Application of the Pulsatile Cardiopulmonary Bypass in Animal Model

이중 박동성 인공심폐기의 동물 실험

  • Shin, Hwa-Kyun (Dept. of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Won, Yong-Soon (Dept. of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Jea-Yook (Dept. of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Her, Keun (Dept. of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Yeum, Yook (Dept. of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Seung-Chul (Dept. of Thoracic and Cardiovascular Surgery, HanMaEum Hospital) ;
  • Min, Byoung-Goo (Dept. of Biomedical Engineering, Seoul National University)
  • 신화균 (순천향대학교 의과대학 흉부외과학교실) ;
  • 원용순 (순천향대학교 의과대학 흉부외과학교실) ;
  • 이재욱 (순천향대학교 의과대학 흉부외과학교실) ;
  • 허균 (순천향대학교 의과대학 흉부외과학교실) ;
  • 염욱 (순천향대학교 의과대학 흉부외과학교실) ;
  • 김승철 (한마음병원 흉부외과) ;
  • 민병구 (서울대학교 의공학과)
  • Published : 2004.01.01

Abstract

Background: Currently, the cardiopulmonary machine with non-pulsatile pumps, which are low in internal circuit pressure and cause little damage to blood cells, is widely used. However, a great number of experimental studies shows that pulsatile perfusions are more useful than non-pulsatile counterparts in many areas, such as homodynamic, metabolism, organ functions, and micro-circulation. Yet, many concerns relating to pulsatile cardiopulmonary machines, such as high internal circuit pressure and blood cell damage, have long hindered the development of pulsatile cardiopulmonary machines. Against this backdrop, this study focuses on the safety and effectiveness of the pulsatile cardiopulmonary machines developed by a domestic research lab. Material and Method: The dual-pulsatile cardiopulmonary bypass experiment with total extracorporeal circulation was conducted on six calves, Extracorporeal circulation was provided between superior/inferior vena cava and aorta. The membrane oxygenator, which was placed between the left and right pumps, was used for blood oxygenation. Circulation took four hours. Arterial blood gas analysis and blood tests were also conducted. Plasma hemoglobin levels were calculated, while pulse pressure and internal circuit pressure were carefully observed. Measurement was taken five times; once before the operation of the cardiopulmonary bypass, and after its operation it was taken every hour for four hours. Result: Through the arterial blood gas analysis, PCO2 and pH remained within normal levels. PO2 in arterial blood showed enough oxygenation of over 100 mmHg. The level of plasma hemoglobin, which had total cardiopulmonary circulation, steadily increased to 15.87 $\pm$ 5.63 after four hours passed, but remained below 20 mg/㎗. There was no obvious abnormal findings in blood test. Systolic blood pressure which was at 97.5$\pm$5.7 mmHg during the pre-circulation contraction period, was maintained over 100 mmHg as time passed. Moreover, diastolic blood pressure was 72.2 $\pm$ 7.7 mmHg during the expansion period and well kept at the appropriate level with time passing by. Average blood pressure which was 83$\pm$9.2 mmHg before circulation, increased as time passed, while pump flow was maintained over 3.3 L/min. Blood pressure fluctuation during total extracorporeal circulation showed a similar level of arterial blood pressure of pre-circulation heart. Conclusion: In the experiment mentioned above, pulsatile cardiopulmonary machines using the doual-pulsatile structure provided effective pulsatile blood flow with little damage in blood cells, showing excellence in the aspects of hematology and hemodynamic. Therefore, it is expected that the pulsatile cardiopulmonary machine, if it becomes a standard cardiopulmonary machine in all heart operations, will provide stable blood flow to end-organs.

배경: 기존에 사용되고 있는 인공심폐기는 비박동성 펌프로 회로 내부에 형성되는 압력이 낮고 혈구 손상이 적어서 표준 인공 심폐기로 선호되고 있다. 그러나 많은 실험적 연구들을 보면 박동성 관류가 혈역학, 대사, 장기의 기능, 미세 순환에 대하여 비박동성 관류보다 유익함을 알 수 있다. 그러나 박동성 인공심폐기는 높은 회로 내부 압력과 혈구손상이 해결되어야 할 문제점으로 개발이 어려웠다. 이 연구의 목적은 국내에서 제작된 이중 박동성 인공심폐기의 안전성 및 유효성을 알아보는 것이다. 대상 및 방법: 6마리의 송아지를 대상으로 이중 박동성 인공 심폐기 실험을 하였으며, 완전체외순환을 시켰다. 체외순환은 상,하 대정맥과 대동맥 사이를 우회하였으며, 막형 산화기를 사용하여 혈액을 산화시켰다. 산화기는 좌우측 펌프 중간에 위치시켰다. 순환 시간은 4시간이었다. 동맥혈가스분석, 혈액검사, 혈장 유리 혈색소를 측정하였으며, 맥압과 회로 내부압력을 관찰하였다. 측정은 인공 심폐기 구동 전과 순환 1, 2, 3, 4시간째에 측정하였다. 결과: 동맥혈 가스분석상 pH, 이산화 탄소분압은 모두 정상 범위였으며, 동맥혈 산소 분압은 100 mmHg 이상의 충분한 산화를 보였다. 혈장 유리혈색소는 완전 체외순환하여 4시간이 경과하면서 15.87 $\pm$5.63 mg/㎗로 점차 증가소견을 보였으나 20 mg/㎗ 이내였다. 혈액검사소견상 뚜렷한 이상소견은 없었다. 순환전 수축기 혈압은 97.5$\pm$5.7 mmHg이었으며 시간 경과하여도 100 mmHg 이상의 혈압을 유지하였다. 확장기 혈압은 72.2$\pm$7.7 mmHg이었으며 시간 경과하여도 잘 유지되었다. 평균 혈압은 순환 전 83$\pm$9.2 mmHg이었으며, 시간 경과 시 증가된 소견을 보였다. 펌프의 유량은 3.3 L/min이상을 유지할 수 있었다. 완전체외순환 동안의 혈압의 변화를 보면 순환 전 심장과 유사한 동맥혈압을 보였다. 결론: 이중 박동 구조를 이용한 박동성 인공심폐기는 효과적인 박동성 혈류를 제공하면서 혈구 세포손상도 적었으며, 혈액학적 및 혈역학적인 면에서도 우수한 결과를 보였다. 따라서 모든 심장수술의 인공심폐기로 사용되어질 경우 말초장기에 생리적이고 안정적인 혈류를 공급할 수 있을 것으로 기대된다.

Keywords

References

  1. Chest v.116 Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass Gu,J.Y.;Mariani,M.A.;Boonstra,P.W.;Grandjean,J.G.;van Overen W. https://doi.org/10.1378/chest.116.4.892
  2. The Heart and Vascular System in Ancient Greek Medicine Harris,C.R.G.
  3. Circulation of the Blood Harvey,W.;Kenneth,J.(ed.)(translated from Latin by)
  4. Ztschr Biol NSF v.474 Die Bedeutung des Pulses fur den Blutstrom Hamel,G.
  5. Minn Med v.37 Application of a mechanical heart and lung apparatus to cardiac surgery Gibbon,J.H.
  6. J Thorac Cardiovasc Surg v.30 Open left heart surgery in dogs during hypothermic asystole with and without extracoporeal circulation Gollan,F.;Phillips,R.J.;Grace,J.T.;Jones;R.M.
  7. Korean J Thorac Cardiovasc Surg v.34 Application of the total artificial heart as an implantable biventricular assist device by left thoracotomy in an ovine model Won,T.H.;Min,B.G.;Kim,W.G.
  8. Ann Thorac Surg v.36 Pulsatile and nonpulsatile cardiopulmonary bypass: Review of a counterproductive controversy Hickey,R.;Buckley,M.J.;Philbin,D.M https://doi.org/10.1016/S0003-4975(10)60286-X
  9. Ann Thorac Surg v.58 Hemodynamic analysis could resolve the pulsatile blood flow controversy Wright,G. https://doi.org/10.1016/0003-4975(94)90498-7
  10. Perfusion v.10 Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during cornary artery bypass grafting. Effects on systemic hemodynamics, oxygenation and inflammatory response parameters Driessen,J.J.;Dhaese,H.;Fransen,G.(et. al.) https://doi.org/10.1177/026765919501000102
  11. Ann Thorac Surg v.68 Effects of perfusion mode on regional and global organ blood folw in a neonatal piglet model Under,A.;Masai,T.;Yang.S.Q.;Goddard-finegold,J.;Frazier,O.H.;Frasr,C.D.Jr. https://doi.org/10.1016/S0003-4975(99)00913-3
  12. Perfusion v.13 Effects of flow types in cardiopulmonary bypass on gastric intramucosal pH. Hamulu,A.;Atay,Y.;Yagdi,T.(et al.) https://doi.org/10.1177/026765919801300208
  13. Perfusion v.10 Long-term blood pumping: an overview McCarthy,T. https://doi.org/10.1177/026765919501000305
  14. Surgery v.37 Extracorporeal circulation: the role of the pulse in maintenance of the systemic circulation during hear lung bypass Welsolwski,S.A.;Sauvage,L.R.;Pinc.R.D.
  15. Arch Jpn Clin v.29 A comparative study of the effectiveness of pulsatile and nonpulsatile flow in extracorporeal circulation Ogata,T.;Ida,T.;Nonoyama,A.(et al.)
  16. Surgery v.54 High amplitude pulsatile pump in extracorporeal circulation with particular reference to hemodynamics Nakayama,k.;Tamiya,Y.;Yamamoto,K.(et al.)
  17. Surgery v.68 Pulsatile cardiopulmonary bypass: clinical evaluation Trinkle,J.K.;Helton,N.E.;Brayant,L.R.;Griffen,W.O.
  18. J Thorac Cardiovasc Surg v.58 Metabolic comparison of a new pulsatile pump and a roller pump for cardiopulmonary bypass Trinkel,J.K.;Helton,N.E.;Wood,R.E.;Brayant,L.R.
  19. N Eng J Med v.267 The physiologic importance of pulsatile blood flow Wilkens,H.;Regelson,W.;Hoffmeister,F.S. https://doi.org/10.1056/NEJM196208302670907
  20. Perfusion v.13 Effects of flow types in cardiopulmonary bypass on gastric intramucosal pH. Hamulu,A.;Atay,Y.;Yagdi,T.(et al.) https://doi.org/10.1177/026765919801300208
  21. Circulation v.49;50 no.suppl II Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest Brunberg,J.A.;Reilly,E.L.;Doty,D.B.
  22. Surgery v.86 Cerebral anoxia: Effect of deep hypothermia and pH Norwood,W.;Norwood,C.;Castaneda,A.
  23. J Thorac Cardiovasc Surg v.86 The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry Treasure,T.;Naftel D.C.;Cogner,K.A.(et al.)
  24. J Thorac Cardiovasc Surg v.87 Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profound hypothermic cardiopulmonary bypass Fox,L.S.;Blackstone,E.H.;Kirklin,J.W.(et al.)
  25. J Thorac Cardiovasc Surg v.97 Brain tissue pH. oxygen tension, and carbon dioxide tension in profoundly hypothermic cardipulmonary bypass I. Watanabe,T.;Orita,H.;Kobayashi,M.(et al.)
  26. J Thorac Cardiovasc Surg v.108 The effect of pulsatile perfusion on cerebral blood flow during profound hypothermia with total circulatory arrest Onoe,M.;Mori,A.;Watarida,S.(et al.)
  27. J Thorac Surg v.68 Determinants of myocardial water content during cardiopulmonary bypass Utley,J.R.;Michalsky,C.B.;Bryant,L.R.;Mobin-Uddin,K.;McKean,H.E.
  28. J Thorac Cardiovasc Surg v.89 Indications for ultrafiltration in the cardiac surgical patient Magilligan,D.J.
  29. Ann Thorac Surg v.68 Effects of perfusion mode on regional and global organ blood flow in a neonatal piglet model Undar,A.;Masai,T.;Yang,S.Q.;Goddard-Finegold,J.;Frazier,O.H.Fraser,C.D.Jr. https://doi.org/10.1016/S0003-4975(99)00913-3
  30. Artif Org v.23 Cytokine and endothelial damage in pulsatile and nonpulsatile cardiopulmonary bypass Orime,Y.;Shiono,M.;Hata,H.(et al.) https://doi.org/10.1046/j.1525-1594.1999.06392.x