The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping

Abstract

This study reports a novel large-animal model of thoracic aortic cross-clamping that allows the study of visceral perfusion strategies. However, we demonstrated with IL-8 and IFABP measurements that thoracoabdominal aortic aneurysm surgery with selective visceral perfusion and distal aortic perfusion is superior to the clamp-and-sew technique, even though small intestinal tissue damage cannot be completely avoided by selective visceral perfusion and distal aortic perfusion. In any case, this model seems to be a platform to evaluate and optimize measures for gut wall protection.

Microcirculatory perfusion shift in the gut wall layers induced by extracorporeal circulation

“…Instead, a shift between the small intestinal gut wall layersdmucosa and muscularisdis verifiable. 13 The aim of this study was to use our previously described porcine model to assess the effect of roller pump-driven distal aortic perfusion (DAP) on perfusion of the small intestinal gut wall layer. 13 Therefore, DAP was compared with a control group with physiologic perfusion and an ECC with low-flow perfusion as induced by selective visceral arterial perfusion (SVP).…”

“…13 The aim of this study was to use our previously described porcine model to assess the effect of roller pump-driven distal aortic perfusion (DAP) on perfusion of the small intestinal gut wall layer. 13 Therefore, DAP was compared with a control group with physiologic perfusion and an ECC with low-flow perfusion as induced by selective visceral arterial perfusion (SVP). In detail, the macrohemodynamics and microhemodynamics, especially the mucosal and muscularis perfusion ratio and markers of intestinal metabolism and systemic inflammation, were assessed.…”

“…The animals were surgically prepared and monitored as previously described and divided into three groups of five animals each. 13 After the surgical preparation and the baseline measurements, the animals of all groups received 3 mg/kg body weight systemic heparin.…”

“…The former published group I (n ¼ 5) served as the control. 13 In group II (n ¼ 5), DAP through the iliac arterial axis was established with a Jostra HL20 roller pump (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) during 1 hour of thoracic aortic crossclamping (TAC). A 16F straight arterial cannula was inserted into the external iliac artery, and a 24F venous cannula was placed below the right atrium using the external iliac vein as the access vessel (both cannulas by MEDOS Medizintechnik AG, Stolberg, Germany).…”

Avaliação dos efeitos do 17beta-estradiol na lesão mesentérica pela oclusão da aorta descendente proximal em ratos machos

“…Estes achados estão de acordo com estudos anteriores que demonstraram que as repercussões histopatológicas na mucosa intestinal, resultantes do pinçamento aórtico supracelíaco em ratos, são intensas e focadas principalmente nas vilosidades (Erling et al, 2013). Vale ressaltar, ainda, que lesão extensa da mucosa intestinal com destruição de vilosidades está descrita em modelo porcino de pinçamento aórtico torácico (Kalder et al, 2012). Conforme demonstrado no presente estudo, o 17β-estradiol mostrou-se eficaz na atenuação da lesão da mucosa intestinal e na prevenção da mortalidade conseguinte à oclusão da aorta em ratos machos.…”