Kitamura M, Morishita A, Kurihara H, Shibuya M, Kodera K, Hirota J, Yamazaki K, Watanabe S, Endo M, Koyanagi H Experimental and Clinical Assessment of

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1 Kitamura M, Morishita A, Kurihara H, Shibuya M, Kodera K, Hirota J, Yamazaki K, Watanabe S, Endo M, Koyanagi H Experimental and Clinical Assessment of Trans-aortic Catheter Venting.This study was undertaken to assess the effectiveness of trans-aortic catheter venting (TACV) during venoarterial bypass (VAB) in a heart failure model and to evaluate special multipurpose catheters for TACV in patients with open heart operation. During VAB in an experimental heart failure model, TACV showed significant reduction of left ventricular work and a significant increase of myocardial adenosene 5'-triphosphate. In 5 surgical patients, special catheters were easily introduced into the left ventricle and TACV was safely performed. The TACV significantly reduced mean pulmonary arterial pressure and left ventricular end-diastolic dimension measured by transesophageal echocardiography during weaning from cardiopulmonary bypass. Keywords: trans-aortic catheter venting, venoarterial bypass, percutaneous cardiopulmonary support, left ventricular funcion, adenosine 5'-triphosphate Jpn J Artif Organs 29 (2),

Fig.3 Operative findings of trans-aortic catheter venting (TACV) during partial cardiopulmonary bypass after coronary arterial bypass grafting. Fig.

2 Fig.3 Operative findings of trans-aortic catheter venting (TACV) during partial cardiopulmonary bypass after coronary arterial bypass grafting. Fig.1 Schema of trans-aortic catheter venting (TACV) during venoarterial bypass (VAB). TACV can be applied during percutaneous cardiopulmonary support (PCPS) or cardiopumonary bypass (CPB) in open heart surgery. Fig.4 Left ventricular stroke work (LVSW). TACV with VAB significantly reduced LVSW. Fig.2 Special multipurp, guiding cao,ders for trans aortic catheter venting (TACV).These catheters (8F, 100cm) have very thin wall and wide lumen. はCABG3例,MVR1例,僧帽弁形成術1例格は身長が146 /77(平均60.4)kg,体均162.2)cm,体表面積が (平であった.体重が50 66(平均1.68)m2であった. 全例で心臓手術操作終了後の人工心肺バイパス(CPB) 中に,大動脈遮断解除後の心機能回復を確認した上で,本 316 Fig.5 Myocardial adenosine 5'-triphosphate (ATP) the left ventricle. TACV with VAB significantly creased the mvocardial ATP. 人工臓器28巻2号1999年 in in

Table1 Hemodynamic and energetic parameters before and during venoarterial bypass *:p<0.05 TACV with VAB vs HF,#:p<0.05 TACV with VAB vs IsoIated VAB <:p<0.

3 Table1 Hemodynamic and energetic parameters before and during venoarterial bypass *:p<0.05 TACV with VAB vs HF,#:p<0.05 TACV with VAB vs IsoIated VAB <:p<0.05 Isolated VAB vs HF LVESP,left velltricularend-systolicpressure;lvedp,left ventricular end-diastolicpressure;edv,end-diastolic volume;esv. end-systolicvolume;sv,stroke Volume;Emax,slope of the end-systolicpressure-volume relation;ea,arterialelastance;sw. stroke work;prsw,preload recruitable stroke work;pe,potential energy;pva,the LV presure-volume area;pe/pva, LV ellergeticcharge;atp,adenosine 5'-triphosphate. Fig.6 Echo findings of the end-diastolic left ventricle before trans-aorticcatheter venting(tacv)under partialcardiopulmonary bypass. カテーテルを大腿動脈から左室まで挿入してTACVをった(Fig.3).CPBのし,TACVの流量は40 50ml/kg/minで行流量は10ml/kg/min以一定と Fig.7 Echo findings of the end-diastolic left ventricle during trans-aorticcatheter Ventlng(TACV)under partialcardiopulmonary bypass. Talbe2 Effect of trans-aortic partial cardiopulmonary catheter venting during bypass 上で安定したベンティングが可能な流量とした. TACVの臨床的評価は,TACVの最大流量,溶血や不整脈の有無,血行動態の変化,左室の収縮拡張動態などを各種モニターや経食道心エコーにより行った. III.結果の軽減は不十分であり,TACV併 1.重症左心不全モデルにおける実験的評価 2.TACV用実験的な重症左心不全モデルではEmax(mmHg/ml)が平均で8.4か VABにら5.9に比べると(平低下した.TACV+VABは均;TACV/VAB),左 (1197.9/1388下7 10-4J;Fig.4),ポ (938.3/ J),圧 J)な l)でみると,重単独室一回仕事量テンシャルエネルギー容積面積(1975.7/2362.9X10-4 どが有意に減少し,左 g wt tissue;fig.5)は室心筋内ATP(3.5/2.0μmol/ 有意に増加した.全症心不全に対してVAB単用によって左室負荷の十分な軽減と左室心筋代謝の改善が得られた. 体の結果(Table 独では左室負荷カテーテルの臨床応用成人開心術5例においてTACV用カテーテルの挿入は容易であり,不整脈等の問題はなかった.全例で安全に12 20ml/kg/min以上の流量が確保され,特に溶血などは認められなかった.TACVの効果として,CPB離均肺動脈圧の低下(4 7,平均5.5mmHg)とコー上の左室短軸拡張末期径の減少(30 40,平 Fig.6,Fig.7)が人工臓器28巻2号1999年脱時の平経食道心エ均35%; 確認された.なおドップラー心エコーに 317

4) Ress MR, Browne T, Sivananthan UM, Whittaker 1) Phillips SJ, Ballentice B, Slonine D, Hall J, Vande haar J, Kongtahworn C: Percutaneous initiation of cardiopulumonary bypass.

4 4) Ress MR, Browne T, Sivananthan UM, Whittaker 1) Phillips SJ, Ballentice B, Slonine D, Hall J, Vande haar J, Kongtahworn C: Percutaneous initiation of cardiopulumonary bypass. Ann Thorac Surg 36: , ) Phillips SJ, Zeff RH, Kongtahworn C, Skinner JR, Toon RS, Grignon A, Kennerly RM, Wickemeyer W, Iannone LA: Percutaneous cardippulumonary bypass: application and indication for use. Ann Thorac Surg 47: , ) Mooney MR, Arom KV, Joyce LD, Mooney JF, Goldenberg gency cardiopulumonary IF, von Rueden TJ, Emery RW: Emer bypass support in patients with cardiac arrest. J Thorac Cardiovasc Surg 101: , S, hick D, Verma SP, Tan LB, Davies GA: Cardiac resuscitation with percutaneous cariopulumonary support. Lancet 340: , ) Shibuya M, Kitamura M, Kurihara H, Kikuchi C, Endo M, Koyanagi H: Significant Left Ventricular Unloading with Transaortic Catheter Venting Dur ing Venoarterial Bypass. Artificial Organs 21: , ) Kurihara H, Kitamura M, Shibuya M, Tsuda Y, Endo M, Koyanagi H: Effect of Transaortic Venting on Left Ventricular Function During Venoarterial Bypass. ASAIO trans 43: M338-M341, ) Proctor E, Kowalik TA: Circulatory support by pump-oxygenator in experimental ventricular fibril lation and acute left heart failure induced by coro nary artery ligation. Cardiovasc Resus 1: , ) Kass DA, Midei M, Brinker J, Maughan WL: Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume rela tions in humans. Circulaton 81: , ) Suga H, Sagawa K: Instantaneous pressure-volume relationship and their ratio in the excised, supported canine left ventricle. Circ Res 35: , ) Kass DA, Tamazaki T, Burkhoff D, Maughan WL, Sagawa K: Determination of left ventricular end systolic pressure-volume relationships by the con ductance (volume) catheter technique. Circulation 73: , ) Suga H: Ventricular energetics. Physiol Rev 70: , ) Kodera K, Kitamura M, Aomi S, Hachida M, Endo -

5 M, Koyanagi H: Biventricular bypass with oxygena tion for postcardiotomy ventricular failure. Artificial Organs 20: , ) Kitamura M, Aomi S, Hachida M, Nishida H, Endo M, Koyanagi H: Determinants of clinical results of mechanical circulatory support for ventricular fail ure after cardiotomy. ASAIO Journal 42: M729- M732, ) Kodera K, Kitamura M, Shibuya M, Kurihara H, Koyanagi H: Effect of a balanced biventricular bypass system on left ventricular energetics. Artificial Organs 22: , ) Kitamura M, Tagusari O, Koyanagi H: Trans mitral ventricular uptake without blood stagnation in temporary left ventricular support for severe cardiac failue. Heart Replacement: Artificial Heart IV, ed by Akutsu T, Koyanagi H, Springer-Verlag Tokyo 1993,

TABLE 1. CHANGES IN HEMODYNAMIC PARAMETERS DURING EXERCISE Figure 1. Hemodynamic changes in right atrial pressure (RAP) bee, and after. Figure 2. Hemo

TABLE 1. CHANGES IN HEMODYNAMIC PARAMETERS DURING EXERCISE Figure 1. Hemodynamic changes in right atrial pressure (RAP) bee, and after. Figure 2. Hemo Yozu Ryohei, Inoue T, Shimomitsu T, Morilnoto T, Sugita Y, Watanabe T, Ishikawa M, Stacy G, Jacobs G, Harasaki H, Nose Y. EXERCISE RESPONSE IN CHRONIC NONPULSATILE (NPBVB) AND PULSATILE TAH ANIMALS. Treadmill