作者要感谢 Roberto、Rueda 和 Sergio Martínez 在动物技术支持方面的宝贵技术帮助。

该协议 （B09-17） 由 INER（Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas"）的生物伦理委员会批准。本研究使用了 23 头临床健康的长白猪，无论性别，体重在 20-25 公斤之间。根据墨西哥官方标准17 和美国实验动物护理和使用指南18 的实验动物护理和使用技术规范处理动物。所有动物均来自 Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas，并被安置在相同的环境条件下的单独笼子中，随意提供水和食物。在所有动物中，在右颈静脉放置热稀释导管，在同一侧的颈动脉中放置动脉导管，收集血气，然后计算 CO。所用试剂和设备的详细信息列在 材料表中。
1. 实验准备
<ol><li>在三种 250 mL 0.9% 氯化钠溶液（生理盐水溶液，SS）中稀释 1000 IU 肝素。</li>
	<li>将压力传感器连接到生命体征监测仪。使用每个传感器测量热稀释导管相应端口的压力。</li>
	<li>通过无针静脉输注将肝素化溶液连接到换能器。确保它们已清除并准备好连接到导管。</li>
	<li>从包装中取出热稀释导管。将远端浸入 0.9% NaCl 中以检查球囊的完整性。</li>
	<li>检查远端和近端导管连接的通畅性。将导管放在手术器械台上直至使用。</li>
</ol>2. 动物准备
<ol><li>在动物准备室中肌肉注射 0.05 mg/kg 阿托品和 4 mg/kg tiletamine-zolazepam（遵循机构批准的方案）。</li>
	<li>让猪不受干扰，但受到监视，直到它们躺下并保持这个姿势，没有兴奋或对伤害性刺激有反应的迹象。</li>
	<li>将镇静的动物置于俯卧位，并将导管插入左耳的边缘静脉。</li>
	<li>将动物转移到手术室进行手术。</li>
	<li>将动物置于背侧位置，施用 4 mg/kg 异丙酚 IV、300 μg/kg 维库溴铵和 0.1 mg/kg 芬太尼 IV。</li>
	<li>在实验室工作人员的帮助下降低猪的下颌骨，以保持嘴巴张开和舌头伸出。</li>
	<li>将 10% 利多卡因喷洒在声带上，用环形镊子夹住纱布清除积聚的唾液，并将会厌与喉口分开。</li>
	<li>用喉镜和 3 号直刀片确定气管入口，然后用球囊插入 7 Fr 气管插管。</li>
	<li>在验证球囊在气道内的位置后，给球囊充气并将管子固定在下颌骨上。</li>
	<li>将猪连接到麻醉机上，以维持 2.5%-3% 七氟烷的麻醉状态（图 1）。</li>
	<li>以 25 次呼吸/分钟的频率，潮气量为 6-8 mL/kg 体重，FiO2% 为 50%-70% 以维持 SaO2 大于 90%，触发 2，呼气末正压 （PEEP） 为 5 cmH2O，吸气比为 1:2 s，吸气流量为 15 L/min，最大为 30 L/min。</li>
</ol>3. 放置热稀释导管和测量心输出量
<ol><li>在全身麻醉下将动物保持在背侧位置，并用碘泊维酮对颈部区域进行消毒（图 2）。使用电烙笔做一个 10 cm 的旁正中切口，解剖皮下组织，通过钝性解剖露出右颈外静脉。</li>
	<li>放置两条 2-0 丝缝合线，一条在解剖血管的远端部分，另一条在解剖血管的近端部分（图3）。</li>
	<li>将导管从颈部部位体外插入心脏所在的胸部区域。使用导管上的标记测量插入深度以到达肺动脉 （PA）。结扎血管的远端部分，并在近端放置一个双环，以便在插入后固定导管。</li>
	<li>使用虹膜剪刀在血管的腹侧部分做一个 2 毫米的横向切口。用 Halsted 蚊式止血钳打开切口边缘，将 5Fr 热稀释导管插入右颈静脉（图 4、 图 5 和 图 6）。按照监视器上显示的曲线将导管对准肺动脉 （PA）。</li>
</ol>4. 动脉导管的放置
<ol><li>一旦静脉被解剖并放置参考缝合线，将胸骨头肌（相当于胸锁乳突肌）向外侧移位。</li>
	<li>解剖气管前（胸骨舌骨）肌肉组织，直到露出颈动脉。</li>
	<li>将颈动脉与颈静脉类似地插管，并将其连接到压力传感器以监测体循环动脉压。</li>
</ol>5. 评估
<ol><li>将热稀释导管放置在右颈静脉中，并将动脉导管放置在同一侧的颈动脉中后，采集样本进行血气分析。</li>
	<li>使用热稀释法、体表面积和 Fick 法获取血气值并评估心输出量 （CO）。 注:有关详细程序，请参阅之前发布的报告19-21。</li>
</ol>6. 统计分析
<ol><li>使用方差分析 （ANOVA） 分析证明正态分布的数据，并执行 Tukey 事后检验。将值表示为平均值±标准误差。将 p 值 <0.05 视为表示统计显著性。</li>
</ol>7. 热稀释法测量
<ol><li>在不到 4 秒的时间内将 5 mL 冷 SS 在 4 °C 下推注到热稀释导管的近端管腔中。</li>
	<li>观察监视器屏幕上的热稀释曲线（温度/时间）。曲线应显示快速上升，然后平稳逐渐下降到基线，数值以小数点后一位或两位显示。</li>
	<li>用另外两次冷 SS 推注重复推注过程，直到曲线有效、相似且在平均值的 10% 以内。</li>
	<li>在确认曲线的有效性和相似性后，计算三个值的平均值并将其记录为最终的 CO 值，以升/分钟为单位。使用基于 Stewart-Hamilton 方程21 的计算从热稀释曲线中获得 CO 和其他指数。</li>
</ol>8. 确定体表面积 （BSA） 或心脏指数的调整后心输出量
<ol><li>要确定调整后的心输出量 （CI），请使用 DuBois-DuBois 公式19 计算体表面积 （BSA）: BSA = 0.007184 × （身高 （cm） 0.725） × （体重 （kg）0.425）。</li>
	<li>获得 BSA 后，使用公式20 计算 CI: CI = CO/BSA。 注:CO 在步骤 7 中确定。</li>
</ol>9. 通过 Fick 方法估计心输出量
<ol><li>要使用 Fick 方法计算心输出量 （CO），请确定耗氧量 （VO2） 以及从动脉 （SaO2） 和静脉 （SvO2） 血气获得的氧水平差异。使用公式2 计算 VO 21: VO2 = CO x （SaO2 - SvO2）。</li>
	<li>然后，使用公式21 确定心输出量: CO = VO2 / （[SaO2 - SvO2] × 10）。</li>
</ol>10. 估计每体重的心输出量
<ol><li>根据先前的报告 8,15 确定动物每体重的心输出量。 注:在 EVLP 方案中，各个小组报告称，猪每体重的估计心输出量 （CO） 为 100 mL/kg 8,15。</li>
</ol>11. 安乐死
<ol><li>一旦完成所有测量，通过颈静脉鞘（遵循机构批准的方案）用过量的戊巴比妥钠 （150 mg/kg/ IV） 对所有 动物实施安乐死。</li>
	<li>继续全身麻醉和心脏监测，直到心电图 （ECG） 轨迹显示无心脏电活动17,18。</li>
</ol>

猪颈静脉热稀释导管放置手术技术

<ol>
	<li>Mohite, P. N., 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=Ex+vivo+lung+perfusion+made+easy.">Ex vivo lung perfusion made easy.</a> Multimed Man Cardiothorac Surg. 23, 2021 (2021).</li><li>Cypel, M., Keshavjee, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex+vivo+lung+perfusion.">Ex vivo lung perfusion.</a> Oper Tech Thorac Cardiovasc Surg. 19 (4), 433-442 (2014).</li><li>Langmuur, S. J. J., Max, S. A., &#199;elik, M., Mahtab, E. A. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex+vivo+lung+perfusion:+A+procedural+guide.">Ex vivo lung perfusion: A procedural guide.</a> Multimed Man Cardiothorac Surg. 2023, (2023).</li><li>Kesseli, S. J., Davis, R. P., Hartwig, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Commentary:+Making+lungs+great+again-introducing+new+modifications+to+the+Toronto+ex+vivo+lung+perfusion+protocol.">Commentary: Making lungs great again-introducing new modifications to the Toronto ex vivo lung perfusion protocol.</a> J Thorac Cardiovasc Surg. 161 (6), 1974-1975 (2021).</li><li>Roman, M. A., Nair, S., Tsui, S., Dunning, J., Parmar, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex+vivo+lung+perfusion:+A+comprehensive+review+of+the+development+and+exploration+of+future+trends.">Ex vivo lung perfusion: A comprehensive review of the development and exploration of future trends.</a> Transplantation. 96 (6), 509-518 (2013).</li><li>Van Raemdonck, D., Neyrinck, A., Cypel, M., Keshavjee, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex-vivo+lung+perfusion.">Ex-vivo lung perfusion.</a> Transpl Int. 28 (6), 643-656 (2015).</li><li>Machuca, T. N., Cypel, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex+vivo+lung+perfusion.">Ex vivo lung perfusion.</a> J Thorac Dis. 6 (8), 1054-1062 (2014).</li><li>Beller, J. P., 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=Reduced-flow+ex+vivo+lung+perfusion+to+rehabilitate+lungs+donated+after+circulatory+death.">Reduced-flow ex vivo lung perfusion to rehabilitate lungs donated after circulatory death.</a> J Heart Lung Transplant. 39 (1), 74-82 (2020).</li><li>Garc&#237;a, X., 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=Estimating+cardiac+output,+utility+in+the+clinical+practice:+Available+invasive+and+non-invasive+monitoring.">Estimating cardiac output, utility in the clinical practice: Available invasive and non-invasive monitoring.</a> Med Intensiva. 35 (9), 552-561 (2011).</li><li>Blanco-Tencio, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparability+of+cardiac+output+measured+by+pulse+contour+analysis+compared+with+transesophageal+echocardiography+at+the+Calder&#243;n+Guardia+Hospital+from+April+to+July+2021.">Comparability of cardiac output measured by pulse contour analysis compared with transesophageal echocardiography at the Calder&#243;n Guardia Hospital from April to July 2021.</a> Tesis Especialidad en Anestesiología y Recuperaci&#243;n. Universidad de Costa Rica. San Jose, Costa Rica. , (2021).</li><li>Physiology, Cardiac output. StatPearls Publishing Available from: <a target="_blank" href="https://www.ncbi.nlm.nih.gov/books/NBK470455/">https://www.ncbi.nlm.nih.gov/books/NBK470455/</a> (2022)</li><li>Johnson, 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=Cardiac+physiology.">Cardiac physiology.</a> Essentials of Cardiac Anesthesia. , 53-66 (2008).</li><li>Corsini, A., Cercenelli, L., Zecchi, M., Marcelli, E., Corazza, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Basic+hemodynamic+parameters.">Basic hemodynamic parameters.</a> Advances in Cardiovascular Technology. , 463-474 (2022).</li><li>Mateu Campos, M. L., 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=Techniques+available+for+hemodynamic+monitoring:+Advantages+and+limitations.">Techniques available for hemodynamic monitoring: Advantages and limitations.</a> Med Intensiva. 36 (6), 434-444 (2012).</li><li>Cypel, 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=Technique+for+prolonged+normothermic+ex+vivo+lung+perfusion.">Technique for prolonged normothermic ex vivo lung perfusion.</a> J Heart Lung Transplant. 27 (12), 1319-1325 (2008).</li><li>National Transplant Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=National+protocol+for+the+maintenance+of+potential+donor+in+brain+death.">National protocol for the maintenance of potential donor in brain death.</a> SEMICYUC. , (2020).</li><li>Estados Unidos Mexicanos. AF&#205;A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Especificaciones+T&#233;cnicas+para+la+Producci&#243;n,+Cuidado+y+Uso+de+Animales+de+Laboratorio+de+la+Norma+Oficial+Mexicana+NOM-062-ZOO-1999.">Especificaciones T&#233;cnicas para la Producci&#243;n, Cuidado y Uso de Animales de Laboratorio de la Norma Oficial Mexicana NOM-062-ZOO-1999.</a> Diario Oficial de la Federaci&#243;n 6 dic. , (1999).</li><li>National Institutes of Health U.S.A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gu&#237;a+Para+el+Cuidado+y+Uso+de+Los+Animales+de+Laboratorio.">Gu&#237;a Para el Cuidado y Uso de Los Animales de Laboratorio.</a> Department of Health and Human Services, Public Health Service, National Institutes of Health U.S.A. , (2002).</li><li>Flint, B., Hall, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Body+surface+area.">Body surface area.</a> StatPearls. , (2023).</li><li>Ewah, P. A., Oyeyemi, A. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+between+derived+cardiovascular+indices,+body+surface+area,+and+blood+pressure/heart+rate+recovery+among+active+and+inactive+Nigerian+student.">Relation between derived cardiovascular indices, body surface area, and blood pressure/heart rate recovery among active and inactive Nigerian student.</a> Bull Fac Phys Ther. 27, 34 (2022).</li><li>Kobe, 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=Cardiac+output+monitoring:+Technology+and+choice.">Cardiac output monitoring: Technology and choice.</a> Ann Card Anaesth. 22 (1), 6-17 (2019).</li><li>Nelson, 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=Animal+models+of+ex+vivo+lung+perfusion+as+a+platform+for+transplantation+research.">Animal models of ex vivo lung perfusion as a platform for transplantation research.</a> World J Exp Med. 4 (2), 7-15 (2014).</li><li>Argueta, E., Paniagua, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermodilution+cardiac+output+a+concept+over+250+years+in+the+making.">Thermodilution cardiac output a concept over 250 years in the making.</a> Cardiology Rev. 27 (3), 138-144 (2019).</li><li>Perry, D. A., 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=Changes+in+tissue+oxygen+tension,+venous+saturation,+and+Fick-based+assessments+of+cardiac+output+during+hyperoxia.">Changes in tissue oxygen tension, venous saturation, and Fick-based assessments of cardiac output during hyperoxia.</a> Acta Anaesthesiol Scand. 63 (1), 93-100 (2019).</li></ol>

作者已声明不存在相互竞争的利益。

鉴于两个物种的大小、生理学和基因组序列的可比性，猪的 EVLP 可以直接转化为人类临床实践22。根据研究人员选择的 EVLP 方案，CO 的测量对于确定灌注肺部所需的流量至关重要。此外，根据可用的资源和知识，可以选择合适的方法。然而，没有研究将同时评估 CO 的方法与参考方法进行比较。因此，本研究旨在比较四种测量 CO 以估计 EVLP 期间肺流量的技术。我们纳入了实验性血流动力学实验室研究中常用的两种技术，以及两种采用临床护理中使用的计算心血管参数的技术。这项研究表明，在健康猪中，当直接比较四种技术时，调整后的 BSA 方法产生的值存在显著差异。
参考方法热稀释法提供快速、简单和即时的测量;因此，如果可以使用测量和数据采集仪器，并且根据方案的需要，热稀释导管是理想的选择。此外，这种方法基于简单的物理原理并且非常精确，因为它使用间接量化血流的指标23。这种方法于 1970 年首次被描述;将预定体积的冷盐水注射到肺动脉导管的近端端口后，测量血液中的热变化。在这项研究中，开放血管清扫术被用于颈静脉和颈动脉插管，因为在切开皮肤和分离颈部肌肉时很容易看到，这导致了我们实验室常规使用这项技术。值得一提的是，Seldinger 技术可用于此实验模型;然而，除了需要额外的设备外，根据我们的经验，如果缺乏足够的训练，这种技术很难在猪身上执行。
热稀释法技术的优点包括可靠性高，并且易于进行连续测量，而无需像 Fick 方法23 那样获取血液样本。另一方面，计算出的心血管参数是重要的临床工具，在评估心血管系统状态时补充直接测量。CI 用于显示 CO 和 BSA 如何关联。这个得出的心血管指数很重要且易于计算，这使得它对于在资源有限的环境中用于决策具有吸引力20。然而，在本研究中，BSA 方法产生的值明显大于其他方法，这可能表明与使用其他方法获得的流量相比，肺灌注流量被高估了。
Fick 的心输出量测量法于 1870 年首次被描述为一种测量人体 CO 的方法。菲克假设肺部对氧气的总摄取或释放是流经肺部的血流与动静脉血氧差异的乘积。该技术用于心导管实验室，因为它非常精确，并根据数学模型提供有关数字趋势的信息;然而，它不适用于临床环境或连续测量 CO21,24。
关于通过重量法获得的 CO，我们发现该值低于其他方法，但对于在猪中进行 EVLP 的人可能有用。正如 Beller 等人 8 所描述的，他们将 EVLP 与预测 CO 的 20% 的流量进行了比较，发现这种方法改善了移植后的肺功能、减少了水肿并减轻了炎症。
最后，文献表明，不同的 CO 监测技术有其自身的局限性，没有设备可以满足所有实践要求。然而，根据研究人员的需要，如果高级测量工具的使用有限，通过计算确定 CO 也是可靠、简单、可重现的，并且比侵入性技术需要更少的时间 2,20。尽管这些估计 CO 的方法可靠，但它们之间存在显著差异。因此，研究人员必须对每种方法进行评估，以确定哪种方法符合其方案的需求。
需要提到的是，这项研究有一个局限性，因为这里没有与其他广泛使用的 CO 测量技术进行比较，例如多普勒技术（经胸、经食管和超声心动图）或生物阻抗-胸部电生物反应。包括这些方法可以为这些技术与肺动脉导管插入术 （PAC） 之间用于猪 CO 测量的一致性提供有价值的见解。

在肺移植中心，离体肺灌注 （EVLP） 是一种工具，有助于增加捐献不符合移植标准标准的肺的可能性1。这是通过保存和改善脑死亡或心脏骤停供体的肺功能，以及通过评估移植前的肺功能来实现的 2,3,4。在 EVLP 中，体外循环泵允许通过膜气体交换器和白细胞捕获过滤器移植肺灌注5。
迄今为止，已经描述了几种 EVLP 方案（Toronto、Lund 和 Organ Care System）。这些根据所用灌注溶液的类型、灌注期间左心房是保持开放还是闭合，以及灌注流量（从供体估计心输出量 （CO） 的 40% 到 100%（取决于所使用的技术）不等）来区分 6,7,8。CO 是心脏每分钟泵送的血量9 ，是维持组织灌注的机制。因此，CO 监测可确保适当的组织氧合。CO 是心率和每搏输出量的乘积，以升 10,11,12 为单位。然而，这种维持组织灌注的方法还取决于其他因素，例如静脉回流、外周氧使用、全身血管阻力、呼吸、总血容量和体位12。
有几种用于测量和监测 CO 的设备，其中一些使用简单的物理原理，而另一些则使用数学模型。这些方法包括 Fick 原则、热稀释法（经肺或锂稀释）、动脉压波分析以估计每搏输出量 （SV） 以及多普勒或胸部生物反应等侵入性较小的方法。然而，由于相应监测技术的局限性，没有一种 CO 监测设备可以满足所有临床要求10,13。
通过经心热稀释法测量 CO 是一种简单且易于重现的猪方法。它包括在肺动脉中放置一根带有热敏电阻的导管，并注入一定量的液体，其温度低于血液的温度。热敏电阻检测温度随时间的变化，然后以曲线的形式绘制，曲线下的面积代表微小体积14。各种研究都表明，对于 EVLP 动物模型，可以通过重量 （100 mL/kg）15、热稀释法和 Fick 法10,13 来计算 CO。然而，在临床上，CO 是使用心脏指数 （CI） 计算的，该指数是根据供体的体表面积调整的 CO16。然而，没有研究在实验猪模型中比较这些方法。
本研究的目的是重现猪通过热稀释法测量的 CO，并将其精度和准确度与使用 BSA 调整的 CO、体重和 Fick 方法获得的精度和准确度进行比较，以确定 EVLP 期间的灌注流量。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Anesthesia machine</td>
			<td>General Electric</td>
			<td>Carescape 620</td>
			<td></td>
		</tr>
		<tr>
			<td>Atropine</td>
			<td>Amixteria, Stern Pharma GmbH</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Catheter Insyte Autoguard 20 GA</td>
			<td>Becton Dickinson</td>
			<td>381434</td>
			<td></td>
		</tr>
		<tr>
			<td>Electrocautery pencil</td>
			<td>BBraun Aesculap</td>
			<td>GN211</td>
			<td></td>
		</tr>
		<tr>
			<td>Endotracheal tube with a 7 Fr balloon</td>
			<td>Rush</td>
			<td>MG 027770 002</td>
			<td></td>
		</tr>
		<tr>
			<td>Fentanyl</td>
			<td>Janssen-Cilag</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Iodopovidone</td>
			<td>Degasa</td>
			<td>NDC6732635208</td>
			<td></td>
		</tr>
		<tr>
			<td>Laryngoscope</td>
			<td>Riester</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine Spray</td>
			<td>Pisa</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Pressure transducers</td>
			<td>Edwards Lifesciences</td>
			<td>PX260</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol</td>
			<td>Pisa</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sevofluorane</td>
			<td>Pisa</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Silk sutures 2-0</td>
			<td>Covidien</td>
			<td>GS833</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium pentobarbital</td>
			<td>Pfizer</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>straight blade of laryngoscope #3</td>
			<td>Miller; Riester</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Swan-Ganz 5Fr thermodilution catheter</td>
			<td>Arrow Thermodilution Ballon Catheter</td>
			<td>Ref AI-07165</td>
			<td></td>
		</tr>
		<tr>
			<td>Tiletamine-zolazepam</td>
			<td>Virbac</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Vecuronium bromide</td>
			<td>Pisa</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

determination of cardiac output in a porcine model for ex vivo pulmonary perfusion

由于猪与人类的生理相似性，猪被用作 离体 肺灌注 （EVLP） 的实验模型。EVLP 是一种通过体外循环泵灌注不适合移植的肺的技术，以改善其功能并提高其活力。现有的 EVLP 方案通过灌注溶液的类型和灌注流量进行区分，根据体表面积 （BSA），灌注流量从估计心输出量 （CO） 的 40%-100% 不等。用于测量 CO 的设备使用简单的物理原理和其他数学模型。动物模型中的热稀释法仍然是估计 CO 的参考标准品，因为它简单且易于复制。因此，本研究的目的是重现猪热稀释法对 CO 的测量，并将其精密度和准确度与 BSA、重量和 Fick 方法获得的精密度和准确度进行比较，以确定 EVLP 期间的灌注流量。在 23 头猪中，在右颈静脉放置热稀释导管，并在同一侧的颈动脉插管。获取血样进行气体测定，并通过热稀释法、调整体表面积、Fick 原理和体重估计 CO。BSA 获得的 CO 大于其他方法获得的 CO （p = 0.0001， ANOVA， Tukey）。我们得出的结论是，尽管本研究中用于估计 CO 的方法是可靠的，但它们之间存在显着差异;因此，每种方法都必须由研究者进行评估，以确定哪种方法符合方案的需要。

所有动物都在外科手术和研究时间内幸存下来。1 只动物 （4.3%） 由于导管插入过程中过度牵引而发生颈静脉撕裂。此外，干预血管均未出现出血。在研究动物中，平均需要 25-30 cm 的导管插入才能到达 PA。在 3 例 （13%） 中，导管对准猪的右上肢。在这些情况下，导管缩回插入部位，猪的上肢重新定位到头部，并手动阻塞颈静脉以将导管引向心脏。2 只动物 （8.6%） 在导管插入过程中出现心动过速和心律失常。这些会自行消退，不需要药物管理。当比较通过四种方法获得的 CO 时，由体表面积调整的值 （p < 0.05;方差分析，Tukey）大于用热稀释法获得的 CO 和按重量调整的 CO（图 7）。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/66798/66798fig01.jpg"> 图 1:插管和麻醉设置。 猪插管并连接到吸入麻醉机。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig01large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/66798/66798fig02.jpg"> 图 2:宫颈区域的消毒。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig02large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/66798/66798fig03.jpg"> 图 3:颈静脉夹层。 颈静脉解剖并在其周围放置参考缝合线。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig03large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/66798/66798fig04.jpg"> 图 4:导管插入。 将导管插入颈静脉腹侧部分的横向切口。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig04large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/66798/66798fig05.jpg"> 图 5:热稀释法导管插入追踪。 热稀释导管放置期间的插入追踪正常。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig05large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/66798/66798fig06.jpg"> 图 6:最终导管放置。 导管放置在颈静脉 （A） 和颈动脉 （B） 中的末端。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig06large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/66798/66798fig07.jpg"> 图 7:心输出量估计。 通过调整后的体表面积法估计的最高心输出量（平均值±标准误差）。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66798/66798fig07large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>

作者聚焦: 通过热稀释法评估猪 EVLP 期间有效灌注流量的心输出量计算

该方案描述了用于通过猪颈静脉放置热稀释导管的手术技术，以估计心输出量并确保在 离体 肺灌注 （EVLP） 期间有足够的肺灌注。

猪离体肺灌注模型中心输出量的测定

Due to their physiological similarities to humans, pigs are used as experimental models for ex vivo lung perfusion (EVLP). EVLP is a technique that ...

determination-cardiac-output-porcine-model-for-ex-vivo-pulmonary

Nanyang Technological University

Research

JoVE Journal

Medicine

Determination of Cardiac Output in a Porcine Model for Ex Vivo Pulmonary Perfusion

385 次观看.  Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas. 进行这项研究是为了确保通过猪热病变法计算心输出量是否允许我们获得与其他技术获得的值相等的值，从而在实验动物模型中建立离体肺灌注或 EVLP 期间的足够灌注流量。挑战之一是开发新的低成本解决方案和技术来执行 EVLP，这将允许恢复在正常情况下可能被丢弃用于肺移植的肺，并允许延长肺保留。评估在不同灌注流量下长期保存至 EVLP 后肺?...

视频: 作者聚焦: 通过热稀释法评估猪 EVLP 期间有效灌注流量的心输出量计算

Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement

The mainstay of contemporary therapies for extensive occlusive arterial disease is venous bypass graft. However, its durability is threatened by intimal hyperplasia (IH) that eventually leads to vessel occlusion and graft failure. Mechanical forces, particularly low shear stress and high wall tension, are thought to initiate and to sustain these cellular and molecular changes, but their exact contribution remains to be unraveled. To selectively evaluate the role of pressure and shear stress on the biology of IH, an ex&#160;vivo perfusion system (EVPS) was created to perfuse segments of human saphenous veins under arterial regimen (high shear stress and high pressure). Further technical innovations allowed the simultaneous perfusion of two segments from the same vein, one reinforced with an external mesh. Veins were harvested using a no-touch technique and immediately transferred to the laboratory for assembly in the EVPS. One segment of the freshly isolated vein was not perfused (control, day 0). The two others segments were perfused for up to 7 days, one being completely sheltered with a 4 mm (diameter) external mesh. The pressure, flow velocity, and pulse rate were continuously monitored and adjusted to mimic the hemodynamic conditions prevailing in the femoral artery. Upon completion of the perfusion, veins were dismounted and used for histological and molecular analysis. Under ex&#160;vivo conditions, high pressure perfusion (arterial, mean = 100 mm Hg) is sufficient to generate IH and remodeling of human veins. These alterations are reduced in the presence of an external polyester mesh.

Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement

The mechanisms leading to the development of intimal hyperplasia (IH) and vein graft failure are still poorly understood. This study describes an ex&#160;vivo system to perfuse human veins under controlled flow and pressure. Furthermore the efficiency of external mesh reinforcement to limit the development of IH was evaluated.

步骤人类隐静脉<em&gt;前体内</em&gt;灌注和外部强化

The mainstay of contemporary therapies for extensive occlusive arterial disease is venous bypass graft. However, its durability is threatened by intimal ...

科研

医学

Method of Isolated Ex Vivo Lung Perfusion in a Rat Model: Lessons Learned from Developing a Rat EVLP Program

The number of acceptable donor lungs available for lung transplantation is severely limited due to poor quality. Ex-Vivo Lung Perfusion (EVLP) has allowed lung transplantation in humans to become more readily available by enabling the ability to assess organs and expand the donor pool. As this technology expands and improves, the ability to potentially evaluate and improve the quality of substandard lungs prior to transplant is a critical need. In order to more rigorously evaluate these approaches, a reproducible animal model needs to be established that would allow for testing of improved techniques and management of the donated lungs as well as to the lung-transplant recipient. In addition, an EVLP animal model of associated pathologies, e.g., ventilation induced lung injury (VILI), would provide a novel method to evaluate treatments for these pathologies. Here, we describe the development of a rat EVLP lung program and refinements to this method that allow for a reproducible model for future expansion. We also describe the application of this EVLP system to model VILI in rat lungs. The goal is to provide the research community with key information and &#8220;pearls of wisdom&#8221;/techniques that arose from trial and error and are critical to establishing an EVLP system that is robust and reproducible.

Method of Isolated Ex Vivo Lung Perfusion in a Rat Model: Lessons Learned from Developing a Rat EVLP Program

Ex-Vivo Lung Perfusion (EVLP) has allowed lung transplantation in humans to become more readily available by enabling the ability to assess organs and expand the donor pool. Here, we describe the development of a rat EVLP program and refinements that allow for a reproducible model for future expansion.

的隔离方法<em&gt;离体</em&gt;肺灌注的大鼠模型:教训制定鼠EVLP课程中学

The number of acceptable donor lungs available for lung transplantation is severely limited due to poor quality. Ex-Vivo Lung Perfusion (EVLP) has allowed ...

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

There is a significant shortage of liver allografts available for transplantation, and in response the donor criteria have been expanded. As a result, normothermic ex vivo liver perfusion (NEVLP) has been introduced as a method to evaluate and modify organ function. NEVLP has many advantages in comparison to hypothermic and subnormothermic perfusion including reduced preservation injury, restoration of normal organ function under physiologic conditions, assessment of organ performance, and as a platform for organ repair, remodeling, and modification. Both murine and porcine NEVLP models have been described. We demonstrate a rat model of NEVLP and use this model to show one of its important applications &#8212; the use of a therapeutic molecule added to liver perfusate. Catalase is an endogenous reactive oxygen species (ROS) scavenger and has been demonstrated to decrease ischemia-reperfusion in the eye, brain, and lung. Pegylation has been shown to target catalase to the endothelium. Here, we added pegylated-catalase (PEG-CAT) to the base perfusate and demonstrated its ability to mitigate liver preservation injury. An advantage of our rodent NEVLP model is that it is inexpensive in comparison to larger animal models. A limitation of this study is that it does not currently include post-perfusion liver transplantation. Therefore, prediction of the function of the organ post-transplantation cannot be made with certainty. However, the rat liver transplant model is well established and certainly could be used in conjunction with this model. In conclusion, we have demonstrated an inexpensive, simple, easily replicable NEVLP model using rats. Applications of this model can include testing novel perfusates and perfusate additives, testing software designed for organ evaluation, and experiments designed to repair organs.

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

There is a significant liver donor shortage, and criteria for liver donors have been expanded. Normothermic ex vivo liver perfusion (NEVLP) has been developed to evaluate and modify organ function. This study demonstrates a rat model of NEVLP and tests the ability of pegylated-catalase, to mitigate liver preservation injury.

体外常温肝灌注的小动物模型

There is a significant shortage of liver allografts available for transplantation, and in response the donor criteria have been expanded. As a result, ...

Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

The current standard method for organ preservation (cold storage, CS), exposes the heart to a period of cold ischemia that limits the safe preservation time and increases the risk of adverse post-transplantation outcomes. Moreover, the static nature of CS does not allow for organ evaluation or intervention during the preservation interval. Normothermic ex situ heart perfusion (ESHP) is a novel method for preservation of the donated heart that minimizes cold ischemia by providing oxygenated, nutrient-rich perfusate to the heart. ESHP has been shown to be non-inferior to CS in the preservation of standard-criteria donor hearts and has also facilitated the clinical transplantation of the hearts donated after the circulatory determination of death. Currently, the only available clinical ESHP device perfuses the heart in an unloaded, non-working state, limiting assessments of myocardial performance. Conversely, ESHP in working mode provides the opportunity for comprehensive evaluation of cardiac performance by assessment of functional and metabolic parameters under physiologic conditions. Moreover, earlier experimental studies have suggested that ESHP in working mode may result in improved functional preservation. Here, we describe the protocol for ex situ perfusion of the heart in a large mammal (porcine) model, which is reproducible for different animal models and heart sizes. The software program in this ESHP apparatus allows for real-time and automated control of the pump speed to maintain desired aortic and left atrial pressure and evaluates a variety of functional and electrophysiological parameters with minimal need for supervision/manipulation.

Normothermic ex situ heart perfusion (ESHP), preserves the heart in a beating, semi-physiologic state. When performed in a working mode, ESHP provides the opportunity to perform sophisticated assessments of donor heart function and organ viability. Here, we describe our method for myocardial performance evaluation during ESHP.

工作模式下的心功能和代谢评估

The current standard method for organ preservation (cold storage, CS), exposes the heart to a period of cold ischemia that limits the safe preservation ...

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart failure. Multiple small-animal models of heart transplantation have been used to study the acute and long-term effects of novel therapies. However, few are tested and demonstrated success in clinical trials. It is of critical importance to evaluate new therapies in a clinically relevant large-animal model for efficient and reliable translation of basic studies&#39;&#160;findings. Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and previously used to investigate novel cardioprotective strategies. This procedure focuses on acute ischemia-reperfusion injury and is a reliable method to investigate novel interventions which have been tested and validated in smaller experimental models, such as the murine model. We demonstrate its usefulness in assessing cardiac performance during the early post-transplantation period and other potential possibilities enabled by the model.

Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and utilized to investigate novel cardioprotective strategies.

正交心脏移植的临床前猪模型

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart ...

Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. However, lung transplantation is limited by a shortage of available donor organs. As such, there is high waitlist mortality. Ex situ lung perfusion (ESLP) has increased donor lung utilization rates in some centers by 15%-20%. ESLP has been applied as a method to assess and recondition marginal donor lungs and has demonstrated acceptable short- and long-term outcomes following transplantation of extended criteria donor (ECD) lungs. Large animal (in vivo) transplantation models are required to validate ongoing in vitro research findings. Anatomic and physiologic differences between humans and pigs pose significant technical and anesthetic challenges. An easily reproducible transplant model would permit the&#160;in vivo&#160;validation of current ESLP strategies and the preclinical evaluation of various interventions designed to improve donor lung function. This protocol describes a porcine model of orthotopic left lung allotransplantation. This includes anesthetic and surgical techniques, a customized surgical checklist, troubleshooting, modifications, and the benefits and limitations of the approach.

This protocol describes a juvenile porcine model of orthotopic left lung allotransplantation designed for use with ESLP research. Focus is made on anesthetic and surgical techniques, as well as critical steps and troubleshooting.

ESLP幼猪模型中的左肺原位移植

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. ...

A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts and complications such as primary graft dysfunction and graft rejection. The recent clinical use of an ex vivo perfusion device in cardiac transplantation introduces a unique opportunity for treating cardiac allografts with therapeutic interventions to improve function and avoid deleterious recipient responses. Establishing a translational, large-animal model for therapeutic delivery to the entire allograft is essential for testing novel therapeutic approaches in cardiac transplantation. The porcine, heterotopic heart transplantation model in the intraabdominal position serves as an excellent model for assessing the effects of novel interventions and the immunopathology of graft rejection. This model additionally offers long-term survival for the pig, given that the graft is not required to maintain the recipient's circulation. The aim of this protocol is to provide a reproducible and robust approach for achieving ex vivo delivery of a therapeutic to the entire cardiac allograft prior to transplantation and provide technical details to perform a survival heterotopic transplant of the ex vivo perfused heart.

We present a protocol for utilizing a normothermic ex vivo sanguinous perfusion system for the delivery of therapeutics to an entire cardiac allograft in a porcine heterotopic heart transplant model.

一种猪异位心脏移植方案，用于向心脏同种异体移植物提供治疗药物

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts ...

A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position

The Ross operation for aortic valve disease has regained new interest due to its outstanding long-term results. Nonetheless, when employed as freestanding root replacement, the possible dilation of the pulmonary autograft and subsequent aortic regurgitation is described. Several animal models have been proposed. However, these are usually limited to ex-vivo models or in-vivo experiments with relatively expensive large animal models. In this study, we sought to establish a rodent model of pulmonary artery graft (PAG) implantation in a systemic position. A total of 39 adult Lewis rats were included. Immediately after euthanasia, the pulmonary root was harvested from a donor animal (n=17). Syngeneic recipient (n=17) and sham-operated (n=5) rats were sedated and ventilated. In the recipient group, the PAG was implanted with an end-to-end anastomosis in infra-renal abdominal aortic position. Sham-operated rats underwent only transection and re-anastomosis of the aorta. Animals were followed with serial ultrasound studies for two months and post-mortem histological analysis. The median PAG diameter in the native position was 3.20 mm (IQR=3.18-3.23). At follow-up, the median diameter of the PAG was 4.03 mm (IQR=3.74-4.13) at 1 week, 4.07 mm (IQR=3.80-4.28) at 1 month, and 4.27 mm (IQR=3.90-4.35) at 2 months (p&lt;0.01). Peak systolic velocity was 220.07 mm/s (IQR=210.43-246.41) at 1 week, 430.88 mm/s (IQR=375.28-495.56) at 1 month, and 373.68 mm/s (IQR=305.78-429.81) at 2 months (p=0.02) and did not differ from the sham-operated group at the end of the experiment (p=0.5). Histological analysis did not show any sign of endothelial thrombosis. This study showed that rodent models may allow for the evaluation of the long-term adaptation of the pulmonary root to a high-pressure system. A systemically placed syngeneic PAG implantation represents a simple and feasible platform for the development and evaluation of novel surgical techniques and drug therapies to further improve the outcomes of the Ross operation.

We demonstrate how to establish a murine model of pulmonary root implantation into the descending aorta to simulate the Ross procedure. This model enables the medium/long-term evaluation of pulmonary autograft remodeling in a systemic position, representing the basis of developing therapeutic strategies to promote its adaptation.

罗斯手术的啮齿动物模型:全身位置的同源肺动脉移植植入

The Ross operation for aortic valve disease has regained new interest due to its outstanding long-term results. Nonetheless, when employed as freestanding ...

Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment

The increase in demand for cardiac transplantation throughout the years has fueled interest in donation after circulatory death (DCD) to expand the organ donor pool. However, the DCD process is associated with the risk of cardiac tissue injury due to the inevitable period of warm ischemia. Normothermic regional perfusion (NRP) allows for an in situ organ assessment, allowing the procurement of hearts determined to be viable. Here, we describe a clinically relevant large-animal model of DCD followed by NRP. Circulatory death is established in anesthetized pigs by stopping mechanical ventilation. After a preset warm ischemia period, an extracorporeal membrane oxygenator (ECMO) is used for a NRP period lasting at least 30 min. During this reperfusion period, the model allows the collection of various myocardial biopsies and blood samples for initial cardiac evaluation. Once NRP is weaned, biochemical, hemodynamic, and echocardiographic assessments of cardiac function and metabolism can be performed before organ procurement. This protocol closely simulates the clinical scenario previously described for DCD and NRP in heart transplantation and has the potential to facilitate studies aimed at decreasing ischemia-reperfusion injury and enhance cardiac functional preservation and recovery.

The protocol describes a large-animal (porcine) model of donation after circulatory death, followed by thoracoabdominal normothermic regional perfusion that closely simulates the clinical scenario in heart transplantation, and has the potential to facilitate therapeutic studies and strategies.

用于心脏评估的循环死亡后捐献和正常区域灌注的大型动物模型

The increase in demand for cardiac transplantation throughout the years has fueled interest in donation after circulatory death (DCD) to expand the organ ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

非原位灌注期间供体心脏的功能评估:来自压力-容量环和表面超声心动图的见解

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...

猪离体肺灌注模型中心输出量的测定

副本

摘要

探索更多视频

此视频中的章节

步骤人类隐静脉

的隔离方法