重症心不全に対する両心補助人工心臓の心補助効果に関する実験的検討
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Recently much progress has been made in mechanical support of the failing heart, ventricular assist device (VAD) is the most currently useful technique. In this report, the effect of VAD as a mechanical support system on profound cardiac failure was studied experimentally. Thirty adult mongrel dogs, divided into 3 groups, were prepared for normothermic global is- chemia (NGI). In groupI (n=10), no mechanical support was carried out after NGI, groupII (n= 10), leftVAD was performed for 3 hours, then weaned and observed for 1 hour, groupIII (n=10), biVAD was performed for 3 hours, then weaned and observed for 1 hour. NGI was induced by aortic cross clamping for 20 minutes under cardiopulmonary bypass (CPB). After the aorta was undamped, all dogs were weaned from CPB, then VAD was commenced, except for group I. Data sampling was performed at Pre, CPBoff (weaned from CPB), VAD1h (VAD used for 1 hour), VAD2h, VAD3h and VADoff1h (weaned from VAD and observed for 1 hour). In groupI, all dogs died within 1.5 hours after CPB off. The bypass ratio in groupII was 58.9± 10.1% and that in groupIII was 60.2±16.5%L(Left) VAD and 79.6±10.2%R(Right) VAD. LAP (mean left atrial pressure) was significantly reduced during the use of VAD. RAP(mean right atrial pressure) was significantly reduced during VAD, and there was no significant difference between group II and group III. RVSWI(Right ventricular stroke work index) in group III was significantly lower than that in group II. RV%SS(Right ventricular %systolic shortening) in group III was significantly higher than that in groupII. PaO? was moderately diminished during the use of VAD and that in groupIII was significantly lower than that in group II at VAD3h. In these experimental studies, the following conclusions were obtained. Recovery from cardiac failure in the right heart system was better than that in the left heart system. The effect of VAD in treatment of cardiac failure would be to decrease the cardiac performance due to atrial decompres- sion. RVAD was useful for the treatment of right heart failure, however, overflow may cause hypoxemia due to pulmonary capillary leak syndrome. In conclusion, these results indicate that VAD is one of the most useful systems in the treatment of profound cardiac failure.
- 1992-08-01
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