For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.
The aim of research was to study parameters of homeostasis and conditions for stable operation of the autoperfused heart-lung complex ex vivo.Materials and methods. A series of acute experiments (n-3) was carried out to create a functioning heart-lung complex and study parameters of homeostasis ex vivo. A large mammal (mini-pig weighed 20-30 kg) was used as an experimental model. During the experiment, invasive blood pressure in the aortic root, pulmonary artery, central venous pressure, temperature of the left ventricle of the heart, gas composition of arterial blood (in the aortic root) and venous blood flowing from the coronary sinus was monitored.Results. The series of experiments evidenced the fundamental possibility of an isolated heart-lung complex ex vivo stable functioning. During 4-hours autoperfusion of the "heart-lung" complex, the parameters of hemodynamics, gas and biochemical blood composition remained within the reference values.Conclusion. The analysis of literature data and the results of experiments on laboratory animals allow us to state that the autoperfusion can be successfully used as an option of safe and long-term conditioning of a donor heart. This technique can be used to improve the results of heart transplantation with prolonged ischemia of the donor organ. Extending the survival of a donor heart ex vivo functioning will significantly expand the geography of donor bases, reducing the ischemic period to a minimum.
HighlightsThe article outlines the modern concept of arterial myocardial revascularization, presents the most promising directions for development of coronary surgery, and describes the results and prospects of the clinical application of autogenous arterial grafts using two internal thoracic arteries in various graft configuration and in situ, making it possible to assess the effectiveness of the procedure. AbstractThere are many approaches to coronary artery bypass grafting with the internal thoracic arteries: the use of I and Y configuration, in situ grafts, and composite grafts. However, there is no consensus on the most effective type of configuration of arterial grafts. This is due to the complexity of making the composite Y graft, determination of the risk factor, and the lack of sufficient evidence regarding the main approaches to bypass grafting with autogenous arterial grafts.
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