Açık kalp cerrahisinde pompa sisteminden oksijenatörün çıkarılması: deneysel hayvan çalışması

Abstract

Amaç: Koyun kullanılan bu deneysel çalışmada, pompa ile yapılan rutin açık kalp cerrahisi yönteminde, oksijenatör yerine pulmoner sistemin kullanılabileceği hipotezinin teknik olarak mümkün olup olmadığı araştırılmıştır.

Gereç ve Yöntem: Beş adet dişi Ankara koyunu kullanılan çalışmada hayvanlara pompa ile açık kalp ameliyatı uygulanmıştır. Temel fark venöz kanülasyon sağ atriyum yerine sol atriyuma yapılmış, oksijenatör sistemden çıkarılmıştır. Kardiyak arrest için 2 denekte ventriküler fibrilasyon, 2 denekte kros klemp-potasyum kardiyoplejisi tekniği kullanılmıştır. 30 dakika boyunca sürüdülen kardiyak arrest boyunca debiler, tansiyonlar, arter kan gazı değerleri gibi hemodinamik parametreler kaydedilmiştir. İlk denek tekniğin gerekli şekilde uygulanması sonucu pompa aşamasında ölmüştür. Diğer hayvanların hayatı test sonuçları elde edildikten sonra sonlandırılmıştır.

Sonuç: İn vivo olarak, tamamen hidrodinamik bir test şeklinde yürütülen çalışmada tekniğin en azından bu testte mümkün olabildiği görülmüştür. Hemodinaminin sıkı takibi ve santral venöz basıncın 18 mmHg civarında tutulmasıyla, ek bir pompaya gerek kalmadan sağ atriyum kanı spontan olarak sol atriyuma geçebilmiştir. Geçen kan miktarı  30dk boyunca, hedef kardiyak indeksin üzerinde stabil olarak sağlanabilmiştir. Çalışmanın düşündürdüğü bir başka sonuç da; akut miyokard infarktüsü gibi bir nedenle kalbin ventriküler fibrilasyona girdiği veya elektriksel iletinin bozularak kalbin kasılmadığı durumlarda sadece sol atriyum-aort arasına perkütan olarak yerleştirilecek bir pompa sistemiyle kardiyak ve sistemik dolaşımda perfüzyon sağlanabileceği şeklindedir.

Keywords

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

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

Abstract

Aim: In this experimental study using sheep, it has been investigated whether the hypothesis that the pulmonary system can be used instead of the oxygenator is technically possible in routine open heart surgery method.

Material and Method: In this study, 5 female Ankara sheep were used. The main difference was that the venous cannulation was made to the left atrium instead of the right atrium and the oxygenator was removed from the system. Ventricular fibrillation was performed in 2 subjects for cardiac arrest and cross clamp-potassium cardioplegia was used in 2 subjects. Hemodynamic parameters such as flow rates, blood pressure, arterial blood gas values ​​were recorded during 30 minutes of cardiac arrest. The first subject died in the pump stage due to the wrong application of the technique. The life of the other animals was terminated after the test results were obtained.

Results: In this in vivo study, which was conducted in the form of a fully hydrodynamic test, it has seen at least possible for this test. With a strict follow-up of hemodynamic parameters and provide central venous pressure as 18mmHg, the right atrial blood could spontaneously pass into the left atrium without the need for an additional pump. The amount of blood passed was stable over the target cardiac index for 30 min. Another result of the study gave rise to a thought that, in case such as heart attack,  cardiac and systemic circulation and perfusion may be provided by a pump system which will be placed percutaneously between the left atrial and aorta when the heartbeat is ended due to VF or the electrical conduction fails.

Keywords

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

References

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