Bu eser tarafından VA Merit inceleme #I01 BX000760 (RFK) Amerika Birleşik Devletleri (ABD) gelen destek verdi Bölümü Veterans Affairs BLR & ö. Bu eser içeriğini sayısı, US Department of Veterans Affairs, Amerika Birleşik Devletleri hükümeti temsil etmemektedir.

Tüm hayvan çalışmaları kurumsal hayvan bakım ve kullanım komitelerinin Minneapolis VA Tıp Merkezi ve Minnesota Üniversitesi tarafından onaylanmıştır. Mevcut ulusal sağlık Enstitüleri kurallar kullanılmak ve laboratuvar hayvanlarının Bakımı izleyin.
1. hazırda bekleme cerrahi
<ol><li>Hayvan hazırlık<ol>
<li>Hazırda bekleme Miyokardiyum, kullanım 5 - hafta yaşlı, kadın, 9,2 kg ortalama ağırlığı ile 8-10 kg aralığında tartmak Yorkshire domuzlar bir model oluşturmak için.</li>
		<li>Önceden cerrahi sistem durumu izleme için ameliyat öncesi 3 gün içinde hayvan tartın.</li>
		<li>Hızlı hayvan anestezi başlamadan önce 12 h için. Su, her zaman açlık hayvanlar için kullanılabilir olduğundan emin olun.</li>
		<li>SR buprenorfin ameliyat öncesi 0,18 mg/kg Im 24 saat ver.</li>
	</ol></li>
	<li>İndüksiyon<ol>
<li>İntramüsküler verilen hayvan 6.6 mg/kg tiletamine-zolazepam ve xylazine kokteyl ile sakinleştir. 5-15 dk ilaç için kokteyl etkili olması için izin.</li>
		<li>Kulak ven aseptik üç kez IV kateter yerleştirme için % 70 izopropil alkolle silerek hazırlayın. Not: bir kulak ven yeterli değilse, başka bir periferik ven olabilir (Yani Sefalik) kullanılır.</li>
		<li>Oftalmik merhem her iki gözün kornea kurutma önlemek için geçerlidir.</li>
		<li>Gerekirse, 1-2 mg/kg propofol IV yönetmek olarak anestezi teşvik veya trakeal entübasyon için izin vermek için 3 L/dk ile oksijen ve % 3 isoflurane, maskeli. Not: blink refleks veya çene sesi yoktur zaman hayvan uygun şekilde imzalat kabul edilir.</li>
		<li>Uygun ölçekli bir endotrakeal tüp hayvanla Tüp takacağım.</li>
	</ol></li>
	<li>Cerrahi<ol>
<li>Bir kez belgili tanımlık hayvan anestezi, ameliyat için sol torasik alan tıraş.</li>
		<li>1-4 L/dak ve isoflurane 1.0 ve 3.0 cerrahi uçağa anestezi korumak için gerektiğinde % arasında en az Set oksijen başına 10-15 nefes, mekanik havalandırma başlatın.</li>
		<li>İzleme aygıtları üzerinde hayvan yer. Cihazları izleme EKG, kan basıncı, sıcaklığı ve nabız oksimetre içermelidir.</li>
		<li>5-10 mL/kg oranında % 0,9 normal salin bir IV damlalıkla IV kateter bağlanmak/s.</li>
		<li>Aseptik bir FDA onaylı cerrahi Maki ile sol yanal göğüs hazırlayın.</li>
		<li>Derinlik değerlendirmek anestezi her 5-15 dk. kayıt temel yaşam belirtileri (kalp hızı, ECG, SpO2, tansiyon, ETCO2 ve sıcaklık) her 15dk. Not: blink refleks veya çene sesi yoktur zaman hayvan uygun şekilde imzalat kabul edilir.</li>
		<li>Onun sağ tarafında döşeme hayvanla yer steril sol tarafındaki omurga göğüs steril alan üçüncü kaburga uzayda merkezleme kürek kemiği için perdeler. Not: Steril alan sol açık omuz göğüs kemiği altıncı kaburga boşluk için cranially devam aksiler alanı da dahil olmak üzere içerir.</li>
		<li>Klorheksidin glukonat gibi bir FDA onaylı cerrahi yöntemi veya 2 dk bir hedef düzeni kullanmak için bir iyot cerrahi fırçalayın alanıyla nazikçe fırçalayın.</li>
		<li>Alan su ile durulayın ve FDA onaylı için bir yöntemi 2 dk. durulama su yıkama arasında ile cerrahi alan ile iki kez daha yıkayın, sonra ile steril sarılma veya 4 x 4 cm gazlı bez sünger kuru pat.</li>
		<li>Alan iyot çözümünü ile sprey ve tüm hayvan (dışında cerrahi alan) ile steril perdeleri asmak. Buhar veya gaz sterilizasyon cihazları, Önlükler ve örtüler yordamı için sterilize etmek için kullanın.</li>
		<li>Bir interkostal sinir bloğu 2, 3 ve 4 kaburga 0.3 mL % 0.5 bölgelerelidokain kullanarak yönetin.</li>
		<li>125 mg IV sülfadiyazin göğsü açmadan önce ver. Not: 1.5 mg/kg sakinilkolin IV felçli bir ajan olarak kas hareketi cerrahın istek başına göğüs boşluğu açılış sırasında azaltmak için verilebilir.</li>
		<li>Sol Torakotomi ile kalp ortaya çıkarmak. Kalp manipülasyon önce 2 mg/kg IV bolus aritmi önlemek için Lidocaine ver. Yapmak yanal 3 alanı Torakotomi kesi monopolar elektrokoter ile. Belgili tanımlık kesme kürek kafatası açıdan aksiler alan için yaklaşık 10 cm. cilt ve göğüs boşluğu içine giriş izin vermek için temel kas deşmek için bir koter kullanımı genişletmek.</li>
		<li>Finochietto kaburga Retraktörü yerleştirin ve akciğer geri çekmek için üçüncü interkostal boşluktan plevral boşluk girin.</li>
		<li>Keskin kalp zarını deşmek ve 2-0 polyglactin kalış dikiş kullanarak, delikanlı arter ve ven ortaya tarafına geri çek. Sol Atriyal apendiks ile bir gazlı bez kaplı spatula Retraktörü geri çek.</li>
		<li>Iris makas kullanarak adventitia delikanlı üzerinde açın.</li>
		<li>Açık açık teşrih bir delikanlı ve sirkumfleks arter kavşak distal delikanlı arter yaklaşık 1 cm yaklaşık 0.25 cm kısmı. DELİKANLI sarmak için bir dik açılı mengene kullanın.</li>
		<li>İki 4-0 polyester dikiş arter etrafında herhangi bir gerginlik koymadan yerleştirin.</li>
		<li>C-şekilli plastik yılanı 1.5 mm bir iç çapı ile gemi occluding olmadan DOSTUM ilk çapraz proksimal yerleştirin.</li>
		<li>Polyester kravat delikanlı çevreleyen iki 4-0 ile güvenli.</li>
		<li>Gevşek 2-0 polyglactin dikiş basit bir kesintiye uğramış desen kullanarak kalp zarını kapatın.</li>
		<li>İnterkostal kas katmanı kapalıyken göğüs havayı çıkarmak için bir nefes tutun gerçekleştirin. Hava yolu basıncı Manometre uygun aralığı 20-30 cm su basıncı korumak ve tamamlandığında serbest bırakmak için anestezi makine üzerinde dikkatle izleyin. Not: Bu post-operatif dönemde göğüs tüpü için gereksinimini ortadan kaldırır.</li>
		<li>2-0 ve 3-0 absorbe dikiş kullanarak standart moda kas ve cilt katmanlarında kapatın.</li>
		<li>Cilt yapışkan kesi üzerinde cilt kapatılması için kullanın.</li>
		<li>Toplam doz 1 mg/kg bupivacaine İntramüsküler vasıl belgili tanımlık kesme yordamının sonunda uzunluğu boyunca birden çok site yönetmek. Meloksikam yönetmek 0.2 mg/kg SQ taşıma önce kurtarma alan.</li>
		<li>Cilt katman kapalı olarak hayvan solunum kapalı vazgeçirmek.</li>
		<li>Kendiliğinden nefes alabiliyorum ve dönmek koruyucu refleksleri başlamak kadar anestezi makineye bağlı hayvan bırakın.</li>
		<li>Hayvan onun hava yolu korumak için yutabilir kadar endotrakeal tüp kaldırmaz.</li>
		<li>Steril, yapışık olmayan soyunma üçlü antibiyotik merhem ile belgili tanımlık kesme üzerinde uygulayın.</li>
	</ol></li>
	<li>Ameliyat sonrası<ol>
<li>Kalp hızı kaydetmek, hayvan sternal bir pozisyon desteksiz tutabilir kadar her 15 dk solunum hızı, vücut ısısı ve müköz membran renk.</li>
		<li>Asansör ve kafasını tutun kadar hayvan başıboş bırakmayın yukarı ve desteksiz duramaz.</li>
		<li>Meloksikam (0.2 mg/kg) subkutan ver.</li>
		<li>Sürekli yayın buprenorfin 6 h ilk önceden cerrahi doz takip yönetmek.</li>
		<li>Temiz ve kuru kalırsa soyunma kesi 3 güne kadar çıkarma. Soyunma yerini kirli olur.</li>
		<li>Ağrı düzeyi, genel refah ve belgili tanımlık kesme 5 gün aşağıdaki yordamı durumunu izleyin. Not: Bir domuz yavrusu yüz buruşturma ölçek post-operatively bu hayvanlar acı düzeyini değerlendirmek kullanılabilir şimdi14. Yarım doz Meloksikam atılım ağrı için günde bir kez gerektiği gibi kullanın.</li>
		<li>Tek-ev etkinliği sınırlamak ve iyileşmek yara izin vermek için 5 gün iyileşme süresi sırasında hayvan.</li>
		<li>Tamamen hazırda bekleme Miyokardiyum fenotip geliştirmek 8 haftalık izin.</li>
	</ol></li>
</ol>2. revaskülarizasyon veya kapalı pompa yan yol
<ol><li>Hayvan hazırlık<ol>
<li>Ameliyat öncesi 3 gün içinde hayvan tartın.</li>
		<li>Ameliyat öncesi 12 h için hızlı hayvan. Su, her zaman açlık hayvanlar için kullanılabilir olduğundan emin olun.</li>
		<li>Sürekli yayın buprenorfin 0,18 mg/kg İntramüsküler 24 h ameliyat öncesi ver.</li>
	</ol>
</li>
	<li>İndüksiyon<ol>
<li>6.6 mg/kg tiletamine-zolazepam/xylazine kokteyl ile hayvan İntramüsküler sakinleştir. 5-15 dakika sonra sedasyon hazırlamak kulak ven aseptik kateter yerleştirilmesi için. Not: bir kulak ven yeterli değilse, başka bir periferik ven olabilir (Yani Sefalik) kullanılır.</li>
		<li>Oftalmik merhem her iki gözde için geçerlidir.</li>
		<li>1-2 mg/kg propofol IV anestezi neden.</li>
		<li>Uygun ölçekli bir endotrakeal tüp hayvanla Tüp takacağım.</li>
	</ol>
</li>
	<li>Cerrahi<ol>
<li>Hayvanın göğüs kemiği, sol lateral göğüs ve femoral üçgen ameliyatı için tıraş.</li>
		<li>Mekanik havalandırma başına dakika, oksijen 1-4 L/dk ve isoflurane 1.0-3.0 cerrahi uçağa anestezi korumak için gerektiği şekilde % 10-15 nefes için ayarlayın.</li>
		<li>İzleme aletleri getirin (kalp hızı, ECG, SpO2, doğrudan kan basıncı, ETCO2 ve sıcaklık) hayvan.</li>
		<li>Normal tuz ya da IRS bir IV damlalıkla IV kateter takın.</li>
		<li>Aseptik povidone iyot fırçalayın ya da diğer FDA onaylı yöntemi ile cildi hazırlamak.</li>
		<li>Anestezi derinliği için hayvan değerlendirin. Not: Hayvan ne zaman derinden imzalat kabul edilir göz veya çene refleks yoktur.</li>
		<li>Hayvan dorsally getirin, daha önce açıklandığı gibi cilt hazırlamak ve hayvan ile steril havlu asmak.</li>
		<li>Femoral arter ve cannulation aşağı bir kesim yapmak. Monopolar elektrokoter oluştururken kullanmak bir yaklaşık 3 cm cilt kesi cannulation için ortaya çıkarmak için femoral arter üzerinde.</li>
		<li>Uyuşturucu kesin yerleşimini izin vermek belgili tanımlık kesme yapıldıktan sonra femoral sinir bloğu gerçekleştirin. Femur kanül ameliyat sırasında kan basıncı izlemek için bir dönüştürücü bağlayın.</li>
		<li>Elektro koter ağız sapı xiphoid işleminin deşmek için gibi kas, yağ ve bağ dokusu göğüs kemiği seviyesine deşmek için kullanın.</li>
		<li>Göğüs kemiği salınan bir testereyle bölün. Not: bir salınan kullanarak gördüm yerine standart bir testeresi Perikardiyal yapışıklıklar sonucu olarak Torakotomi delikanlı yerleşimde yılanı için potansiyel miyokardiyal yaralanma önler.</li>
		<li>Lidokain (2 mg/kg IV yükleme dozu, 50 µg/kg/dk sürekli IV infüzyon) aritmiler önlemek için yönetmek. Lidokain normal tuz konsantrasyonu 1 mg/mL, 500 mL torba içinde sulandırmak.</li>
		<li>Posterior sternal plaka düz Mayo makas ile bölün.</li>
		<li>Bir göğüs Retraktörü göğüs boşluğuna ortaya çıkarmak için kullanın.</li>
		<li>Yapışıklıklar monopolar elektro koter ile aşağı çekmek.</li>
		<li>Aynı Retraktörü kullanarak, nazik bir asistan tarafından sol sternal sınır yükselmesine ile sol iç meme arter göğüs duvarından ücretsiz incelemek.</li>
		<li>Arter dalları ile hemoclips kontrol eder.</li>
		<li>100-300 adet/kg IV heparin hayvanla heparinize.</li>
		<li>3 dakika sonra distal ucu olan arter bölmek üzerinde dikili. Proksimal uç nakil için hazırlayın.</li>
		<li>Açın ve kalp zarını geri çek. LIMA uzunluğu delikanlı uygun anastomoz ücreti ulaşmak yeterli olduğunu doğrulayın.</li>
		<li>LIMA delikanlı anastomoz için kapalı bir pompa kullanarak 7-0 polipropilen sütür ile gerçekleştirmek tekniği bir kardiyak sabitleyici, Bahar formu klibi ve uygun ölçekli intraluminal aygıtlar.</li>
		<li>Externalized ve 15-30 dk da göğüs boşluğunda hava kaldırmak için vakum bağlı sol yanal göğüs üzerinde kaburga arasında göğüs tüpü yerleştirin.</li>
		<li>Göğüs kemiği bir sekiz şekli düzeni kullanmak #5 polyester dikiş ile yaklaşık.</li>
		<li>Kas, hazırda bekleme ameliyat her zamanki biçimde açıklandığı gibi cilt altı ve cilt katmanlarında yakın. Göğüs tüpünü göğüs boşluğundan herhangi bir kalıntı havayı çıkarmak ve belgili tanımlık kesme bir deri dikiş ile kapatmak için bir Valsalva manevrası yaparken kaldırın.</li>
		<li>Cilt yapışkan sternal kesi korumak için cilt üzerinde uygulayın. Yavaşça femoral kateter kaldırmak ve 7-0 polipropilen sütür bir çanta dize deseni kullanarak arter onarım. Deri 2-0 polyglactin dikiş subcuticular desende kullanarak kapatın.</li>
		<li>Toplam doz 1 mg/kg bupivacaine İntramüsküler vasıl belgili tanımlık kesme yordamının sonunda uzunluğu boyunca birden çok site yönetmek.</li>
		<li>Meloksikam yönetmek 0.2 mg/kg taşıma kurtarma alanına önce subkutan.</li>
		<li>Hazırda bekleme yordamı ameliyat sonrası protokolünde izleyin.</li>
	</ol>
</li>
</ol>

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O., 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=Utility+of+positron+emission+tomography+in+predicting+improved+left+ventricular+ejection+fraction+after+coronary+artery+bypass+grafting+among+patients+with+ischemic+cardiomyopathy.">Utility of positron emission tomography in predicting improved left ventricular ejection fraction after coronary artery bypass grafting among patients with ischemic cardiomyopathy.</a> Cardiology. 93 (1-2), 105-112 (2000).</li><li>Pasquet, A., 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=Prediction+of+global+left+ventricular+function+after+bypass+surgery+in+patients+with+severe+left+ventricular+dysfunction.+Impact+of+pre-operative+myocardial+function,+perfusion,+and+metabolism.">Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Impact of pre-operative myocardial function, perfusion, and metabolism.</a> Eur Heart J. 21 (2), 125-136 (2000).</li></ol>

Yazarlar ifşa gerek yok.

İşte, HM bizim domuz modeli doğru bir şekilde tek damar hastalığı olan hastalarda klinik deneyimi taklit eder ve sol ventrikül fonksiyonları korunmuş göstermektedir. Revaskülarizasyon öncesinde tek gemi HM hayvanlarla ejeksiyon fraksiyonu göre ölçülen genel işlevinde en az bozulma ama bölgesel duvar kalınlaşma Haritayı önemli azalma sergi. Revaskülarizasyon CMR düşsel vasıl bir ya da üç ay kurtarma kalıcı bölgesel fonksiyon bozukluğu, düşük doz dobutamin stres testi ile contractile rez...

Koroner kalp hastalığı (KKH) yaklaşık 15.5 milyon kişi Amerika Birleşik Devletleri 1 etkiler ve genel olarak ölüm sebeplerinden biridir. KKH ile ilişkili ölüm oranı son yıllarda aşağı gitti, insidans ve hastalar ve sağlık sistemi üzerindeki yükü yüksek 1kalır. Birincil şiddetli CAD revaskülarizasyon, hayatta kalma geliştirir ve angina2,3,4azaltır tedavisidir. Ancak, kardiyak fonksiyon kez özellikle artan iş yükü altında depresif kalır ve kalp yetmezliği5,-6ilerleyebilir. Klinik denemelerin koroner arter bypass cerrahisi (CABG) Kronik iskemi için hayatta kalma ve belirtileri göstermek ama ejeksiyon fraksiyonu % 8-10 7,8sadece mütevazı gelişmeler gösterir. Yenilikçi ve iyi karakterize domuz modelimiz kronik miyokardiyal iskemi klinik CAD ilerici damar darlığı ile bir modeldir. Kan akışı 9kademeli azaltma kaynaklanan indirimli miyokard contractility göstermiştir. Miyokardiyum değil enfarktüsü yapar ve bu senaryoya göre canlı kalabilir. Sonuçlar zamanında revaskülarizasyon değişkenle bile olsa kurtarma mümkündür. Kronik olarak uygun kalır iskemik Miyokardiyum düşük kan akımı ile karakterize ve fonksiyon için tutulan contractile rezerv dinlenerek HM olarak adlandırdığı ve CABG tedavi gerektirir. Her ne kadar HM revaskülarizasyon contractile işlevi geri yüklemelisiniz, deneysel ve klinik gözlem kurtarma eksik8,10olduğunu ispat.
Bölgesel kan akışı11varlığı işlevsiz Miyokardiyum azaltılmış henüz HM uygun varlığı ile karakterizedir. Rağmen contractility Engelli ve istirahat, HM metabolik aktivite fonksiyonel ve metabolik rezerv inotropic stimülasyon12altında göstermek yapabiliyor. HM CAD ile hastaların bir çoğu şüpheli olduğunu ve hastalık geniş bir yelpazede kapsar. Bu protokol için klinik senaryo taklit eder delikanlı arter ile sol iç meme arter (LIMA) ile yan yol HM bizim kurulan domuz modeli göstermektedir. Domuz epicardial köprüleme de¤erler yok gibi diğer büyük hayvanlar üzerinde kalp hastalığı mükemmel bir model sağlar. Bu yalnız bölgesel iskemi13' te neden delikanlı stenoz sağlar.
Burada, biz delikanlı arter tek-damar darlığı oluşturarak domuz hazırda bekleme Miyokardiyum inducing cerrahi yöntemi açıklanmaktadır. Kronik iskemi kurulduktan sonra (8 hafta sonrası delikanlı yılanı implant), biz bizim domuz modelindeki HM için tedavi klinik yeniden oluşturma yöntemi açıklamak: bir "off-pump" koroner arter bypass greft. Bu cerrahi yöntemler sadece kronik kalp iskemi, klinik bir modeli eğitim için ama aynı zamanda kalp iskemi bypass cerrahisi etkilerini araştırmak yanı sıra potansiyel alternatif veya ek tedaviler kardiyak iskemi için test için kullanılabilir.

<table border="0" cellpadding="0" cellspacing="0" style="width:1155px;" width="1154">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Bair Hugger</td>
			<td style="width:223px;">3M</td>
			<td style="width:203px;">Model 505</td>
			<td style="width:468px;">Patient Warming system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">SR Buprenorphine 10 mg/mL</td>
			<td style="width:223px;">Abbott Labs</td>
			<td style="width:203px;">NADA 141-434</td>
			<td>Post operative Analgesic</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Surgical Spring Clip</td>
			<td>Applied Medical</td>
			<td>A1801</td>
			<td>Clamp end of LIMA after takedown</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Arterial Line Kit</td>
			<td>Arrow</td>
			<td>ASK-04510-HF</td>
			<td>Femoral catheter for blood pressure monitoring</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">1000mL 0.9% Sodium chloride</td>
			<td>Baxter</td>
			<td>2B1324X</td>
			<td>IV replacement fluid</td>
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			<td height="21" style="height:21px;width:261px;">250 mL 0.9% saline</td>
			<td>Baxter</td>
			<td>&#160;UE1322D</td>
			<td>Replacement IV Fluid&#160;</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">500mL 0.9% Sodium chloride</td>
			<td>Baxter</td>
			<td>2B1323Q</td>
			<td>Drug delivery, Provide mist for Blower Mister</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Flo-thru 1.0</td>
			<td>Baxter</td>
			<td>FT-12100</td>
			<td>used to anastomos LIMA to L</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Flo-thru 1.25</td>
			<td>Baxter</td>
			<td>FT-12125</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Flo-thru 1.5</td>
			<td>Baxter</td>
			<td>FT-12150</td>
			<td></td>
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			<td height="21" style="height:21px;width:261px;">Flo-thru 2.0</td>
			<td>Baxter</td>
			<td>FT-12200</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Cloroprep</td>
			<td style="width:223px;">Becton Dickenson</td>
			<td style="width:203px;">260815</td>
			<td>Surgical skin prep</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Meloxicam</td>
			<td>Boehringer Ingelheim Vetmedica, Inc.</td>
			<td>0010-6013-01</td>
			<td>NSAID for analgesia</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Hypafix</td>
			<td>BSN Medical</td>
			<td>4210</td>
			<td>Secure wound dressing and IV catheters</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">IV Tubing for Blower Mister</td>
			<td>Carefusion</td>
			<td>42493E</td>
			<td>Adapts to IV Fluids for Blower/Mister</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Bovie Cautery hand piece&#160;</td>
			<td>Covidien</td>
			<td>E2516</td>
			<td>Hemostasis&#160;</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Chest Tube</td>
			<td>Covidien</td>
			<td>8888561043</td>
			<td>Evacuates air from chest cavity&#160;</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Monopolar Cautery&#160;</td>
			<td>Covidien</td>
			<td>Valleylab FT10</td>
			<td>Hemostasis&#160;</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Telpha pad</td>
			<td style="width:223px;">Covidien</td>
			<td style="width:203px;">2132</td>
			<td>Sterile wound dressing</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">4-0 Tevdek II Strands</td>
			<td style="width:223px;">Deknatel</td>
			<td style="width:203px;">7-922</td>
			<td>Suture to secure constrictor around LAD</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Propofol</td>
			<td style="width:223px;">Diprivan</td>
			<td style="width:203px;">269-29</td>
			<td>Induction agent</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">&#160;long blade for laryngoscope&#160;</td>
			<td style="width:223px;">DRE</td>
			<td>12521</td>
			<td>Allows for visualization of trachea for intubation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">ECG Pads</td>
			<td>DRE</td>
			<td>1496</td>
			<td>Monitor heart rhythm</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">laryngoscope&#160;</td>
			<td style="width:223px;">DRE</td>
			<td>12515</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Anesthesia Machine + ventilator</td>
			<td style="width:223px;">DRE Drager- Fabius Tiro</td>
			<td style="width:203px;">DRE0603FT</td>
			<td>Deliver Oxygen and inhalant to patient</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">&#160;5 Ethibond&#160;</td>
			<td>Ethicon</td>
			<td>MG46G</td>
			<td>Suture</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">0 Vicryl</td>
			<td>Ethicon</td>
			<td>J208H</td>
			<td>Suture</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">2-0 Vicryl</td>
			<td>Ethicon</td>
			<td>J317H</td>
			<td>Suture</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:261px;">3-0 Vicryl</td>
			<td>Ethicon</td>
			<td>VCP824G</td>
			<td>Suture</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">7-0 Prolene</td>
			<td>Ethicon</td>
			<td>M8702</td>
			<td>Suture</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Dermabond</td>
			<td style="width:223px;">Ethicon</td>
			<td>DNX12</td>
			<td>Skin adhesive</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Ligaclips</td>
			<td>Ethicon</td>
			<td>MSC20</td>
			<td>Surgical Staples for LIMA takedown</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Sterile Saline 20 mL</td>
			<td>Fisher Scientific</td>
			<td>20T700220</td>
			<td>Flush for IV catheters</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Telazol 100 mg/mL</td>
			<td style="width:223px;">Fort Dodge</td>
			<td style="width:203px;">01L60030</td>
			<td>Pre operative Sedative</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Triple Antibiotic Ointment</td>
			<td style="width:223px;">Johnson &#38; Johnson</td>
			<td style="width:203px;">23734</td>
			<td>Topical over wound</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">6.0 mm ID endotracheal tube</td>
			<td>Mallinckrodt</td>
			<td>86049</td>
			<td>Establish airway for Revasc,MRI and Termination</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">1&#34; medical tape</td>
			<td style="width:223px;">Medline</td>
			<td>MMM15271Z</td>
			<td>Secure wound dressing and IV catheters</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">4.0 mm ID endotracheal tube</td>
			<td>Medline</td>
			<td>DYND43040</td>
			<td>Establish airway for Hibernation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">4.5 mm ID endotracheal tube</td>
			<td>Medline</td>
			<td>DYND43045</td>
			<td>Establish airway for Hibernation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">5.0 mm ID endotracheal tube</td>
			<td>Medline</td>
			<td>DYND43050</td>
			<td>Establish airway for Hibernation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">6.5 mm ID endotracheal tube</td>
			<td>Medline</td>
			<td>DYND43065</td>
			<td>Establish airway for Revasc,MRI and Termination</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">7.0 mm ID endotracheal tube</td>
			<td>Medline</td>
			<td>DYND43070</td>
			<td>Establish airway for Revasc,MRI and Termination</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:261px;">Bair Hugger Blanket -&#160; Large size, underbody</td>
			<td>Medline</td>
			<td>AUG55501</td>
			<td>Patient Warming system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Basic pack</td>
			<td style="width:223px;">Medline</td>
			<td style="width:203px;">DYNJP1000</td>
			<td>Sterile drapes and table cover</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Bone Wax</td>
			<td>Medline</td>
			<td>ETHW31G</td>
			<td>Hemostasis of cut bone</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suction&#160; tubing</td>
			<td>Medline</td>
			<td>DYND50223</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Suction Container&#160;</td>
			<td>Medline</td>
			<td>DYNDCL03000</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">1 mL Syringe</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>1188100777</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">12 mL Syringe</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>8881512878</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">20 mL Syringe</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>8881520657</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">3 mL Syinge</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>1180300555</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">6&#160; mL Syringe</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>1180600777</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">60 mL Syringe</td>
			<td style="width:223px;">Medtronic/Covidien</td>
			<td>8881560125</td>
			<td>Administer injectable agents</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Blower Mister Kit</td>
			<td>Medtronic/Covidien</td>
			<td>22120</td>
			<td>Clears surgical field for vessel anastomosis</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Roncuronium</td>
			<td>Mylan</td>
			<td>67457-228-05</td>
			<td>Neuromuscular blocking agent</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;"># 40 clipper blade</td>
			<td>Oster</td>
			<td>078919-016-701</td>
			<td>Remove hair from surgery sites</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Hair Clipper</td>
			<td>Oster</td>
			<td>078566-011-002</td>
			<td>Remove hair from surgery sites</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Bupivicaine</td>
			<td>Pfizer</td>
			<td>00409-1161-01</td>
			<td>Local Anesthetic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Cephazolin</td>
			<td>Pfizer</td>
			<td>00409-0805-01</td>
			<td>Antibiotic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Heparin&#160;</td>
			<td>Pfizer</td>
			<td>&#160;0409-2720-03</td>
			<td>anticoaggulant</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Lidocaine 2%</td>
			<td>Pfizer</td>
			<td>00409-4277-01</td>
			<td>Local Anesthetic/ antiarrthymic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Succinylcholine 20 mg/mL</td>
			<td style="width:223px;">Pfizer</td>
			<td style="width:203px;">00409-6629-02</td>
			<td>Neuromuscular blocking agent</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Anesthesia Monitor</td>
			<td>Phillips&#160; Intellivue&#160;</td>
			<td style="width:203px;">MP70&#160;</td>
			<td>Supports ventilation with inhalant</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Artificial Tears</td>
			<td style="width:223px;">Rugby</td>
			<td style="width:203px;">0536-1086-91</td>
			<td>Lubricate eyes to prevent corneal drying</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Buprenorphine 0.3 mg/mL</td>
			<td style="width:223px;">Sigma Aldrich</td>
			<td style="width:203px;">B9275</td>
			<td>Pre operative Analgesic for survivial procedures</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Isoflurane</td>
			<td style="width:223px;">Sigma Aldrich</td>
			<td style="width:203px;">CDS019936</td>
			<td>General Anesthestic- Inhalant</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">36&#8221; Pressure monitoring tubing</td>
			<td>Smith&#8217;s Medical</td>
			<td>MX563</td>
			<td>Connect art. Line&#160; to transducer</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">48&#8221; Pressure monitoring tubing</td>
			<td>Smith&#8217;s Medical</td>
			<td>MX564</td>
			<td>Connect art. Line&#160; to transducer</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Jelco 18 ga IV catheter&#160;</td>
			<td style="width:223px;">Smiths medical</td>
			<td style="width:203px;">4054</td>
			<td>IV access in Revasc, MRI and Term</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Jelco 20 ga IV catheter</td>
			<td style="width:223px;">Smiths medical</td>
			<td style="width:203px;">4059</td>
			<td>IV access in the MRI</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Jelco 22 ga&#160; IV catheter</td>
			<td style="width:223px;">Smiths medical</td>
			<td>4050</td>
			<td>IV access in Hibernation Procedure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">OPVAC Synergy II</td>
			<td>Terumo Cardiovascular System</td>
			<td>401-230</td>
			<td>Heart positioner and Stabilizer</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Sternal Saw/ Necropsy Saw</td>
			<td>Thermo Fisher</td>
			<td>812822</td>
			<td>Used to open chest cavity</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Delrin Constrictor</td>
			<td style="width:223px;">U of MN</td>
			<td style="width:203px;">Custom made</td>
			<td>Creates stenosis of LAD</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Oxygen Tank E cylinder</td>
			<td>various</td>
			<td>various</td>
			<td>Used for Blower Mister if anesthesia machine doesn&#39;t have auxiliary flow meter</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Pressure Transducer</td>
			<td>various</td>
			<td>Must adapt to anesthesia monitor</td>
			<td>Monitor direct arterial pressures</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:261px;">Xylazine 100 mg/mL</td>
			<td style="width:223px;">Vedco</td>
			<td style="width:203px;">468RX</td>
			<td>Pre operative Sedative/ analgesic</td>
		</tr>
	</tbody>
</table>

surgical swine model of chronic cardiac ischemia treated by off-pump coronary artery bypass graft surgery

Kardiyak fonksiyon bozar ama enfarktüsü, yol açmaz kronik kalp iskemi hazırda bekleme Miyokardiyum (HM) olarak adlandırılır. Koroner arter hastalığı (CAD) hastaların büyük bir klinik alt var HM, hangi engelliler fonksiyonu, neden yanı sıra aritmi ve gelecekteki kardiyak olaylar için daha yüksek risk altında yerleştirmektedir. Bu durum için standart tedavi revaskülarizasyon olmakla beraber bu kusurlu bir terapi olarak gösterilmiştir. Önceden klinik kardiyak araştırma çoğunluğu bırakarak bu alt büyük ölçüde az hizmet kronik iskemi hastaların kardiyak iskemi, enfarktüsü modelleri üzerinde duruluyor. Domuz insan kalp hastalığı için ideal translasyonel modelleri gibi araştırma bu boşluğu adrese biz domuz, hazırda bekleme Miyokardiyum iyi karakterize ve son derece tekrarlanabilir model geliştirdik. Bu benzersiz hastalığı model oluşturmanın yanı sıra, domuz koroner arter bypass cerrahisi klinik tedavi modeli optimize. Bu doğru bir şekilde kalp hastalığı bypass cerrahisi etkilerini incelemek, hem de ek veya alternatif terapiler araştırmak için bize izin verir. Bu model ameliyatla sol ön inen (evlat) arter içinde genç bir domuz üzerinde bir yılanı Reproduction tarafından tek damar darlığına neden olmaktadır. Domuz büyüdükçe, yılanı kronik iskemi Engelli bölgesel fonksiyon ile sonuçlanan, ancak doku canlılığı koruyarak kademeli bir stenoz oluşturur. Hazırda bekleme Miyokardiyum fenotip kurulması gerçekleştiriyoruz "off-pump" koroner arter bypass greft cerrahisi iskemik bölgenin revascularize için altın standart tedavi kliniği hastalarda için taklit.

İlk hazırda bekleme ameliyat stenoz 70 %'den büyük klinik görüntüleme teknikleri gibi anjiyografi veya kardiyak MRG (şekil 1A) tarafından uyulması gerekir. 8 hafta delikanlı yılanı cerrahi uygulama aşağıdaki bölgesel işlev yankı ya da kardiyak MRG tarafından analiz azaltılmış işlev artan iş yükü (Şekil 2) altında ortaya koymaktadır. Bu dobutamin (5 mg/kg/dak) kalple uyarıcı ve çev...

Watch this Scientific Journal Video about Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery at JoVE.com

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

Bu iletişim kuralı bölgesel anormallikleri neden olur, ancak enfarktüsü, hazırda bekleme Miyokardiyum bilinen oluşturmaz kronik, tek damar iskemi cerrahi büyük hayvan modeli sunar. Kronik iskemi kurulması, hayvanlar iskemik doku revascularize için "off-pump" LIMA-delikanlı koroner arter bypass greft cerrahisi ile tedavi edilir.

Kronik kalp iskemi "Off-Pump" koroner arter Bypass greft cerrahisi ile tedavi cerrahi domuz modeli

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

surgical-swine-model-chronic-cardiac-ischemia-treated-off-pump

Research

JoVE Journal

Medicine

9.4K Görüntüleme.  University of Minnesota. Bu iletişim kuralı bölgesel anormallikleri neden olur, ancak enfarktüsü, hazırda bekleme Miyokardiyum bilinen oluşturmaz kronik, tek damar iskemi cerrahi büyük hayvan modeli sunar. Kronik iskemi kurulması, hayvanlar iskemik doku revascularize için "off-pump" LIMA-delikanlı koroner arter bypass greft cerrahisi ile tedavi edilir.

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

A Swine Model of Neonatal Asphyxia

Annually more than 1 million neonates die worldwide as related to asphyxia. Asphyxiated neonates commonly have multi-organ failure including hypotension, perfusion deficit, hypoxic-ischemic encephalopathy, pulmonary hypertension, vasculopathic enterocolitis, renal failure and thrombo-embolic complications. Animal models are developed to help us understand the patho-physiology and pharmacology of neonatal asphyxia. In comparison to rodents and newborn lambs, the newborn piglet has been proven to be a valuable model. The newborn piglet has several advantages including similar development as that of 36-38 weeks human fetus with comparable body systems, large body size (&tilde;1.5-2 kg at birth) that allows the instrumentation and monitoring of the animal and controls the confounding variables of hypoxia and hemodynamic derangements.
We here describe an experimental protocol to simulate neonatal asphyxia and allow us to examine the systemic and regional hemodynamic changes during the asphyxiating and reoxygenation process as well as the respective effects of interventions. Further, the model has the advantage of studying multi-organ failure or dysfunction simultaneously and the interaction with various body systems. The experimental model is a non-survival procedure that involves the surgical instrumentation of newborn piglets (1-3 day-old and 1.5-2.5 kg weight, mixed breed) to allow the establishment of mechanical ventilation, vascular (arterial and central venous) access and the placement of catheters and flow probes (Transonic Inc.) for the continuously monitoring of intra-vascular pressure and blood flow across different arteries including main pulmonary, common carotid, superior mesenteric and left renal arteries. Using these surgically instrumented piglets, after stabilization for 30-60 minutes as defined by Z&lt;10% variation in hemodynamic parameters and normal blood gases, we commence an experimental protocol of severe hypoxemia which is induced via normocapnic alveolar hypoxia. The piglet is ventilated with 10-15% oxygen by increasing the inhaled concentration of nitrogen gas for 2h, aiming for arterial oxygen saturations of 30-40%. This degree of hypoxemia will produce clinical asphyxia with severe metabolic acidosis, systemic hypotension and cardiogenic shock with hypoperfusion to vital organs. The hypoxia is followed by reoxygenation with 100% oxygen for 0.5h and then 21% oxygen for 3.5h. Pharmacologic interventions can be introduced in due course and their effects investigated in a blinded, block-randomized fashion.

Large animal models have good translational values in the examination of physiology and pharmacology of neonatal asphyxia. Using newborn piglets, we develop an experimental protocol to simulate neonatal asphyxia which has advantages of studying the systemic and regional hemodynamics, oxygen transport with biochemical and pathologic pathways and correlations.

Yenidoğan Asfiksi Bir Domuz Modeli

Annually more than 1 million neonates die worldwide as related to asphyxia. Asphyxiated neonates commonly have multi-organ failure including hypotension, ...

Tıp

Implantation of Inferior Vena Cava Interposition Graft in Mouse Model

Biodegradable scaffolds seeded with bone marrow mononuclear cells (BMCs) are often used for reconstructive surgery to treat congenital cardiac anomalies. The long-term clinical results showed excellent patency rates, however, with significant incidence of stenosis. To investigate the cellular and molecular mechanisms of vascular neotissue formation and prevent stenosis development in tissue engineered vascular grafts (TEVGs), we developed a mouse model of the graft with approximately 1 mm internal diameter. First, the TEVGs were assembled from biodegradable tubular scaffolds fabricated from a polyglycolic acid nonwoven felt mesh coated with &#949;-caprolactone and L-lactide copolymer. The scaffolds were then placed in a lyophilizer, vacuumed for 24 hr, and stored in a desiccator until cell seeding. Second, bone marrow was collected from donor mice and mononuclear cells were isolated by density gradient centrifugation. Third, approximately one million cells were seeded on a scaffold and incubated O/N. Finally, the seeded scaffolds were then implanted as infrarenal vena cava interposition grafts in C57BL/6 mice. The implanted grafts demonstrated excellent patency (&#62;90%) without evidence of thromboembolic complications or aneurysmal formation. This murine model will aid us in understanding and quantifying the cellular and molecular mechanisms of neotissue formation in the TEVG.

To improve our knowledge of cellular and molecular neotissue formation, a murine model of the TEVG was recently developed. The grafts were implanted as infrarenal vena cava interposition grafts in C57BL/6 mice. This model achieves similar results to those achieved in our clinical investigation, but over a far shortened time-course.

Fare Modeli Inferior Vena Cava İnterpozisyon Greft İmplantasyonu

Biodegradable scaffolds seeded with bone marrow mononuclear cells (BMCs) are often used for reconstructive surgery to treat congenital cardiac anomalies. ...

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

This paper describes a novel nonocclusive coronary anastomotic connector in a porcine off-pump coronary artery bypass (OPCAB) model. This easy-to-use coronary connector has intrinsic potential to facilitate minimally invasive OPCAB surgery.

Trinity Clip - - Roman Lazer destekli Koroner Anastomoz Connector Değerlendirilmesi Domuz Off-pompa Bypass Modeli

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the ...

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. 
During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). 
The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. 
The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains.

Coronary flow reserve (CFR) is useful for assessment of myocardial oxygen demand and evaluation of cardiovascular risk. This study establishes a step-by-step transthoracic Doppler echocardiographic (TTDE) method for longitudinal monitoring of the changes in CFR, as measured from coronary artery in mice, under the experimental pressure overload of aortic banding.

Farelerde Basınç Aşırı Modeli Koroner Arter Akış ve Koroner Akım Rezervi Ultrason Dayalı Değerlendirme

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency

Bypass grafting is an established treatment method for coronary artery disease. Graft patency continues to be the Achilles heel of saphenous vein grafts. Research models for bypass graft failure are essential for a better understanding of pathobiological and pathophysiological processes during graft patency loss. Large animal models, such as pigs or sheep, resemble human anatomical structures but require special facilities and equipment. This video describes a rat vein interposition model to investigate vein graft patency loss. Rats are inexpensive and easy to handle. Compared to mouse models, the convenient size of rats permits better operability and enables a sufficient amount of material to be obtained for further diverse analysis. In brief, the inferior epigastric vein of a donor rat is harvested and used to replace a segment of the femoral artery. Anastomosis is conducted via single stitches and sealed with fibrin glue. Graft patency can be monitored non-invasively using duplex sonography. Myointimal hyperplasia, which is the main cause for graft patency loss, develops progressively over time and can be calculated from histological cross sections.

This video demonstrates a model to study the development of myointimal hyperplasia after venous interposition surgery in rats.

Ven interpozisyonu Model: baypas açıklığının Eğitim için uygun bir model

Bypass grafting is an established treatment method for coronary artery disease. Graft patency continues to be the Achilles heel of saphenous vein grafts. ...

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.

Bir Ameroid yılanı kullanarak domuz kronik kalp iskemi modelinde

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

Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment methods. Here, we present such a model by tachycardia-induced cardiomyopathy, which can be produced by rapid cardiac pacing in swine.
A single pacing lead is introduced transvenously into fully anaesthetized healthy swine, to the apex of the right ventricle, and fixated. Its other end is then tunneled dorsally to the paravertebral region. There, it is connected to an in-house modified heart pacemaker unit that is then implanted in a subcutaneous pocket. 
After 4 - 8 weeks of rapid ventricular pacing at rates of 200 - 240 beats/min, physical examination revealed signs of severe heart failure - tachypnea, spontaneous sinus tachycardia, and fatigue. Echocardiography and X-ray showed dilation of all heart chambers, effusions, and severe systolic dysfunction. These findings correspond well to decompensated dilated cardiomyopathy and are also preserved after the cessation of pacing.
This model of tachycardia-induced cardiomyopathy can be used for studying the pathophysiology of progressive chronic heart failure, especially hemodynamic changes caused by new treatment modalities like mechanical circulatory supports. This methodology is easy to perform and the results are robust and reproducible.

Here, we present a protocol to produce tachycardia-induced cardiomyopathy in swine. This model represents a potent way to study the hemodynamics of progressive chronic heart failure and the effects of applied treatment.

Kronik kalp yetmezliği model domuz olarak taşikardi kaynaklı kardiyomiyopati

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment ...

Brachial Artery Catheterization in Swine

The video describes in detail the catheterization of the distal brachial artery in swine. This technique enables researchers to measure arterial blood pressure continuously and collect arterial blood samples to assess arterial blood gas measurements. Arterial blood pressures and arterial blood gases are important physiological parameters to monitor during experimental procedures. In swine, four common methods of arterial catheterization have been described, including catheterization of the carotid, femoral, auricular, and medial saphenous arteries. Each of these techniques have advantages, such as ease of access for the auricular artery, and disadvantages that include deep tissue dissection for carotid artery catheterization. The described alternative method of arterial catheterization in swine, the catheterization of the distal aspect of the brachial artery, is a rapid procedure that requires relatively minimal tissue dissection and provides information that is in line with data collected from other arterial catheterization sites. The procedure uses a medial approach along an oblique plane of the lower brachium, positioned between the olecranon and the flexor aspect of the elbow joint, and this approach allows researchers the major advantage of unimpeded freedom for procedures that involve the caudoventral, caudodorsal back, or hind limbs of the pig. Due to the location of the upper forelimb of the catheterized vessel and potential challenges of effective homeostasis following catheter removal from the artery, this technique may be limited to non-recovery procedures.

The video describes in detail the catheterization of the distal brachial artery in swine. This procedure accurately measures arterial blood pressure and is a simple and fast method to collect samples for arterial blood gas measurements.

Domuz Brakiyal arter Kateterizasyonu

The video describes in detail the catheterization of the distal brachial artery in swine. This technique enables researchers to measure arterial blood ...

Murine Myocardial Infarction Model using Permanent Ligation of Left Anterior Descending Coronary Artery

Myocardial infarction (MI) and acute coronary diseases are among the most prominent causes of death in population with western lifestyle. The murine models of MI with permanent ligation of left-anterior descending (LAD) coronary artery closely mimics MI in humans. Murine models benefit from the extensive genetic engineering available nowadays. Here we propose a reproducible murine surgical model of myocardial infarction by permanent LAD coronary ligation. Our technique comprises anesthesia with ketamine/xylazine that can be rapidly reversed by administration of an antagonist, intubation without tracheotomy for mechanical-assisted ventilation, ventilation with application of extrinsic positive end-expiratory pressure (PEEP) to avoid alveolar collapse, a thoracotomy method limiting to the minimum surgical lesions made to skeletal muscles, and lung inflation without thoracentesis. This method is sparsely invasive, reproducible and reduces post-surgery mortality and complications.

Herein we describe a surgical procedure showing how to achieve permanent ligation of the left-anterior descending coronary artery in mice. This model is of high relevance to investigate the pathophysiology of myocardial infarction and the concomitant biological processes.

Sol Anterior İnen Koroner Arterin Kalıcı Ligasyonu ile Murine Miyokard Enfarktüsü Modeli

Myocardial infarction (MI) and acute coronary diseases are among the most prominent causes of death in population with western lifestyle. The murine ...

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Acute kidney injury (AKI) is associated with higher risk for morbidity and mortality post-operatively. Ischemia-reperfusion injury (IRI) is the most common cause of AKI. To mimic this clinical scenario, this study presents a highly reproducible large animal model of renal IRI in swine using temporary percutaneous bilateral balloon-catheter occlusion of the renal arteries. The renal arteries are occluded for 60 min by introducing the balloon-catheters through the femoral and carotid artery and advancing them into the proximal portion of the arteries. Iodinated contrast is injected in the aorta to assess any opacification of the kidney vessels and confirm the success of the artery occlusion. This is furtherly confirmed by the flattening of the pulse waveform at the tip of the balloon catheters. The balloons are deflated and removed after 60 min of bilateral renal artery occlusion, and the animals are allowed to recover for 24 h. At the end of the study, plasma creatinine and blood urea nitrogen significantly increase, while eGFR and urine output significantly decrease. The need for iodinated contrast is minimal and does not affect renal function. Bilateral renal artery occlusion better mimics the clinical scenario of perioperative renal hypoperfusion, and the percutaneous approach minimizes the impact of the inflammatory response and the risk of infection seen with an open approach, such as a laparotomy. The ability to create and reproduce this clinically relevant swine model eases the clinical translation to humans.

This study presents a highly reproducible large animal model of renal ischemia-reperfusion injury in swine using temporary percutaneous bilateral balloon-catheter occlusion of the renal arteries for 60 min and reperfusion for 24 h.

Geçici bilateral Renal Arter Tıkanma ile Akut Böbrek Yaralanması için Büyük Bir Hayvan Modeli

Acute kidney injury (AKI) is associated with higher risk for morbidity and mortality post-operatively. Ischemia-reperfusion injury (IRI) is the most ...