Name: use of two intracorporeal ventricular assist devices as a total artificial heart
Uploaded: 2018-05-11T12:30:00
Description: Watch this Scientific Journal Video about Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart at JoVE.com

我们要感谢劳拉 Janney 和方丈医疗部分资金。我们还要感谢公爵灌注服务和大型动物外科核心在手术中的帮助。

年龄匹配 (为献血如果需要) 小牛 (重量80–90公斤) 在动物设施被关心。住房和所有治疗程序都是按照杜克大学医学中心动物护理和使用委员会的指导方针进行的。
1. 麻醉的启动
<ol><li>禁食后 8–12 h, 前用药小牛与 Telazol (4.5 毫克/千克/肌肉), 然后管理异氟醚 (1–4%) 通过口罩。</li>
	<li>把母牛放在一个被加热的桌子和插管的仰卧位置。用沉重的领带把四肢固定在桌子上。</li>
	<l...

<ol>
	<li>Mozzafarian, D., 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=Heart+disease+and+stroke+statistics&#8212;2016+update:+a+report+from+the+American+Heart+Association.">Heart disease and stroke statistics&#8212;2016 update: a report from the American Heart Association.</a> Circulation. 133 (4), e38-e360 (2016).</li><li>Slaughter, M. S., 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=Advanced+heart+failure+treated+with+continuous-flow+left+ventricular+assist+device.">Advanced heart failure treated with continuous-flow left ventricular assist device.</a> N Engl J Med. 361 (23), 2241-2251 (2009).</li><li>Fang, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rise+of+the+Machines+&#8212;+Left+Ventricular+Assist+Devices+as+Permanent+Therapy+for+Advanced+Heart+Failure.">Rise of the Machines &#8212; Left Ventricular Assist Devices as Permanent Therapy for Advanced Heart Failure.</a> N Engl J Med. 361, 2282-2285 (2009).</li><li>Kirklin, J. 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=Seventh+INTERMACS+annual+report:+15,000+patients+and+counting.">Seventh INTERMACS annual report: 15,000 patients and counting.</a> J Heart Lung Transplant. 34 (12), 1495-1504 (2015).</li><li>Leidenfrost, 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=Right+ventricular+assist+device+with+membrane+oxygenator+support+for+right+ventricular+failure+following+implantable+left+ventricular+assist+device+placement.">Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement.</a> Eur J Cardiothorac Surg. 49 (1), 73-77 (2016).</li><li>Gerosa, G., Gallo, M., Bottio, T., Tarzia, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Successful+heart+transplant+after+1374+days+living+with+a+total+artificial+heart.">Successful heart transplant after 1374 days living with a total artificial heart.</a> Eur J Cardiothorac Surg. 49 (4), e88-e89 (2016).</li><li>Pelletier, 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=System+overview+of+the+fully+implantable+destination+therapy--ReinHeart-total+artificial+heart.">System overview of the fully implantable destination therapy--ReinHeart-total artificial heart.</a> Eur J Cardiothorac Surg. 47 (1), 80-86 (2015).</li><li>Krabatsch, T., 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=Biventricular+circulatory+support+with+two+miniaturized+implantable+assist+devices.">Biventricular circulatory support with two miniaturized implantable assist devices.</a> Circulation. 124, S179-S186 (2011).</li><li>Milano, C. A., Schroder, J., Daneshmand, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+Artificial+Heart+Replacement+With+2+Centrifugal+Blood+Pumps.">Total Artificial Heart Replacement With 2 Centrifugal Blood Pumps.</a> Oper Tech Thorac Cardiovasc Surg. 20 (3), 306-321 (2016).</li><li>Strueber, M., 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=Placement+of+2+implantable+centrifugal+pumps+to+serve+as+a+total+artificial+heart+after+cardiectomy.">Placement of 2 implantable centrifugal pumps to serve as a total artificial heart after cardiectomy.</a> J Thorac Cardiovasc Surg. 143 (2), 507-509 (2012).</li></ol>

在这篇手稿中, 我们描述了使用两个离心流 VADs 作为一个体内 TAH。这项技术也许对研究人工循环对肺和肝脏等次生器官的影响非常有用。此外, 它可能有助于研究不同的泵方向和流动情况下的血流动力学变化。本协议中的关键步骤涉及如何将缝纫环连接到心室组织, 同时也纳入瓣膜套管的力量。确保正确执行此操作是非常关键的, 因为这会影响设备的稳定性。此外, 重要的是要确保流出物的测量和?...

心力衰竭患者的数量有所增长, 据估计, 目前美国有570万成年人患有这种情况, 今天为1。约30万例患者终末期心力衰竭, 预期寿命不到一年。虽然心脏移植仍然是治疗终末期心力衰竭的金本位疗法, 但它受现有捐献器官数量的限制很大。MCS 作为心脏移植的一种可行的替代方案, 特别是通过使用 VADs2来实施。VADs 工作通过卸载左心室和提供向前流动 (由泵支持) 直接进入动脉循环。VADs 可能被植入为一座桥梁移植, 以及一个目的地治疗的病人, 不符合移植的3。自从他们的 FDA 批准不到十年前, 每年的 VADs 植入的数量已经超过心脏移植的数字, 这个数字呈指数递增的4。然而, 在患者的一个子集, 心力衰竭是心室 (i. e. 影响左、右心室), 仅支持左心室可能无法提供足够的灌注。在这种情况下, 右心室需要临时机械支持5。这种类型的 "RVAD" 需要使用大型套管连接到一个体外循环泵, 限制病人的重症监护病房 (ICU), 而心室恢复。对于有限的病人子集, 另一个选项是 TAH67。TAH 使用的适应症是: 后梗塞后心室失败, 心室间隔缺损 (VSD), 严重限制性肌病, 排除心室插管, 和失败的心脏移植需要长期支持。然而, 目前 FDA 批准的 TAH 设备很大, 不能用于较小的患者。此外, 气动驱动程序也相当可观, 限制了病人的机动性。
对于某些患者, 一个实验性的策略是使用第二个辅助心室来支持右侧脑室8,9,10。在这种情况下, 两个心室被切除, 两个 VADs 作为 TAH 植入。由于设备设计的改进和设备配置文件的收缩, 使得这一点成为可能。新的离心 VADs 更小, 允许两个 VADs 被植入相邻, 以支持左和右循环。这种方法仍然是实验的许多重要的挑战, 包括设备设置平衡的权利和左循环, 设备的方向和流出的影响对溶血和其他不利事件。本协议的目的是为奶牛模型中的两个离心 VADs 提供一种可重现的 TAH 替换方法。

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			<td height="42" style="height:42px;width:216px;">SPO2&#160; and heart rates are to be monitored: Multiparameter</td>
			<td style="width:148px;">Meditech Equipment, Co., Ltd.</td>
			<td style="width:168px;">MD-908</td>
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			<td style="width:148px;">Amazon</td>
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			<td>Skin incision</td>
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			<td height="21" style="height:21px;width:216px;">Matzenbaum scissor</td>
			<td style="width:148px;">BD-V. Mueller, USA</td>
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			<td>Vascular exploration</td>
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			<td height="63" style="height:63px;width:216px;">A self-retractor</td>
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			<td style="width:167px;">SCHUKNECHT Self-Retaining Postauricular Retractor,&#160;</td>
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			<td height="46" style="height:46px;width:216px;">Sternal retractor</td>
			<td style="width:148px;">BD-V. Mueller, USA</td>
			<td style="width:168px;">CH6950-007</td>
			<td style="width:167px;">Cooley sternal retractor</td>
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			<td height="63" style="height:63px;width:216px;">Pressure transducer (Millar Mikro-Tip, 5Fr)</td>
			<td style="width:148px;">Millar, USA</td>
			<td style="width:168px;">MillarMikro-Tip, SPR-350S</td>
			<td style="width:167px;">Assessment for pulmonary artery or venous pressure</td>
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			<td height="42" style="height:42px;width:216px;">AD instruments (PowerLab)</td>
			<td style="width:148px;">AD instruments, USA</td>
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			<td style="width:167px;">Pressure signal transduction</td>
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			<td style="width:148px;">Medline industries Inc., USA</td>
			<td style="width:168px;">U11</td>
			<td style="width:167px;">For isolation and snaring of superior or inferior vena cava</td>
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			<td height="21" style="height:21px;width:216px;">Vessel loops</td>
			<td style="width:148px;">Aspen Surgical, USA</td>
			<td style="width:168px;">3901, 3902 and 3904</td>
			<td style="width:167px;">Isolation of vessels</td>
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			<td style="width:148px;">Ethicon US, LLC, USA</td>
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			<td style="width:167px;">For snare of superior or inferior vena cava</td>
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			<td height="21" style="height:21px;width:216px;">Prolene, 6-0</td>
			<td style="width:148px;">Covidien, USA</td>
			<td style="width:168px;">Surgipro II</td>
			<td style="width:167px;">Vascular suture</td>
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			<td height="21" style="height:21px;width:216px;">Prolene, 4-0</td>
			<td style="width:148px;">Covidien, USA</td>
			<td style="width:168px;">Surgipro II</td>
			<td style="width:167px;">Vascular suture</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Prolene, 3-0</td>
			<td style="width:148px;">Covidien, USA</td>
			<td style="width:168px;">Surgipro II</td>
			<td style="width:167px;">Vascular suture</td>
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			<td height="63" style="height:63px;width:216px;">Aortic cannula, 15-18 Fr</td>
			<td style="width:148px;">Medtronic, USA</td>
			<td style="width:168px;">Elongated-One-Piece-Arterial cannula 3D</td>
			<td style="width:167px;">Aortic cannula for setting of cardiopulmonary bypass</td>
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			<td height="63" style="height:63px;width:216px;">Venous cannula, 28Fr</td>
			<td style="width:148px;">Edwards Lifesciences</td>
			<td style="width:168px;">single stage</td>
			<td style="width:167px;">Venous cannula for setting of cardiopulmonary bypass</td>
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use of two intracorporeal ventricular assist devices as a total artificial heart

机械循环支持 (MCS) 是一种可行的替代心脏移植主要通过使用体内心室辅助装置 (VADs), 以支持左心室。然而, 某些临床方案需要心室机械支持。对于一些患者来说, 其中一个策略是切除两脑室, 并将两个心室泵作为全人工心脏 (TAH) 植入。最近, 由于设备设计的改进和离心装置的小外形, 使得这一点成为可能。这种 TAH 方法仍然是实验的许多重要的挑战, 如设备设置平衡的权利和左循环, 设备的方向和流出移植物对溶血和稳定性的影响, 和结果使用这种方向的慢性支持。本协议旨在为奶牛模型中两体内离心 VADs 的全人工心脏置换提供一种可重现的方法。

图 1中演示的是缝纫环的附件。图 1A显示了可能造成泵附件问题的脑室组织的 "群聚"。图 1B表示正确的附件。
图 2和图 3是泵的两个不同方向。在图 2中, 泵处于定位状态, 因此流出的移植物是?...

Watch this Scientific Journal Video about Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart at JoVE.com

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

两体内心室辅助装置作为全人工心脏的应用

在这里, 我们提出了一个协议使用两个离心泵作为一个全人工心脏置换。

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

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