Establishment of a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs / 器官移植

Objective To establish a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs with high repeatability and stability. Methods Twelve Bama miniature pigs were randomly divided into the donor group (n=6) and recipient group (n=6). Pigs underwent non-venous bypass orthotopic liver transplantation. The time of anhepatic phase during operation was shortened, blood pressure during anhepatic phase was stably maintained, and management of anesthesia and body fluid during operation were strengthened. The operation time, anhepatic phase and survival status of the recipients were observed and recorded. The intraoperative heart rate, mean arterial pressure (MAP) and changes in arterial blood gas analysis were monitored. The perioperative liver function was evaluated. Results Among 6 Bama miniature pigs, 1 died from transplantation failure intraoperatively. The operation time of the remaining 5 pigs was (247±27) min and the time of anhepatic phase was (46±4) min. Three animals survived for more than 2 weeks. Compared with the preanhepatic phase, the heart rate of the animals was significantly faster, MAP was considerably reduced to (46±6) mmHg, blood pH value, base excess (BE) and HCO3- level were all significantly decreased and serum level of K+ was significantly elevated during the anhepatic phase (all P < 0.05). In the neohepatic phase, MAP of Bama miniature pigs was significantly increased, heart rate was dramatically slower.Blood pH value, BE, HCO3- level were significantly increased and serum level of K+ was significantly declined (all P < 0.05). During abdominal closure, MAP, blood gas indexes and serum level of K+ were almost recovered to those in the preanhepatic phase. Compared with preoperative levels, the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)were significantly increased after operation (all P < 0.05), the change in AST was the most obvious, and it gradually decreased at postoperative 2 d. The level of γ-gutamyl transferase(GGT) did not significantly elevated. The level of total bilirubin (TB) was evidently elevated at postoperative 5 d. Compared with the preoperative levels, the levels of total protein (TP) and albumin (ALB) were significantly decreased after operation (both P < 0.05), and began to gradually increase at postoperative 1 d. Conclusions The non-venous bypass orthotopic liver transplantation model of Bama miniature pig is convenient, with highly reproducible and survival rate, which can be utilized as a standardized liver transplantation model.

Clinical practice and discovery of selective coronary venous bypass grafting in the treatment of diffuse coronary artery disease / 中华胸心血管外科杂志

Objective To summarize the clinical features of patients with diffuse coronary artey diseases,and evaluate the clinical efficacy of off-pump coronary artery bypass grafting(OPCABG) combined with selective coronary venous bypass grafting (SCVBG).Methods Retrospectively analyzed the clinical data of 61 patients with diffuse right coronary stenosis undergoing operation of OPCABG + SCVBG from January 2007 to December 2013,and couducted the comparative study of the patients who underwent OPCABG during the same period based on propensity score.Patients were divided into SCVBG group(61 cases,underwent OPCABG + SCVBG) and control group(60 cases,matched by propensity score and underwent OPCABG without SCVBG).Results Compared with control group,the rate of myocardial infarction in SCVBG group was higher (67.2％ vs.46.7c％,P ＜0.05),the heart rate was faster[(69.92 ± 15.82) bpm vs.(64.48 ± 13.72) bpm,P ＜ 0.05],the low density lipoprotcin and triglyceride were higher[(2.67 ± 0.78) mmol/L vs.(2.37 ± 0.78) mmol/L (1.84 ± 0.79) mmol/L vs.(1.36 ± 0.60) mmol/L,both P ＜ 0.05] and the troponin I was higher in the first postoperative day [0.85 (0.29,3.15)μg/L vs.5.09 (2.02,13.03)μg/L,P ＜ 0.05].The perioperative(postoperative) mortality(1.6％ vs.0) and the long-term survival curve difference had no statistically significance(P ＞0.05).Conclusion Patients with coronary artery disease should pay more attention to the control of heart rate and blood lipids,poorly controlled heart rate and high blood lipids are the important factors for the development of coronary heart disease.The exact efficacv of selective coronary vein arterialization for diffuse coronary artery disease is confirmed through the small sample comparative study.

Left Common Femoral to Right Common Iliac Venous Bypass Through a Retroperitoneal Exposure

The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.

Discussion on the veno-venous bypass in autologous liver transplantation / 中华肝胆外科杂志

Liver transplantation is the main treatment for end-stage liver diseases and liver tumor.To solve the problem of the insufficient donor liver,autologous liver transplantation (ALT) is becoming widely acknowledged,which could serve as a complementary technique for treating unresectable liver space-occupying lesions in routine operation.However,compared with allogeneic liver transplantation,the long anhepatic phase during ALT may influence the outcome of such patients.Veno-venous bypass (VVB) as a technology which can maintain the stability of hemodynamics and internal environment in the anhepatic phase is routinely used in ALT.In this paper,the application of VVB in the ALT was mainly discussed.

Rapid Veno-venous bypass by magnetic anastomosis technique in ex situ liver resection animal model / 中华肝胆外科杂志

Objective To invent a set of novel veno-venous bypass (VVB) device based on magnetic anastomosis technique which can be used in ex situ liver resection, and verify its clinical value and performance in animal models.Methods Each VVB device was constructed using three magnetic rings and an inverted Y-shaped tube with magnetic rings on each end.The magnetic ring was made of NdFeB with electrode cutting, and the tube was made of polyvinyl chloride (PVC) and preconditioned with heparin coating on the surface of the lumen.Ten dogs underwent the ex situ liver resection, and VVB was established via magnetic anastomosis technique with the novel VVB device during the operation.The time for completing VVB was recorded, and the hemodynamic indexes including the venous flow velocity, carotid pressure, central venous pressure and portal pressure was detected.The changes of intestinal lumen and kidney were also observed.Results It only took 6 ～ 10 minutes to establish VVB by the novel VVB device in the operation,and the hemodynamics stability was maintained smoothly during the anheptic phase.The shunt index of inferior vena cava and portal vein was 76.2％ and 75.5％, respectively.The congestion of intestinal canal and kidney were also alleviated during the anheptic phase.Conclusions It could reduce the time to establish VVB with magnetic anastomosis technique in ex situ liver resection.This study showed that utilizing the novel VVB device for intraabdominal VVB during the anheptic phase could be helpful to maintain the hemodynamics stability.

Current status of veno-venous bypass in liver transplantation / 中华肝胆外科杂志

Since Shaw et al,first reported the first case successfully treated by veno-venous bypass (VVB),there has been great controversy on the routine application of VVB during conventional liver transplantation and piggyback liver transplantation in recent decades.With the improvements on the surgical skills,surgical techniques and anesthesiology,only a small portion of patients have the indications for VVB in liver transplantation routinely.This article reviews the current publications in this topic,which may provide new insight into the liver transplantation in clinical practice.

Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction / Transposição de veia cefálica para salvamento de fístula arteriovenosa de hemodiálise e tratamento de obstrução venosa central sintomática

It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL), few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

Sabemos que estenose ou obstrução venosa central ocorre em 20 a 50% dos pacientes que são submetidos à colocação de cateter em veias centrais. Nos pacientes que realizam hemodiálise pelos membros superiores, este problema causa sintomas debilitantes e um grande risco de perda do acesso para hemodiálise. Relatamos um caso atípico de tratamento em um paciente dialítico com múltiplas comorbidades, queixa de dor e edema severo do membro superior direito (MSD), escassas alternativas de acessos vasculares para hemodiálise e fístula braquiobasílica funcionante do MSD associada à severa hipertensão venosa deste membro, secundária à oclusão venosa central da veia jugular interna e do tronco braquiocefálico direito. O tratamento cirúrgico alternativo foi a transposição da veia cefálica do MSD, formando colar venoso na região cervical anterior, resultando em um bypass sobre o sítio venoso ocluído. Para isso, realizamos a dissecção da veia cefálica no braço direito até a sua junção com a veia axilar, devalvulamos e anastomosamos a veia cefálica na veia jugular externa contralateral, permitindo a drenagem venosa do MSD, aliviando os sintomas da hipertensão venosa e mantendo a fístula braquiobasílica funcionante.

Establishment and evaluation of models for small-for-size graft injury without veno-venous bypass in miniature pigs / 中华肝胆外科杂志

Objective To establish small-for-size (SFS) graft injury models in miniature pigs with high standardization, reproducibility and similarity to clinical situation. Methods Ba-Ma miniature pigs were introduced in this study and orthotopic liver transplantations (OLTs) were performed in 12 pigs with 30% liver volume allogeneil grafts (small portion of right paramedian lobe, right lateral lobe and caudate lobe) without veno-venous bypass. The profiles of intra-operational hemodynamics and metabolism were investigated. Animals were observed for 7 days with daily serum biochemistry and coagulation function exam. The survival rate related to operation itself and the SFS grafts were respectively calculated as well as the graft regenerative ratio at post-operational day (POD) 7. Results Graft weight as a percentage of the recipient's native liver weight (GW/RLW) and the total body weight (GW/BW) were (28. 63±4. 42)% and (0. 73±0.06)%. The mean operation time, anhepatic phase, and the time of blockage of infra-hepatic IVC were (191. 7±14. 2) min, (28. 3±3. 6) min, and (45. 0±5. 8) min. The survival rate related to the operation itself and the SFS graft were 83. 33% (10/12) and 40% (4/10), and the graft regenerative ratio at POD7 was (278. 06±42. 95) %. Contrast to the remarkable increase of heart rate and serum potassium during anhepatic phase, the mean arterial pressure, central venous pressure, rectal temperature, PH value and buffer excess had a significant decrease (P<0.01) with a gradual recovery after reperfusioa Serum ALT, AST, PT, Cr, and TB were significantly increased with a peak level at POD1 for the former 4 and POD2 for TB, and then began to decrease and favorably recovered at POD7, but TB, PT, and AST levels were still high when compared to those of prereperfusion (P<0. 05). Conclusion This model of OLT performed with 30% liver volume graft without veno-venous bypass was an ideal large animal model for series studies related to SFS graft injury.

Veno-veno Bypass for Central Vein Occlusion in Hemodialysis Patients: Two cases report

Central venous stenosis or occlusion is a serious complication in end-stage renal disease patients undergoing maintenance hemodialysis. It is mostly secondary to trauma caused by temporary or permanent hemodialysis catheter placement. Venous hypertension may cause pain, edema of the ipsilateral arm and increased venous pressure prevents acceptable flow rates during dialysis. Venous bypass to the internal jugular vein, the external jugular vein, or axillary vein to saphenous vein bypass have been described as alternative options of surgical management. Our patients underwent internal jugular vein bypass. We think it is an effective and low risk surgical option.

Surgical Resection of Renal Cell Carcinoma Extended to the Inferior Vena Cava Using Pump Driven Veno-venous Bypass / 대한흉부외과학회지

In a 46 year-old man who has complained of epigastric pain and dyspnea for 10 days including melena for 1 month, abdominal ultrasonography and computerized tomography revealed a large, solid mass in the right kidney and thrombus of inferior vena cava (IVC) that extended to the cavoatrial junction. Renal cell carcinoma was performed by percutaneous needle biopsy. IVC thromboembolectomy was performed using centrifugal pump driven veno-venous bypass without cardiac arrest and cardiopulmonary bypass (CPB).

Extracorporeal Venous Bypass in Porcine Orthotopic Liver Transplantation: A Comparative Study / 中国普外基础与临床杂志

Objective To explore the application of extracorporeal veno venous bypass in orthotopic liver transplantation in pigs and to compare hemodynamic changes during operation of two different bypass ways. Methods Twenty five porcine orthotopic liver transplantations were performed and extracorporeal veno venous bypass was established during anhepatic phase through a catheter in portal vein (group A, n =16) or in splenic vein (group B, n =9).Hemodynamic changes were monitored continuously.Results Fourteen recipients survived two days after operation (14/16) in group A while all survived in group B (9/9).Transient hemodynamic disturbance (MAP and CVP decreased,and HR increased) was monitored at both the beginning and the end of anhepatic stage in group A,while these parameters kept stable in group B ( P

Behavior of cholinesterase and liver mitochondrial function in dogs submitted to normothermic ischemia and reperfusion

PURPOSE: The plasmatic activity of the cholinesterase (CHE) and the liver mitochondrial function, expressed by the ratio of respiratory control (RCR), were studied during normothermic ischemia. METHODS: Sixteen adult mongrels, eight females and eight males were submitted to ischemia by clamping of the hepatic artery, portal vein and infrahepatic inferior vena cava, infra-hepatic, for two h, follwed by reperfusion for 1 h. The CHE and the mitochondrial function were evaluated at 60 and 120 min. of ischemia and at 15 and 60 minutes of reperfusion. RESULTS: The CHE decreased, significantly, during ischemia and in reperfusion. The RCR was decreased at 120 min. of ischemia, returning to the initial values on reperfusion. CONCLUSION: In this study, the CHE was a sensitive indicator of ischemic injury , suggesting irreversibility of ischemia injury. The RCR, by other side, showed a greater sensibility than the CHE in detection sense, during the studied period, the reversibility of the hepatic ischemic injury.

OBJETIVO: A atividade plasmática da colinesterase (CHE) e a função mitocondrial do fígado expressa pela RCR- razão de controle respiratório mitocondrial foram estudadas durante a isquemia/reperfusão hepáticas. MÉTODOS: Dezesseis cães adultos sem raça definida (oito machos e oito fêmeas) foram submetidos a isquemia normotérmica por pinçamento do pedículo hepático e da veia cava inferior infra-hepática por 2 horas, seguida de 15 e 60 minutos de reperfusão.A CHE e a RCR foram avaliadas após 60 e 120 minutos de isquemia e após 15 e 60 minutos de reperfusão. RESULTADOS: Os níveis de CHE diminuíram significativamente na isquemia e reperfusão.A RCR diminuiu após 120 minutos de isquemia retornando a níveis semelhantes ao controle após a reperfusão. CONCLUSÃO: A CHE foi sensível para indicar a lesão isquêmica, sugerindo irreversibilidade da lesão. Já a RCR foi mais sensível no sentido de detectar a reversibilidade da lesão isquêmica após a reperfusão.

Extra-anatomic Venous Bypass for Central Venous Obstruction in Hemodialysis Patient: Another Treatment Option: A case report

Placement of central venous catheter is the most common cause of central venous thrombosis. In the setting of a functioning of ipsilateral upper extremity arteriovenous fistula (AVF), symptoms with venous hypertension may be exacerbated. We report a case of patient with successful decompression of severe venous hypertension in the left arm, neck and anterolateral chest wall of a patient whose access for hemodialysis was functioning on the left wrist with left innominate vein occlusion. Left axillary vein to right innominate vein Dacron crossing bypass provided prompt and effective maintenance of venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of dialysis fistula.

Surgical Resection for HCC invading the Inferior Vena Cava: using veno-venous bypass and saphenous vein patch graft / 한국간담췌외과학회지

Technical advancement, accurate preoperative diagnosis, understanding of hepatic architecture and function, and enhanced anesthetic support have expanded the indications of hepatic resection while lowering perioperative morbidity and mortality. Especially in cases of infiltration of retrohepatic vena cava by tumor, aggressive hepatic resection involving the inferior vena cava( IVC ) has become safe and feasible using total vascular isolation(TVI) with veno-venous bypass and patch grafting. Authors reported a case of curative resection for hepatocellular carcinoma invading the inferior vena cava using TVI with veno-venous bypass and saphenous vein patch graft

Central Vein Occlusion Secondary to Hemodialysis Catheterization in Chronic Renal Failure Patient: One Case Report / 대한흉부외과학회지

A 51-year-old male with chronic renal failure had marked swelling and tenderness of the right arm. Venography revealed central vein occlusion involving stenosis of right proximal subclavian vein, right internal jugular vein, and left distal innominate vein, and obstruction of right brachiocephalic vein. Multiple obstruction of these veins was thought to have resulted from repeated subclavian catheterization. Right subclavian-superior vena cava was bypassed with 10 mm Gore-tex vascular graft and then left subclavian vein with 8 mm Gore-tex vascular graft was bypassed to the 10 mm Gore-tex vascular graft. The results were excellent.

Experience of an En Bloc Resection of Right Lobe of Liver, Adrenal, Kidney and Infrahepatic Vena Cava with the Aid of Veno-venous Bypass / 한국간담췌외과학회지

Resection of hepatic tumors located near the confluence of hepatic vein or invading retrohepatic vena cava has become technically feasible and relatively safe with the introduction of veno-venous bypass. Hepatic vascular exclusion(HVE) with the aid of veno-venous bypass using centrifugal pump enables safe resection and reconstruction of vena cava without hemodynamic instability, compared to conventional HVE. The authors report a case of a successful en bloc resection of right lobe and caudate process of liver, right adrenal, right kidney, and retrohepatic vena cava, in order to extirpate huge retroperitoneal tumor, with the aid of veno-venous bypass using centrifugal pump. Pathologic diagnosis revealed B cell type non Hodgkin's lymphoma arising from adrenal gland. After resection, caval defect was reconstructed with Dacron graft. Patency of reconstructed cava could be observed at five months postoperatively.

Acid-base and biochemical alterations and their analysis in clinical orthotopic liver transplantation with veno-venous bypass / 中华麻醉学杂志

Objective:To observe acid-base and biochemical changes in clinical orthotopic liver transplantation with veno-venous bypass.Method,Seven patients receiving orthotopic liver transplantation, veno-venous bypass was undergone in anheptic phase.The acid-base and biochemical parameters were monitored during operation. Result:Compared to preoperation,pH decreased a little in each phase,BE and SBC slightly decreased 60 min following bypass and during skin closure. Compared to before bypass,pH had no changes during bypass and new liver phases. The serum Ca~(2+) level decreased and serum glucose level elevated in each phase,The temperature gradually decreased during operation. The serum K~+ level was transiently elevated from 3.17mmol/L to 3.53 mmol/L early after the heptic revascularizaton. Conclusion:With the application of the veno-venous bypass technique,the hazard of acid-base and biochemical changes can be reduced during orthotopic heptic transplantation.

Anesthetic management for patients undergoing orthotopic liver transplantation / 中华麻醉学杂志

Objective To investigate the peri operative changes and anesthetic management during orthotopic liver transplantation (OLT) Methods General anesthesia or general anesthesia combined with epidural anesthesia was applied During the anhepatic phase, extracorporeal veno venous bypass (EVVB) was established Hemodynamics, respiratory function, blood gas, biochemistry, blood coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored According to the different characteristics of the pre anheptic phase, anheptic phase and neoheptic phase during OLT, the corresponding anesthetic management was supplied Results Applying EVVB during the anheptic phase could keep hemodynamics stable, but in 15 min of the primary anheptic and neoheptic stages a transient circulatory instablity occurred,and the rapid blood volume expansion was required Through comprehensive management, there was no obvious acid base disturbance during the phases The hypocalcemia, hypokalemia and hyperglycemia occurred and thebody temperature changed greatly,to require timly corrective measures Certain coagulative disturbances occurred, to require the supplement of coagulation factors, proper hemostatic drugs and protamine for neutralizing heparin Intraoperatively, anti rejection drugs were required Peri operatively, the blood glucose levels were higher than normal Conclusions Utilizing EVVB during the anheptic phase can be helpful to maintain hemodynamics stable, prevent obvious acidosis and hyperkalemia The anesthetic management during the neoheptic phase should be required to correcte hypothermia, hypocalcemia, hypokalemia, hyperglycemia and disturbence of coagulation

Changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation / 中华麻醉学杂志

Objective To observe the changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation Methods During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was utilized in 20 patients undergoing live transplantation Systemic and pulmonary hemodynamics were monitored through Swan-Ganz catheter during whole procedures Results As compared with the preoperative values , MAP remained unchanged in normal range during perioperative period;CO,CI,LVSW and RVSW decreased significantly during anhepatic phase and increased markedly 15 min after hepatic reperfusion (P

Influence of Changes in Mixed Venous Oxygen Tension(PvO2) by Extracorporeal Membrane Oxygenation(ECMO) on Hypoxic Pulmonary Vasoconstriction / 대한마취과학회지

Blood flow generally decreases to areas of the lung that become hypoxie, thereby reducing pulmonary shunt and preventing arterial hypoxemia. The mechanism of blood flow reduction in the hypoxic area is believed to be hypoxic pulmonary vasoconstriction(HPV). Over the years, serious attention has been given to the question of whether hypoxia of the airway(alveolar hypoxia) is the only way to elicit pulmonary vasoconstriction. the current consensus favors this traditional view. Even though the usual experiments have succeeded in proving that a large drop in alveolar PO2(PAO2) does elicit pulmonary vasoconstriction, they have not excluded the possibility that a sufficient drop in mixed venous PO(PvO2) may have the same eonsequenee. The purpose of this study is to test the hypothesis that a decrease in PvO2 may elicit hypoxic pulmonary vasoconstriction. For the selective change of PvOwe used venovenous extracorporeal circulation(VVECMO), a technique which had been tested for adequacy in hemodynamics and oxygenation in preliminary studies on 6 mongrel dogs. In eight pentobarbital-anesthetized, mechanically ventilated mongrel dogs, stepwise reductions in oxygen concentration(F1O2,) from 0.21 to 0.15 and 0.10 caused remarkable HPV. The mean pulmonary arterial pressure(MPAP) and the pulmonary vascular resistance(PVR) were increased from 17.3+/-3 mmHg and 185+/-64 dyne sec cm(-5) in normoxia(F1O2=0.21) to 30+/-6 mmHg and 401+/-257 dyne sec cm in severe hypoxia(F1O2=0.10, P(A)O2=30+/-9 mmHg), respectively ; while, in moderate hypoxia(F1OP2=0.15, P(A)O2=53+/-12 mmHg), only the MPAP increased and the increase was from 17.3+/-3 mmHg to 23+/-3 mmHg. The selective increase in PvO2without any change in P(A)O2 by extracorporeal veno-venous bypass from 37+/-6 mmHg and 22+/-4 mmHg to 54+/-8 mmHg and 45+/-5 mnHg in moderate and severe hypoxia, respectively, depressed HPV: decrease in MPAP in moderate hypoxia(MPAP=21+/-4 mmHg) and decrease in MPAP and PVR in severe hypoxia(MPAP=23+/-5 mmHg, PVR=319+/-228 dyne sec * cm(-5)). This study indicates that the mixed venous oxygen tension is an important determinant of the magnitude of hypoxic pulmonary vasoconstriction in diffuse alveolar hypoxia. Moreover, the method used in this study and the result might be useful other pulmonary pathophysiological studies and clinical situations with acute diffuse alveolar hypoxia, such as acute respiratory failure and chronic obstructive pulmonary diseases.