[Renal, intestinal and whole body metabolic changes in pig LVAD model].
We investigated renal, intestinal, and whole body metabolic changes in response to variations in Left Ventricle Assist Device (LVAD) flow and inspired oxygen concentration (FiO2). Left ventricular assist devices were implanted in 10 adult pigs (weight, 55 +/- 1.76 kg). Renal vein (RV), superior mesenteric vein (SMV), and pulmonary artery (PA) blood oxygen saturation and lactate concentration were measured and used as tissue perfusion markers. These measurements were made before and after changes in LVAD flow or FiO2. Oxygen saturation in PA, SMV, and RV decreased significantly after a reduction in LVAD flow (p = 0.05), with a greater reduction in SMV than in the PA and RV (p < 0.05 at LVAD flow 3.5 l/min; p < 0.01 at LVAD flow 2.0 and 1.0 l/min). The lactate concentration in the PA and SMV increased significantly (p < 0.01) with decreased flow, with a greater increase in the SMV than in the PA (p < 0.05). whereas it remained unchanged in the RV. Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in FiO2 (p < 0.05). Lactate concentration in the PA, SMV, and RV increased significantly at FiO2 of 0.10 (p < 0.05). Lactate concentration in the PA and SMV was significantly higher than that in the RV at FiO2 of 0.10 (p < 0.01). The results show that the gastrointestinal tract is at high risk during low perfusion or low FiO2, whereas in the kidneys metabolic function appears to be less disturbed. In clinical practice, this emphasizes the need to ensure adequate blood flow and respiratory function, especially after extubation, in patients with implanted LVAD. This might avoid intestinal ischemia and subsequent endotoxemia.
Miyama
M
M
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
D000818:Animals; D006353:Heart-Assist Devices; D007413:Intestinal Mucosa / Q000378:metabolism*; D007668:Kidney / Q000378:metabolism*; D007773:Lactates / Q000097:blood; D010100:Oxygen / Q000032:analysis; D013552:Swine
D007773:Lactates; D010100:Oxygen