Name: complete and partial aortic occlusion for the treatment of hemorrhagic shock in swine
Uploaded: 2018-08-24T14:45:00.000+00:00
Duration: 9 min 37 s
Description: Watch this Scientific Journal Video about Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine at JoVE.com

우리는 그들의 동물 연구를 레이첼 오코넬 제시카 리를 인정 하 고 싶습니다. 우리 또한 소 령 일반 해 롤 드 Timboe, 메릴랜드, MPH, 미국 육군 (ret.), 누구는 고문과이 프로젝트에 대 한 멘토를 인정 하 고 싶습니다.

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E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+REBOA+in+the+control+of+exsanguinating+torso+hemorrhage.">The role of REBOA in the control of exsanguinating torso hemorrhage.</a> Journal of Trauma and Acute Care Surgery. 78 (5), 1054-1058 (2015).</li><li>Manzano Nunez, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+meta-analysis+of+resuscitative+endovascular+balloon+occlusion+of+the+aorta+(REBOA)+or+open+aortic+cross-clamping+by+resuscitative+thoracotomy+in+non-compressible+torso+hemorrhage+patients.">A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients.</a> World Journal of Emergency Surgery. 12, 30 (2017).</li><li>Gupta, B. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+intra-aortic+balloon+occlusion+in+penetrating+abdominal+trauma.">The role of intra-aortic balloon occlusion in penetrating abdominal trauma.</a> Journal of Trauma. 29 (6), 861-865 (1989).</li><li>Inoue, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resuscitative+endovascular+balloon+occlusion+of+the+aorta+might+be+dangerous+in+patients+with+severe+torso+trauma:+A+propensity+score+analysis.">Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: A propensity score analysis.</a> Journal of Trauma and Acute Care Surgery. 80 (4), 559-566 (2016).</li><li>Russo, R. 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B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surviving+blood+loss+without+blood+transfusion+in+a+swine+poly-trauma+model.">Surviving blood loss without blood transfusion in a swine poly-trauma model.</a> Surgery. 146 (2), 325-333 (2009).</li><li>Jin, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traumatic+brain+injury+and+hemorrhagic+shock:+evaluation+of+different+resuscitation+strategies+in+a+large+animal+model+of+combined+insults.">Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults.</a> Shock. 38 (1), 49-56 (2012).</li><li>Nikolian, V. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Valproic+acid+decreases+brain+lesion+size+and+improves+neurologic+recovery+in+swine+subjected+to+traumatic+brain+injury,+hemorrhagic+shock,+and+polytrauma.">Valproic acid decreases brain lesion size and improves neurologic recovery in swine subjected to traumatic brain injury, hemorrhagic shock, and polytrauma.</a> The Journal of Trauma and Acute Care Surgery. 83 (6), 1066-1073 (2017).</li><li>Langeland, H., Lyng, O., Aadahl, P., Skjaervold, N. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+coherence+of+macrocirculation,+microcirculation,+and+tissue+metabolic+response+during+nontraumatic+hemorrhagic+shock+in+swine.">The coherence of macrocirculation, microcirculation, and tissue metabolic response during nontraumatic hemorrhagic shock in swine.</a> Physiological Reports. 5 (7), (2017).</li><li>Johnson, M. 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이 작품은 미국 육군 의료 연구 및 계약 번호 아래 물자 명령에 의해 지원 W81XWH-16-C-0102입니다. 조회, 의견 및 결과이 보고서에 포함 된의 저자 고 해석 해서는 안 육군 위치, 정책, 또는 결정의 공식 학과로 그래서 다른 설명서 지정 하지 않는 한.

이 프로토콜에서 우리 돼지에서 출혈 충격 모델을 강조. 이 모델은 안정적이 고 재현16,17,,1819수를 보였다. 유사한 모델 동물 생리학16,20에 출혈 충격의 효과 조사 하는 여러 과학적 연구에서 고용 있다. 또한,이 모델 또한 표시 성공12,</...

출혈 환자 충격적인 사건, 군사 설정에서 외상 관련 된 죽음의 90% 및 민간인 인구1, 에서 외상 후 죽음의 40%에서에서 예방 가능한 죽음의 지배적인 원인이 되 2. 직접 압력 압축할 출혈을 치료할 수, 비록 비 압축할 몸통 출혈 하기 어려운 남아 치료 및 신속한 hemostatic 제어 없이 치명적일 수 있다. Resuscitative thoracotomy 또는 대동맥 크로스 클램핑으로 개복 술의 역사적 접근은 극단적으로 침략 적3,4을 입증 했다. 이 개입에는 외상 성 모욕5받은 환자 후보를 결정 하는 복잡 한 선택 알고리즘을 또한 필요 합니다.
최근 몇 년 동안, 앞에서 설명한 접근 방식에 대 한 관심의 부활 하고있다-대동맥 (REBOA)6,,78의 resuscitative 혈관 내 수술 풍선 폐색. REBOA 출혈에 단기 생존 이점을 수 여, 비록 풍선 인플레이션 동안 대동맥의 머리말 붙인된 완전 한 폐색 돌이킬 수 없는 끝-기관 허 혈9,10를 포함 하는 심각한 우려를 제기 한다. 이 잠재적인 병 적 상태를 극복 하기 위해 시도, 출혈 관리할 대체 혈관 내 수술 전략 고안 되 있다. 성장 주의 본 한 이러한 전략은 대동맥11,12의 부분 폐색. 부분 대동맥 풍선 폐색의 아이디어는 폐색, 향상 된 생리 인접 대동맥 지도 및 점진적 afterload 감소 풍선 디플레이션을 다음의 사이트에 말 초 혈관 침대의 관류를 준다. 매개 변수에서 이러한 변화는 출혈 동물의 생리 적 특성을 원하는 수정. 인 간에 게이 방법의이 번역, 이전 완료 하 고 부분 대동맥 풍선 폐색 카 무 겁 게 출혈 충격11,,1213의 돼지 모델에서 테스트 되었습니다.
돼지는 몇 년 동안 출혈 충격을 반하는 연구에 이용 되었다. 출혈 성 쇼크의 병 태 생리학의 현재 이해의 대부분은 돼지를 포함 하 여 동물 모델 활용 연구에서 파생 됩니다. 그들의 생리학 및 항상성 응답 pathologic 볼륨 고갈 다음 출혈, 혈액 응고 및 심장 혈관 응답에 관련 된 특히 그들, 잘 문서화 되어 있으며 인간14같은 설정에서. 출혈 충격의 돼지 모델 또한 출혈 충격에 대 한 치료 전략 및 기타 외상 성 부상 조사 수 있는 기회를 제공 합니다.
이 연구에서 전체 및 부분 대동맥 풍선 폐색 등 혈관 내 수술 치료 전략을 평가 하는 돼지에서 출혈 충격의 임상 현실적인 모델을 설명 합니다. 우리는 더 나은 physiologic 귀착되는 대동맥의 부분 폐색 및 실험실 프로필 제어 고정 볼륨 출혈을 겪고 돼지에서 대동맥의 완전 한 폐색에 비해 가설.
우리 돼지 모델에서 출혈 성 쇼크에 대 한 치료로 부분 하 고 완전 한 대동맥 폐색의 생리 효과 비교 목적. 부분 대동맥 폐색 외상 (송탄) 카 테 터 (그림 1)에서 선택적 대동맥 풍선 폐색을 사용 하 여 달성 되었다. 송탄 테 2-풍선 수 있는 시스템을 내부 luminal 혈액의 흐름, 그로 인하여 혈관 침대는 폐색에 원심 부분 대동맥 흐름을 제공 하는. 완전 한 대동맥 폐색 (예를 들어,코 다) 대동맥 폐색 단일 풍선 카 테 터를 사용 하 여 달성 되었다 (그림 1). 치료 그룹 전체 또는 부분 대동맥 풍선 폐색 카 resuscitative 대동맥 폐색을 무작위로 했다 (n = 2/그룹).
마 취 및 삽 관 법의 유도, 마 취, 계측, 35 %TBV 출혈 (20 분 총; 첫 번째 7 분 동안 절반 및 절반 나머지 13 분 이상), 대동맥 풍선 폐색의 유지 보수를 포함 하는 모델의 주요 단계 및 전 혈 소생 (폐색의 60 분;는 폐색의 마지막 20 분 동안 20% 전체 혈액 소생), 중요 한 관리 hemodynamic 관찰, 그리고 수확 하는 조직으로 안락사 (240 분) 모니터링. 그림 2 에서는이 실험에 활용 하는 모델을 보여 줍니다.

<table><tbody><tr><td>Yorkshire-Landrace Swine</td><td>Michigan State University Veterinary Farm</td><td></td><td></td></tr><tr><td>Anesthesia: Telazol</td><td>Pfizer</td><td></td><td>Dose: 2-8 mg/kg; IM</td></tr><tr><td>Anti-cholinergic: Atropine</td><td>Pfizer</td><td></td><td>Dose: 1mg, IM</td></tr><tr><td>Anesthesia: Isoflurane</td><td>Baxter</td><td></td><td>Dose: 1-5%, INH</td></tr><tr><td>Betadine</td><td>Humco</td><td></td><td></td></tr><tr><td>Alcohol 70%</td><td>Humco</td><td>NDC 0395-4202-28</td><td></td></tr><tr><td>Datex-Aespire Anesthesia Machine</td><td>GE Healthcare</td><td>7900</td><td></td></tr><tr><td>Endotracheal tube</td><td>DEE Veterinary</td><td>20170518</td><td>Appropriate size for animal (6.5 or 7.0F)</td></tr><tr><td>Laryngoscope</td><td>Miller</td><td>85-0045</td><td></td></tr><tr><td>Stylet</td><td>Hudson RCI</td><td>5-151--1</td><td></td></tr><tr><td>Jelco 20G IV Catheter</td><td>Smiths Medical</td><td>4054</td><td></td></tr><tr><td>Operating Room Monitor (Vital Signs Monitor)</td><td>SurgiVet Advisor</td><td>V9201</td><td>May require at least 2</td></tr><tr><td>Surgical Gowns</td><td>Kimberly Clark</td><td>90142</td><td>Use appropriate size for surgeon.</td></tr><tr><td>Sterile surgical gloves</td><td>Cardinal Health (Allegiance)</td><td>22537-570</td><td>Use appropriate size for surgeon.</td></tr><tr><td>Cautery Pencil</td><td>Medline</td><td>ESPB 2000</td><td></td></tr><tr><td>Suction tubing</td><td>Medline</td><td>DYND50251</td><td></td></tr><tr><td>Sunction tip: Yankauer</td><td>Medline</td><td>DYND50130</td><td></td></tr><tr><td>Bovie Aaron 1250 Electrocautery Unit</td><td>Bovie Medical Co. FL</td><td>BOV-A1250U</td><td></td></tr><tr><td>Salpel Blade - Size #10</td><td>Cardinal Health (Allegiance)</td><td>32295-010</td><td></td></tr><tr><td>Scalpel Handle</td><td>Martin</td><td>10-295-11</td><td></td></tr><tr><td>Debakey Forceps</td><td>Roboz</td><td>RS-7562</td><td></td></tr><tr><td>Weitlander Retractor</td><td>Roboz</td><td>RS-8612</td><td></td></tr><tr><td>Mayo Scissors</td><td>Roboz</td><td>RS-76870SC</td><td></td></tr><tr><td>Army-navy Retractor</td><td>Teleflex</td><td>164715</td><td></td></tr><tr><td>Mixter Right-angle Forceps</td><td>Teleflex</td><td>175073</td><td></td></tr><tr><td>5F (1.7 mm) 11 cm Insertion Sheath with 0.35&quot; Guidewire</td><td>Boston Scientific</td><td>16035-05B</td><td></td></tr><tr><td>8F (2.7 mm) 11 cm Insertion Sheath with 0.35&#039;&#039; Guidewire</td><td>Boston Scientific</td><td>16035-08B</td><td></td></tr><tr><td>20G angled Introducer Needle</td><td>Arrow</td><td>AK-09903-S</td><td></td></tr><tr><td>14F (4.78 mm) 13 cm Insertion Sheath with 10F dilator</td><td>Cook Medical</td><td>G08024</td><td></td></tr><tr><td>2-0 Silk 18&#039;&#039; 45 cm</td><td>Ethicon</td><td>A185H</td><td></td></tr><tr><td>3-0 Vicryl 36&#039;&#039; 90 cm</td><td>Ethicon</td><td>J344H</td><td></td></tr><tr><td>3-0 Nylon 18&#039;&#039; 45 cm</td><td>Ethicon</td><td>663G</td><td></td></tr><tr><td>4-0 Prolene 30&#039;&#039; 75 cm</td><td>Ethicon</td><td>8831H</td><td></td></tr><tr><td>20 ml syringe</td><td>Metronic/Covidien</td><td>8881512878</td><td></td></tr><tr><td>3 mL syringe</td><td>Metronic/Covidien</td><td>1180300555</td><td></td></tr><tr><td>6 mL syringe</td><td>Metronic/Covidien</td><td>1180600777</td><td></td></tr><tr><td>1000ml 0.9% Saline</td><td>Baxter</td><td>2B1324X</td><td></td></tr><tr><td>Foley Catheter (18F 30 cc)</td><td>Bard</td><td>0166V18S</td><td></td></tr><tr><td>Urinary Drainage Bag</td><td>Bard</td><td>154002</td><td></td></tr><tr><td>9F 10 cm Insertion Sheath</td><td>Arrow</td><td>AK-09903-S</td><td></td></tr><tr><td>Swan-Ganz pulmonary artery catheter (8F)</td><td>Edwards Lifesciences co. CA</td><td>746F8</td><td></td></tr><tr><td>Carotid Flow Probe System</td><td>Transonic, Ithaca, NY</td><td></td><td>3, 4, or 6 mm probes</td></tr><tr><td>SABOT catheter</td><td>Hayes Inc.</td><td></td><td></td></tr><tr><td>CODA balloon catheter</td><td>Cook Medical</td><td>8379144</td><td></td></tr><tr><td>Ultrasound, M-Turbo</td><td>SonoSite</td><td></td><td></td></tr><tr><td>Amplatz Stiff Guidewire (0.035 inch, 260 cm)</td><td>Cook Medical</td><td>G03460</td><td></td></tr><tr><td>Arterial Blood Gas Syringes</td><td>Smiths Medical</td><td>4041-2</td><td></td></tr><tr><td>Arterial Blood Gas Analyzer</td><td>Nova Biochemical</td><td>ABL800</td><td></td></tr><tr><td>Masterflex Pump</td><td>Cole Palmer</td><td>HV-77921-75</td><td></td></tr><tr><td>Blood Collection Bags</td><td>Terumo</td><td>1BBD606A</td><td></td></tr><tr><td>Macro IV drip set</td><td>Hospira</td><td>12672-28</td><td></td></tr><tr><td>Pentobarbital</td><td>Pfizer</td><td></td><td>Dose: 100 mg/kg; IV</td></tr><tr><td>Eppendorf Tubes</td><td>Sorenson</td><td>11590</td><td></td></tr><tr><td>50 cc conical tubes</td><td>Falcon</td><td>352097</td><td></td></tr><tr><td>Formalin</td><td>Fisherbrand</td><td>431121</td><td></td></tr><tr><td>Bair Hugger Normothermia System</td><td>Arizant Healthcare, Inc.</td><td></td><td></td></tr></tbody></table>

complete and partial aortic occlusion for the treatment of hemorrhagic shock in swine

출혈 외상에 예방 가능한 사망의 주요 원인이 남아 있습니다. 비 압축 몸통 출혈의 혈관 내 수술 관리 최근 몇 년 동안에서 외상 치료의 최전선에 왔다. 완전 한 대동맥 폐색 선물 심각한 우려, 이후 부분 대동맥 폐색의 개념 성장 주의 얻고 있다. 여기, 우리 소설 부분 대동맥 풍선 폐색 카 테 터의 효과 조사 하 고 완전 한 대동맥 폐색의 원리에 작동 하는 카 테 터와 비교를 출혈 충격의 큰 동물 모델 제시. 돼지는 취 하 고 제어 고정 볼륨 출혈을 수행 하려면 계측 hemodynamic 및 생리 적 매개 변수 모니터링 됩니다. 출혈, 따라 대동맥 풍선 폐색 카 테 터 삽입 하 고는 동물 (TBV) 총 혈액 량의 20%로 전체 혈액 소생 받을 60 분, supraceliac 대동맥에 비정상적으로 증가. 풍선 디플레이션, 다음 동물 동안 유체 소생술을 받아 vasopressors 필요에 따라 4 h에 대 한 중요 한 치료 환경에서 모니터링 됩니다. 부분 대동맥 풍선 폐색 풍선 인플레이션 동안 향상 된 원심 평균 동맥 압력 (지도)를 시연, 허 혈, 마커를 감소 하 고 소생은 유체와 vasopressor 사용 감소. 돼지 생리학 및 항상성 응답 출혈 다음 문서화 되었습니다 하 고 인간, 그 같은 돼지 출혈 충격 모델 다양 한 치료 전략을 테스트를 사용할 수 있습니다. 출혈을 치료, 뿐만 아니라 대동맥 풍선 폐색 카 심장 마비, 심장 및 혈관 수술, 및 다른 고 위험도 선택 수술 절차에 그들의 역할에 대 한 인기가 있다.

Hemodynamic 및 생리 적 매개 변수:
지도 (그림 3A - 3D) 출혈 후 즉시 감소. 풍선 인플레이션 단계 동안 완전 한 폐색 그룹에서 동물 부분 폐색 그룹 (그림 3A 와 3B)에서 동물에 비해 더 높은 인접 지도 경험. 풍선 물가 동안 평균 원심 지도 완전 한 폐색 그룹에 비해 부분 폐색 그룹에서 ...

Watch this Scientific Journal Video about Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine at JoVE.com

Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

여기, 선물이 대동맥 폐색 외상에 확실 한 치료에 다리를 사용 하는 돼지에서 출혈 충격 모델을 설명 하는 프로토콜. 이 모델은 다양 한 수술 및 약물 치료 전략을 테스트 응용 프로그램.

돼지에서 출혈 성 쇼크의 치료에 대 한 전체 및 부분 대동맥 폐색

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the ...

complete-partial-aortic-occlusion-for-treatment-hemorrhagic-shock

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JoVE Journal

Medicine

10.4K 조회수.  University of Michigan. 여기, 선물이 대동맥 폐색 외상에 확실 한 치료에 다리를 사용 하는 돼지에서 출혈 충격 모델을 설명 하는 프로토콜. 이 모델은 다양 한 수술 및 약물 치료 전략을 테스트 응용 프로그램.

비디오: Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Myocardial Infarction and Functional Outcome Assessment in Pigs

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents.

This protocol describes the porcine myocardial infarction (MI) model using a 90 min closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. Furthermore, the protocol for several outcome parameters, such as cardiac function, hemodynamics, microvascular resistance, and infarct size, are also presented.

돼지의 심근 경색 및 기능적 결과의 평가

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One ...

연구

의학

A Chronic Cardiac Ischemia Model in Swine Using an Ameroid Constrictor

Cardiovascular disease remains the number one cause of mortality in the United States. There are numerous approaches to treating these diseases, but regardless of the approach, an in vivo model is needed to test each treatment. The pig is one of the most used large animal models for cardiovascular disease. Its heart is very similar in anatomy and function to that of a human. The ameroid placement technique creates an ischemic area of the heart, which has many useful applications in studying myocardial infarction. This model has been used for surgical research, pharmaceutical studies, imaging techniques, and cell therapies.
There are several ways of inducing an ischemic area in the heart. Each has its advantages and disadvantages, but the placement of an ameroid constrictor remains the most widely used technique. The main advantages to using the ameroid are its prevalence in existing research, its availability in various sizes to accommodate the anatomy and size of the vessel to be constricted, the surgery is a relatively simple procedure, and the post-operative monitoring is minimal, since there are no external devices to maintain. This paper provides a detailed overview of the proper technique for the placement of the ameroid constrictor.

The purpose of this protocol is to demonstrate the placement of a delayed constricting device (an ameroid constrictor) around a coronary artery in a swine model. This device creates an ischemic area of the heart that is useful for studying new diagnostic imaging techniques and new methods of treatment.

Ameroid 압축을 사용 하 여 돼지에서 만성 심장 허 혈 모델

Cardiovascular disease remains the number one cause of mortality in the United States. There are numerous approaches to treating these diseases, but ...

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

Chronic cardiac ischemia that impairs cardiac function, but does not result in infarct, is termed hibernating myocardium (HM). A large clinical subset of coronary artery disease (CAD) patients have HM, which in addition to causing impaired function, puts them at higher risk for arrhythmia and future cardiac events. The standard treatment for this condition is revascularization, but this has been shown to be an imperfect therapy. The majority of pre-clinical cardiac research focuses on infarct models of cardiac ischemia, leaving this subset of chronic ischemia patients largely underserved. To address this gap in research, we have developed a well-characterized and highly reproducible model of hibernating myocardium in swine, as swine are ideal translational models for human heart disease. In addition to creating this unique disease model, we have optimized a clinically relevant treatment model of coronary artery bypass surgery in swine. This allows us to accurately study the effects of bypass surgery on heart disease, as well as investigate additional or alternate therapies. This model surgically induces single vessel stenosis by implanting a constrictor on the left anterior descending (LAD) artery in a young pig. As the pig grows, the constrictor creates a gradual stenosis, resulting in chronic ischemia with impaired regional function, but preserving tissue viability. Following the establishment of the hibernating myocardium phenotype, we perform off-pump coronary artery bypass graft surgery to revascularize the ischemic region, mimicking the gold-standard treatment for patients in the clinic.

This protocol presents a surgical large animal model of chronic, single vessel ischemia that results in regional abnormalities but does not create infarct, known as hibernating myocardium. Following establishment of chronic ischemia, animals are treated with off-pump LIMA-LAD coronary artery bypass graft surgery to revascularize the ischemic tissue.

떨어져 펌프 관상동맥 바이패스 접목 수술에 의해 치료 만성 심장 허 혈의 수술 돼지 모델

Chronic cardiac ischemia that impairs cardiac function, but does not result in infarct, is termed hibernating myocardium (HM). A large clinical subset of ...

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

돼지의 뇌산소측정및 확장된 혈역학적 모니터링에 의해 유도된 표준화된 출혈성 쇼크 유도

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Development of a Selective Aortic Arch Perfusion System in a Porcine Model of Exsanguination Cardiac Arrest

Hemorrhage constitutes the majority of potentially preventable deaths from trauma. There is growing interest in endovascular resuscitation techniques such as selective aortic arch perfusion (SAAP) for patients in cardiac arrest. This involves active perfusion of the coronary circulation via a thoracic aortic balloon catheter and is approaching clinical application. However, the technique is complex and requires refinement in animal models before human use can be considered. This paper describes a large animal model of exsanguination cardiac arrest treated with a bespoke SAAP system.
Swine were anesthetized, instrumented and a splenectomy was performed before a controlled, logarithmic exsanguination was initiated. Animals were heparinized and the shed blood collected in a reservoir. Once cardiac arrest was observed, the blood was pumped through an extra-corporeal circuit into an oxygenator and then delivered through a 10 Fr balloon catheter placed in the thoracic aorta.
This resulted in the return of a spontaneous circulation (ROSC) as demonstrated by ECG and aortic root pressure waveform. This model and accompanying SAAP system allow for standardized and reproducible recovery from exsanguination cardiac arrest.

The goal of this protocol is to demonstrate a porcine exsanguination cardiac arrest model and a specifically built selective aortic arch perfusion circuit for translational research.

Hemorrhage constitutes the majority of potentially preventable deaths from trauma. There is growing interest in endovascular resuscitation techniques such ...

Myocardial Infarction by Percutaneous Embolization Coil Deployment in a Swine Model

Myocardial infarction (MI) is the leading cause of mortality worldwide. Despite the use of evidence-based treatments, including coronary revascularization and cardiovascular drugs, a significant proportion of patients develop pathological left-ventricular remodeling and progressive heart failure following MI. Therefore, new therapeutic options, such as cellular and gene therapies, among others, have been developed to repair and regenerate injured myocardium. In this context, animal models of MI are crucial in exploring the safety and efficacy of these experimental therapies before clinical translation. Large animal models such as swine are preferred over smaller ones due to the high similarity of swine and human hearts in terms of coronary artery anatomy, cardiac kinetics, and the post-MI healing process. Here, we aimed to describe an MI model in pig by permanent coil deployment. Briefly, it comprises a percutaneous selective coronary artery cannulation through retrograde femoral access. Following coronary angiography, the coil is deployed at the target branch under fluoroscopic guidance. Finally, complete occlusion is confirmed by repeated coronary angiography. This approach is feasible, highly reproducible, and emulates the pathogenesis of human non-revascularized MI, avoiding the traditional open-chest surgery and the subsequent postoperative inflammation. Depending on the time of follow-up, the technique is suitable for acute, sub-acute, or chronic MI models.

Myocardial infarction (MI) animal models that emulate the natural process of the disease in humans are crucial to understanding pathophysiological mechanisms and testing the safety and efficacy of new emergent therapies. Here, we describe an MI swine model created by deploying a percutaneous embolization coil.

돼지 모델에서 경피 색전술 코일 배치에 의한 심근 경색

Myocardial infarction (MI) is the leading cause of mortality worldwide. Despite the use of evidence-based treatments, including coronary revascularization ...

Swine Models of Aneurysmal Diseases for Training and Research

Large animal models, specifically swine, are widely used to research cardiovascular diseases and therapies, as well as for training purposes. This paper describes two different aneurysmal swine models that may help researchers to study new therapies for aneurysmal diseases. These aneurysmal models are created by surgically adding a pouch of tissue to carotid arteries in swine. When the model is used for research, the pouch must be autologous; for training purposes, a synthetic pouch suffices.
First, the right external jugular vein (EJV) and right common carotid artery (CCA) must be surgically exposed. The EJV is ligated and a vein pouch fashioned from a short segment. This pouch is then sutured to an elliptical arteriotomy performed in the CCA. Animals must be kept heparinized during model creation, and local vasodilators may be used to decrease vasospasms. Once the suture is completed, correct blood flow should be inspected, checking for bleeding from the suture line and vessel patency. Finally, the surgical incision is closed by layers and an angiography performed to image the aneurysmal model.
A simplification of this aneurysmal carotid model that decreases invasiveness and surgical time is the use of a synthetic, rather than venous, pouch. For this purpose, a pouch is tailored in advance with a segment of a polytetrafluoroethylene (PTFE) prosthesis, one end of which is sutured close using polypropylene vascular suture and sterilized prior to surgery. This "sac" is then attached to an arteriotomy performed in the CCA as described. 
Although these models do not reproduce many of the physiopathological events related to aneurysm formation, they are hemodynamically similar to the situation found in the clinical setting. Therefore, they can be used for research or training purposes, allowing physicians to learn and practice different endovascular techniques in animal models that are close to the human system.

Description of two different aneurysmal swine models for neuroradiology training courses and research studies. This study provides evidence of the feasibility of these aneurysm porcine model creations and the reproducible methods that are close to the clinical setting.

Large animal models, specifically swine, are widely used to research cardiovascular diseases and therapies, as well as for training purposes. This paper ...

Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for hemorrhage control. With the advent of purpose-built devices, REBOA has become increasingly common in civilian trauma and acute care settings. Currently available REBOA catheters were designed as complete aortic occlusion devices. However, the therapeutic window for complete aortic occlusion is time-limited due to ischemia-reperfusion injury. The partial procedure allows blood flow past the level of occlusion while maintaining targeted proximal pressure, which has been shown to reduce distal ischemia and adjunctive resuscitation requirements in preclinical studies with prolonged occlusion times as compared to traditional complete occlusion.
pREBOA-PRO is the first catheter designed to enable partial and complete aortic occlusion and is currently in limited market release at seven Level I trauma centers in North America. This paper will focus on procedural considerations for REBOA, including patient selection criteria and a comparison of complete and partial aortic occlusion in a simulator, along with highlighting critical steps to improve clinical outcomes. Additionally, this paper reviews a contrast-enhanced CT scan from a trauma patient that shows distal perfusion after 2 h of partial aortic occlusion using this newly designed catheter and discusses representative results from the limited market release to highlight the profound effect of technological innovation on outcomes in vascular emergencies.

A commercial catheter was designed to facilitate true partial resuscitative endovascular balloon occlusion of the aorta (REBOA) and address the complications associated with complete aortic occlusion. Initial clinical reports indicate that partial REBOA improves transition to reperfusion, reduction of distal ischemia, and extension of safe occlusion time compared to complete occlusion.

출혈성 쇼크에 대한 대동맥의 완전하고 부분적인 재흡수성 혈관 내 풍선 폐색

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for ...

압력 과부하 유발 심부전을 연구하기 위한 상행 대동맥 밴딩

A Minimally Invasive Model of Aortic Stenosis in Swine

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological similarities to humans. Efforts have been dedicated to creating a model of pressure-overload induced heart failure, and ascending aortic banding while still supra-coronary and not a perfect mimic of aortic stenosis in humans, closely resembling the human condition.
The purpose of this study is to demonstrate a minimally invasive approach to induce left ventricular pressure overload by placing an aortic band, precisely calibrated with percutaneously introduced high-fidelity pressure sensors. This method represents a refinement of the surgical procedure (3Rs), resulting in homogenous trans-stenotic gradients and reduced intragroup variability. Additionally, it enables swift and uneventful animal recovery, leading to minimal mortality rates. Throughout the study, animals were followed for up to 2 months after surgery, employing transthoracic echocardiography and pressure-volume loop analysis. However, longer follow-up periods can be achieved if desired. This large animal model proves valuable for testing new drugs, particularly those targeting hypertrophy and the structural and functional alterations associated with left ventricular pressure overload.

저자 스포트라이트: 신뢰할 수 있고 재현성 있는 심혈관 연구를 위한 최소 침습 대동물 모델 개발 

This protocol describes a minimally invasive surgical procedure for ascending aortic banding in swine.

돼지 대동맥 협착증의 최소 침습 모델

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological ...

돼지에서 출혈 성 쇼크의 치료에 대 한 전체 및 부분 대동맥 폐색

요약

더 많은 비디오 탐색

이 비디오의 챕터

돼지의 심근 경색 및 기능적 결과의 평가

Ameroid 압축을 사용 하 여 돼지에서 만성 심장 허 혈 모델

떨어져 펌프 관상동맥 바이패스 접목 수술에 의해 치료 만성 심장 허 혈의 수술 돼지 모델

돼지의 뇌산소측정및 확장된 혈역학적 모니터링에 의해 유도된 표준화된 출혈성 쇼크 유도

Development of a Selective Aortic Arch Perfusion System in a Porcine Model of Exsanguination Cardiac Arrest

돼지 모델에서 경피 색전술 코일 배치에 의한 심근 경색

Swine Models of Aneurysmal Diseases for Training and Research

출혈성 쇼크에 대한 대동맥의 완전하고 부분적인 재흡수성 혈관 내 풍선 폐색

돼지 대동맥 협착증의 최소 침습 모델

돼지 대동맥 협착증의 최소 침습 모델