated circuit during aortic arch surgery. Journal of Artificial Organs. 2016;19:233-40.11. Kofidis T, Baraki H, Singh H, Kamiya H, Winterhalter M, Didilis V, Klima U. The minimized extracorporeal circulation system causes less inflammation and organ damage. Perfusion 2008;23: 147-51.12. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971;26:240–8.13. Gewillig, Marc. "The fontan circulation." Heart 91.6 2005:839-46.14. Apostolakis EE, Koletsis EN, Baikoussis NG, Siminelakis SN, Papadopoulos GS. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. Journal of cardiothoracic surgery, 2010;5:1.15. Iwahashi H, Yuri K, Nosé Y. Development of the oxygenator: past, present, and future. Journal of Artificial Organs. 2004;7:111-20.16. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, Novitzky D. On-pump versus off-pump coronary-artery bypass surgery. New England J Med, 2009;361:1827-37.17. Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J, 2006;151:198.