Experimental Study Of The Closed Pericardium Transverse Sinus Of The Pericardium-right Atrial Drainage For Refractory Arterial Root Bleeding In Animals

Objective To verify the hemostatic effect of the lcosed pericardium transverse sinus-right atrial drainage on controlling refractory massive hemorrhage in aortic root by animal experiment.Methods 8 healthy Panamanian fragrant pigs with weight of 46.7±5.6kg were randomly selected for the study.In order to establish a closed transverse pericardial sinus separated from the oblique pericardial sinus,the left and right openings of the transverse pericardial sinus were successively sutured.An acute aortic root hemorrhage model was established by perforating the ascending aorta.The right atrium was perforated to establish a closed right atrial transposition of the transverse sinus of the pericardium to control acute aortic root bleeding.The hemostatic effect and local morphological changes of this method were verified by observing the field drainage,hemodynamic changes,postoperative blood routine,coagulation function,cardiac ultrasound,chest enhanced CT and local anatomy.Results All animals were successfully completed with the operation of transverse sinus closure of pericardium and right atrial diversion,with satisfactory hemostatic effect,no active bleeding,no death of experimental animals.There was no significant change in blood routine before and after the operation.7days after the operation,all the experimental animals were free form anemia.Intraoperative drainage volume was150.2±34.4ml.Hemoglobin(HB),red blood cell count and platelet count all decreased after operation,but there were no statistical significance.There were no statistically significane in prothrombin time,international standard ratio and fibrinogenc.Heart rate(HR)increased significantly after the operation(76.2±8.5times/min,89.5±11.3 times/min,P < 0.05).Mean arterial pressure(MAP)was75.6±11.2 and 76.6± 12.1mmHg,respectively,with no significant difference.Beforeand after the operation,Right Atrial Pressure(RAP)was 3.4±0.7 and 3.5±0.6mmHg,respectively(p > 0.05).Cardiac ultrasound showed that there was no statistical difference in left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),right ventricular antero posterior diameter(RVAPD)and left ventricular ejection fraction(LVEF)after the surgery.After the surgery,the diameter of the transverse sinus was large,and no left to right shunt was observed.The density of the posterior wall and lateral wall of the aorta in the transverse sinus increased,indicating the formation of thrombosis in the transverse sinus.The CT value in the transverse sinus of the pericardium was 71.3±3.6Hu,and the transverse sinus of the pericardium was significantly wider.There was no stenosis of pulmonary artery and pulmonary artery.Local anatomy: thrombus formation in transverse sinus of pericardium,no thrombus formation in pulmonary arteries at all levels.Conclusion the method is effective,safe and feasible in hemostasis.It can be used as the final remedy for uncontrolled active bleeding in cardiac macrovascular surgery.