Endovascular stent-grafting via the aortic arch for chronic aortic dissection combined with coronary artery bypass grafting

AbstractJ Thorac Cardiovasc Surg 1999;117:825-

Newly Designed Eccentric Roller Type Total Artificial Heart

We have produced an eccentric roller type total artificial heart (ERTAH). As the first step in the development of this ERTAH, we conducted simulations such as a numerical simulation, a mock test, and an acute animal experiment using DeBakey roller pumps to analyze the left-right balance during its operation. The next step was redesigning the blood chambers to improve energy efficiency and implanting the ERTAH with an interatrial shunt into an animal for evaluation of the in vivo performance of the device. In the simulations, shunt flow through the bronchial arteries was approximately 500-600mlJmin, and the interatrial resistance was varied from 2.9-7.7 mmHg・min/liter. Redesigning the blood chambers resulted in the mock test in a 20% increase in energy efficiency, about a two-fold increase in cardiac output and improved durability compared to the previous type in the mock test. In the animal experiment the ERTAH operated with a left flow rate of 6.0 liters/min and a right flow rate of 5.4 liters/min. The interatrial shunt flow rate was 250-400m1Jmin. Creating an interatrial shunt is a useful method for balancing the blood flow between the left and right heart of the ERTAH. A decrease in friction resistance and the prevention of backward flow resulted in an increase in energy efficiency, cardiac output, and improved durability, in spite of downsizing the blood chambers.This work was supported in part by a Research Grant for Cardiovascular Disease 10C-2 from the Ministry of Health and Welfare, Japan

Assessment of a New Silicone Tri-leaflet Valve Seamlessly Assembled with Blood Chamber for a Low-cost Ventricular Assist Device

We have developed a practical, low-cost ventricular assist device (VAD) comprising a newly designed blood chamber with a silicone lenticular sac and two silicone tri-leaflet valves (STV), made en bloc. This new VAD is seamless, can be made cost-effectively and assembled with the blood chamber and valve as one body. This novel design should reduce the incident of thrombus formation because of the absence of a junction at the connecting ring and because of the use of flexible silicone materials which have both antithrombogenecity and biocompatibility. In in vitro hemodynamics testing, a batch of 3 consecutively manufactured V ADs with STV s underwent hydrodynamic functional testing. These showed less regurgitation, a lower value of water hammer phenomenon, and a slightly greater pressure gradient across the valves than a mechanical valve (MV) [Björk-Shiley monostrut valve]. The flow and pulsatile efficiency were adequate and similar to that of a VAD with MVs. In in vitro durability and hemolysis tests, a V AD with STV functioned well for 54 days and showed similar hemolytic profiles to a V AD with MVs. In an in vivo acute experiment using an adult sheep, our device was promblem-free providing sufficient output as a left ventricular assist device (LVAD). Although it will be necessary to decrease the pressure gradient across this STV in the future, our device showed efficient performance as a practical and cost-effective V AD for short term use.This work was supported in part by the Tsuchiya Foundation and by a Research Grant for Cardiovascular Diseases (7A-1) from the Ministry of Health and Welfare, Japa

Ammonia Determination as an Early Indicator in Experimental Superior Mesenteric Artery Occlusion

Superior mesenteric artery occlusion (SMAO) is often fatal. An indicator which enables the early diagnosis of SMAO is needed. As we think putrefaction products must appear and increase in the blood and ascites in SMAO, changes in the concentrations of ammonia, one of the putrefaction products, were measured in this study.　　 Thirteen adult mongrel dogs were used for the in vitro experiment. The jejunum, ileum, and ascending colon were resected and incubated in saline. Changes in ammonia concentrations in the saline were examined at various incubation times.　　 In the in vivo experiment, 11 mongrel dogs comprised the SMAO group and another 10 mongrel dogs comprised the control group. Changes in ammonia concentrations in the blood and ascites were examined in both groups.　　 In the in vitro experiment, ammonia concentrations in the saline bath increased in all samples. It was highest in the sample from around the ascending colon, and lowest from around the jejunum. However, at the end of experiment, this difference became insignificant.　　 In the in vivo experiment, ammonia concentrations in samples of the blood increased early and significantly in the SMAO group, compared with the control group. Ammonia concentrations in samples of the ascites also increased significantly.　　 The in vitro experiment showed that ammonia leaked from the ischemic intestines, and secondarily, a large amount of ammonia was produced from intestinal putrefaction. The in vivo experiment revealed that the ammonia level in the blood could be used as a good early indicator of acute mesenteric ischemia.This work was presented at the 96th Annual Meeting of the Japan Society for Surgery, Makuhari, 1996

Protective Effects of Pretreatment with Ginsenosides on Cardiac and Coronary Vascular Function After Hypothermic Rat Heart Preservation

Prevention of cardiac and vascular dysfunction with pretreatment has been accepted as an important factor in heart transplantation. Ginsenosides (GS) have been reported to have some beneficial effects on the cardiac and vascular system. We hypothesized that pretreatment with GS would result in an improvement of functional recovery after a 12 hour (hr) rat heart preservation.　　 A Langendorff apparatus was applied to estimate the cardiac and vascular function in an isolated rat heart preparation. The hearts were preserved in University of Wisconsin solution at 0°C for 12hr, after pretreatment with 0.9% sodium chloride or GS 100 mg/kg, respectively, in control (n = 9) and GS (n = 14) groups. After storage, the cardiac function, myocardial water content, and coronary vasodilatory response were evaluated.　　 The GS group showed a significantly higher recovery percentage of cardiac function compared with the control group: aortic flow 81.4 ± 21.4% versus 57.2 ± 11.0% (p = 0.0052); coronary flow 81.4 ± 14.5% versus 57.2 ± 6.0% (p = 0.0001); ±dp/dt max 72.5 ± 16.1 % and 66.0 ± 16.1 % versus 53.7 ± 4.1 % and 51.4 ± 7.1 % (p = 0.0027 and p = 0.0189) respectively. The GS group showed a lower increase in myocardial water content. With Langendorff perfusion, the endothelial and vascular smooth-muscle cell function were evaluated by an increasing percentage of coronary flow in response to acetylcholine chloride (0.3 × 10-7 mol/liter) and nitroglycerin (0.5 × 10-5 mol/liter). It was significantly higher in the GS group than that in the control group (19.2 ± 8.8% and 28.0 ± 14.1% versus 9.9 ± 4.7% and 14.7 ± 8.1%, p = 0.008 and p = 0.0187, respectively) at the first minute.　　 These results suggest a protective effect on ventricular and coronary vascular function in the rats pretreated with Ginsenosides, indicating potential benefits for long-term heart preservation