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

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Presentation on theme: "The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping "— Presentation transcript:

1 The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping  Johannes Kalder, MD, Paula Keschenau, Sebastiaan J. Hanssen, PhD, Andreas Greiner, MD, Iris C. Vermeulen Windsant, MD, Lieven N. Kennes, Rene Tolba, PhD, Fritz W. Prinzen, PhD, Wim A. Buurman, PhD, Michael J. Jacobs, PhD, Thomas A. Koeppel, MD  Journal of Vascular Surgery  Volume 56, Issue 1, Pages (July 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Experimental setup: A thoracolaparotomy was performed in all animals. A, Cohort I: no procedure (sham-operation); cohort II: 1 hour of thoracic aortic cross-clamping (TAC), followed by 2 hours of reperfusion. B, Cohort III: 1 hour of TAC with selective visceral perfusion (SVP), followed by 2 hours of distal aortic perfusion (DAP). Five pigs in each cohort (n = 15). CT, Celiac trunk; SMA, superior mesenteric artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Timeline of experiments. Part 1: Thoracolaparotomy, catheter, and flow probe placement, baseline measurement. Part 2: One hour of specific procedure (cohorts I-III). Part 3: Reperfusion period (2 hours). DAP, Distal aortic perfusion; SVP, selective visceral perfusion. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Periprocedural blood pressure measurement. An intra-arterial line was placed into the right common carotid artery and the pressure was measured at T1, T4, T5 and T6 in all cohorts as well as in cohort I at T2 and T3. In cohort II, the blood pressure was measured through an intra-arterial catheter deployed in the visceral aorta. In cohort III at T2 and T3, the pressure was monitored through lines at the tip of the selective perfusion catheters. Thus, in cohort III at T2 and T3, the celiac trunk (TAC + SVP + DAP-CT) and superior mesenteric artery (TAC + SVP + DAP-SMA) were separately measured and analyzed. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Flow rate measurements during the whole experiment were performed at the origin of the (A) celiac trunk (CT) and (B) superior mesenteric artery (SMA) vessels and at T2 and T3 in cohort III at the selective perfusion tubing system. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Measurement of microcirculation by 15-μm fluorescent microspheres injected into the descending aorta or at T2 and T3 in cohort III directly into the extracorporeal circulation tubing system. A, Perfusion is calculated for the entire gut wall. B, The ratio between the weight-corrected emanated fluorescence between the mucosal and the muscular layer is calculated. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Markers for (A) aerobic oxygen extraction ratio and (B) anaerobic (lactate) metabolism were measured and calculated. The oxygen extraction ratios were calculated from arterial and portal venous blood. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

8 Fig 7 A, Repeated pH measurements were conducted in the portal vein. B, Plasma levels (inferior cava vein) of intestinal fatty acid-binding protein (IFABP), which is a sensitive marker for intestinal small-bowel damage. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Hematoxylin and eosin staining of small intestinal biopsy specimens at 15 minutes of reperfusion (original magnification, ×100). Moderate tissue damage (height loss of villi) was seen in (A) sham-operated animals (cohort I) and (C) TAC + SVP + DAP animals (cohort III). B, In cohort II (TAC), extensive mucosal injury (destruction of villi and starting ulcer) was detected. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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