Intra Vascular Ultra Sound: One More Tool to Diagnose Aorto-duodenal Fistula

The incidence of aorto-enteric fistula in the first 5 years after abdominal aortic replacement ranges from 0.3 to 2%. We present a clinical case in which all conventional diagnostic tools failed to demonstrate the aorto-enteric fistula. A 73 year-old male suffering intermittent episodes of melena without signs and symptoms of infection was repeatedly admitted at our institution. All conventional diagnostic tools failed to show the bleeding source. Precise diagnosis was obtained using intra vascular ultrasound (IVUS). IVUS allowed prompt diagnosis of the aorto-duodenal fistula and opened the way to its endovascular treatment.

[Management of critical limb ischemia]

Critical limb ischemia (CLI) is the leading cause of major leg amputation. Diabetes, smoking and end stage renal disease are the main risk factors for CLI. Despite their reduced survival rate, most CLI patients should be treated by surgical or endovascular arterial reconstruction, since amputation rate with conservative treatment alone is as high as 95% at 1 year in surviving patients with tissue loss, and can be reduced to 25% with successful reconstruction. When arterial reconstruction is impossible or fails, spinal cord stimulation also allows to avoid major amputation in up to 75% of precisely selected patients. Timely management and multidisciplinary approach are advised to reduce the risk of major amputation.

[Surgical options for terminal heart failure]

Terminal heart failure can be the cause or the result of major dysfunctions of the organisms. Although, the outcome of the natural history is the same in both situations, it is of prime importance to differentiate the two, as only heart failure as the primary cause allows for successful mechanical circulatory support as bridge to transplantation or towards recovery. Various objective parameters allow for the establishment of the diagnosis of terminal heart failure despite optimal medical treatment. A cardiac index <2.0 l/min, and a mixed venous oxygen saturation <60%, in combination with progressive renal failure, should trigger a diagnostic work-up in order to identify cardiac defects that can be corrected or to list the patient for transplantation with/without mechanical circulatory support.

Muscular counterpulsation: preliminary results of a non-invasive alternative to intra-aortic balloon pump

OBJECTIVES

IABP is the most widely used form of temporary cardiac assist and its benefits are well established. We designed an animal study to evaluate a device based on muscular counterpulsation (MCP) that should reproduce the same hemodynamic effects as IABP in a completely non-invasive way.

METHODS

Six calves, 60+/-4 kg, divided into 2 groups, in general anaesthesia, equipped with EKG, Swan-Ganz, pressure probe in the femoral artery and flow probe in the left carotid artery, received either IABP through right femoral artery, or muscle counterpulsation (MCP). MCP consists of electrically induced skeletal muscle contraction during early diastole, triggered by EKG and microprocessor controlled by a portable device. For each animal the following parameters were also considered: mean aortic pressure (mAoP), CO, CI, left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) and mean femoral artery flow (Faf). We did 3 sets of measurements: baseline (BL), after 20 (M20) and 40 (M40) min of cardiac assistance. These measurements have been repeated after 40 min of rest for 3 times. Results are expressed as mean+/-SD.

RESULTS

Baseline values: mAoP, 76.51+/-12 mmHg; mCVP, 11.5+/-3 mmHg; CO, 5+/-1 l/min per m(2); LVSWI, 0.77+/-0.2 KJ/m(2); SVR, 1040+/-15 dyns/cm(-5); Faf, 75.5+/-10 ml/min. IABP group: mAoP, 81.1+/-6 mmHg; mCVP, 1+/-0.1 mmHg; CO, 4.5+/-0.7 l/min per m(2); LVSWI, 0.69+/-0.2 KJ/m(2); SVR, 1424+/-8 dyns/cm(-5); Faf, 64.3+/-3 ml/min. MCP group: mAoP, 60.1+/-7 mmHg; mCVP, 23.6+/-2 mmHg; CO, 4.8+/-0.4 l/min per m(2); LVSWI, 0.69+/-0.2 KJ/m(2); SVR, 608+/-25 dyns/cm(-5); Faf, 92.3+/-12 ml/min.

CONCLUSIONS

MCP and IABP had the same effects on CO and LVSWI. Moreover, MCP reduced SVR and increased the peripheral circulation without requiring any vascular access nor anticoagulation therapy.

Sutureless Videoendoscopic Thoracic Aorta to Iliac Artery Bypass: The Easiest Approach to Occlusive Aorto-iliac Diseases

OBJECTIVE

We designed an animal study to determine the feasibility of videoendoscopic thoracic aorta to iliac artery bypass using a sutureless anastomotic device for proximal anastomosis construction.

METHODS

In 12 pigs the descending thoracic aorta was exposed using the thoracoscopic technique. A 4 mm PTFE thin wall graft was used as conduit. The proximal anastomosis was constructed using a mechanical device for sutureless anastomosis inserted through the camera port incision. The prosthesis was passed through the diaphragm in the retroperitoneal space and the distal anastomosis was done with running suture.

RESULTS

The operation was successfully completed in 11 animals. One animal died due to hemorrage during anastomosis construction. Mean graft flow was 144 ml/min (range 88-167 mmHg). The angiogram showed no graft kinking or stenosis. Total operative time was 58 min (range 47-68 min).

CONCLUSIONS

This approach allows quick and excellent exposure of the entire descending thoracic aorta. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demands of this procedure and could avoid an aortic clamp.

Cross-sectional compliance overestimates arterial compliance because it neglects the axial strain

A high resolution echo-tracking system permits the calculation of cross-sectional compliance considering vessel diameter variations alone, and assumes that longitudinal movement of the vessel wall due to pulse pressure is negligible. However, using piezoelectric crystals sutured on the adventitia of the vessel wall we demonstrated that arterial length changes up to 5% (mean 2.7%) as a function of pulse pressure. Therefore, cross-sectional compliance seems to provide a limited approximation of the real phenomenon because it neglects axial vessel movement. Axial vessel movement is taken into account when the vessel compliance is calculated according to the principle of continuity of the mass: [equation: see text]. To verify this hypothesis we measured the blood flow gradient through 10 cm long segments of 10 pig carotid arteries (Qin - Qout) and divided it for the derivative of blood pressure over a given time (deltaP/deltat). For the same vessels, we calculated the cross-sectional compliance (CC) using the echo-tracking system (NIUS 02). We found a CC of (5.91 +/- 0.4) x 10(-7) micro m(2)/mm Hg and a segmental carotid compliance or dynamic compliance (C(d)) of (6.21 +/- 0.2) x 10(-8) micro m(3)/mm Hg. The impact of axial strain in calculations of compliance results in a dynamic compliance, which is one order of magnitude smaller than traditionally calculated arterial compliance.

Cross-sectional compliance overestimates arterial compliance because it neglects the axial strain

A high resolution echo-tracking system permits the calculation of cross-sectional compliance considering vessel diameter variations alone, and assumes that longitudinal movement of the vessel wall due to pulse pressure is negligible. However, using piezoelectric crystals sutured on the adventitia of the vessel wall we demonstrated that arterial length changes up to 5% (mean 2.7%) as a function of pulse pressure. Therefore, cross-sectional compliance seems to provide a limited approximation of the real phenomenon because it neglects axial vessel movement. Axial vessel movement is taken into account when the vessel compliance is calculated according to the principle of continuity of the mass: [equation: see text]. To verify this hypothesis we measured the blood flow gradient through 10 cm long segments of 10 pig carotid arteries (Qin - Qout) and divided it for the derivative of blood pressure over a given time (deltaP/deltat). For the same vessels, we calculated the cross-sectional compliance (CC) using the echo-tracking system (NIUS 02). We found a CC of (5.91 +/- 0.4) x 10(-7) micro m(2)/mm Hg and a segmental carotid compliance or dynamic compliance (C(d)) of (6.21 +/- 0.2) x 10(-8) micro m(3)/mm Hg. The impact of axial strain in calculations of compliance results in a dynamic compliance, which is one order of magnitude smaller than traditionally calculated arterial compliance.

Endothelium-dependency of yohimbine-induced corpus cavernosum relaxation

Development and maintenance of penile erection requires the relaxation of the smooth muscle cells in the cavernous bodies and is essentially mediated by nitric oxide (NO). The penile flaccid state is conversely maintained by the alpha adrenergic neuroeffector system and by other vasoconstrictors, such as endothelin-1 (ET-1). In this study we examined the mechanisms involved in yohimbine-induced relaxation in human and rabbit corpora cavernosa (CC). We essentially found that yohimbine not only blocks contractions induced by adrenergic agonists, but also by non-adrenergic substances, such as ET-1. This effect was unrelated to antagonism at the level of ET receptors, because yohimbine did not affect ET-1-induced increase in intracellular calcium in isolated CC cells. Conversely, our data suggest that yohimbine counteracts ET-1-induced contractions by interfering with NO release from the endothelium. In fact, yohimbine-induced CC relaxation was inhibited by the mechanical removing of the endothelium and by blocking NO formation or signalling via guanylate cyclase and cGMP formation. Conversely, yohimbine activity was strongly increased by inhibiting cGMP degradation. In an experimental model of hypogonadism, performed on rabbits by chronic treatment with a long-lasting GnRH agonist, the relaxant yohimbine activity was also decreased, but completely restored by androgen supplementation. This effect was evident only in preparations in which the main source of NO was present (endothelium) or in which NO formation was not impaired by L-NAME. Our data indicate that the relaxant effect of yohimbine is both endothelium and androgen-dependent. This might justify the lack of efficacy of this drug in treatment of some form of organic erectile dysfunction.

The GraftConnector experience. Long-term patency and histological work up in an animal model

BACKGROUND

A device to perform sutureless end-to-side coronary artery anastomosis has been developed by means of stent technology (GraftConnector). The present study assesses the long-term quality of the GraftConnector anastomosis in a sheep model.

METHODS

In 8 adult sheep, 40-55 kg in weight, through left anterior thoracotomy, the right internal mammary artery (RIMA) was prepared and connected to the left anterior descending artery (LAD) by means of GraftConnector, on beating heart, without using any stabilizer. Ticlopidine 250 mg/day for anticoagulation for 4 weeks and Aspirin 100 mg/day for 6 months were given. The animals were sacrificed after 6 months and histological examination of anastomoses was carried out after slicing with the connector in situ for morphological analysis.

RESULTS

All animals survived at 6 months. All anastomoses were patent and mean luminal width at histology was 1.8 +/- 0.2 mm; mean myotomia hyperplasia thickness was 0.21 +/- 0.1 mm.

CONCLUSIONS

Long-term results demonstrate that OPCABGs performed with GraftConnector had 100% patency rate. The mean anastomotic luminal width corresponds to mean LAD's adult sheep diameter. We may speculate that myotomia hyperplasia occurred as a result of local device oversizing.

Surgery for aortic coarctation: a 30 years experience

OBJECTIVE

A retrospective study to review the experience of a single center with surgery for aortic coarctation over a period of 30 years (1970-1999).

METHODS

Criteria for inclusion: (a) aortic coarctation, isolated or associated with congenital heart defect; (b) surgery between 1970 and 1999. Data recorded: (1) date of surgery; (2) age at surgery; (3) associated lesions; (4) surgical technique; (5) simultaneous surgical procedures; (6) early and late surgical results in term of: (a) deaths; (b) need for reoperation because of re-coarctation or other cardiac lesion; (c) residual/recurrent pressure gradient, evaluated at cuff/Doppler at rest; (d) systemic hypertension, requiring medical treatment.

RESULTS

One hundred and forty-one patients underwent surgery for aortic coarctation: 30 neonates, 29 infants, 45 children and 37 adults. Associated lesions were found in 8/37 (=21.6%) adults and in 73/104 (=70.1%) pediatric patients. There were no hospital deaths. During the follow-up there were one late death in the adults group (1/37=2.7%) and three late deaths in the pediatric group (3/104=2.9%), all unrelated with aortic coarctation. Re-operation because of re-coarctation occurred only in ten late survivors of the pediatric group (10/101=9.9%), 9/10 operated on before 1980 (P<0.00001). End-to-end anastomosis, enlarged to the aortic arch in neonates, was associated with the lowest incidence of re-coarctation (P<0.005). A significant (>20 mmHg at rest) pressure gradient was found in none of the adults, and in seven of the 91 pediatric patients (7/91=7.7%) late survivors. Three adults (3/36=8.3%) late survivors are on medical treatment to control systemic hypertension.

CONCLUSIONS

The long-term results of our retrospective study confirm that surgery has to be considered the gold standard for the treatment of aortic coarctation. The interventional angioplasty techniques have to provide long-term outcome at least similar to the results obtained with surgery.

Preliminary clinical experience with the Heartflo anastomosis device

A clinical, prospective trial to evaluate a multi-suture anastomotic device (Heartflo) is currently underway. This new surgical tool can be used during CABG to perform end-to-side or side-to-side coronary arteries anastomoses with interrupted suture technique. This reports our interim preliminary clinical experience.

METHODS

From February to November 2000, we attempted 15 anastomoses with the multi-suture anastomotic device (Heartflo) in 11 patients with coronary artery disease.

RESULTS

7 males, 4 females, mean age 64 +/- 3 yrs received 15 anastomoses with the device. The target vessels were: 8 RCA, 3 LAD, 4 OM. Mean coronary diameter was 2 +/- 0.3 mm. Grafts used were 14 saphenous veins and 1 IMA. 13/15 anastomoses were completed with the device. 5/13 required 0 - 1 additional stitches versus 8/13 requiring more due to inappropriate tissue capture on the native coronary side. Average time was 17.7 +/- 2 min. In 2/15 cases, the procedure was converted to a traditional handsaw anastomosis. Postoperative CK movement without Q-wave in the EKG was observed in 1/11 patients.

CONCLUSIONS

This device is a reliable instrument that provides reproducible coronary anastomoses with interrupted suture technique, although it also requires additional measures to improve tissue capture and process of handling sutures before extensive clinical application.

Is the GraftConnector a valid alternative to running suture in end-to-side coronary arteries anastomoses?

BACKGROUND

An animal study was carried out to compare long-term patency rates of coronary anastomoses performed with the GraftConnector versus running suture technique.

METHODS

10 sheep, 45 to 55 kg, underwent off-pump coronary artery bypass grafting (right internal mammary artery to left anterior descending artery). In 5 animals, the anastomosis was performed with a GraftConnector and in 5 animals with 7-0 running suture. Intraoperative fluoroscopy and a fluoroscopic control at 6 months were performed. After 6 months, the animals were sacrificed and the anastomoses were examined histologically.

RESULTS

All animals survived at 6 months with 100% anastomosis patency rates in both groups. In the GraftConnector group, the anastomosis diameter at 6 months fluoroscopy was 118% of native left anterior descending artery versus 97% of the control group. Luminal anastomotic width at histology was 1.7 +/- 0.2 mm in the device group versus 1.6 +/- 0.1 mm in the control group. Mean intimal hyperplasia thickness was 0.21 +/- 0.1 mm in the device group versus 0.01 mm in the control group.

CONCLUSIONS

The GraftConnector provides a consistent and reproducible coronary artery anastomosis and reduces technical demand and manual dexterity in coronary operations. Long-term results demonstrate that off-pump coronary artery bypass grafting performed with the GraftConnector had the same patency rate and luminal width as those performed with running suture.

Silver-coated prosthetic heart valve: a double-bladed weapon

A St. Jude Medical Silzone was implanted in a 72-year-old female, suffering from mitral valve disease. Four months later, the patient had acute cardiac failure due to partial detachment of the prosthetic valve. The mitral annulus was ulcerated and there were multiple erosions in the myocardial tissue in contact with the prosthetic valve. Histological examination revealed chronic inflammation with hemosiderine deposits and giant cells. No allergy to silver ions was found. The silver-coated sewing cuff had caused a chronic inflammatory reaction due to a toxic reaction to silver. The Silzone valve was withdrawn from the market on January 2000.

Systolic axial artery length reduction: an overlooked phenomenon in vivo

To demonstrate axial artery motion during the cardiac cycle, the common carotid arteries (CCA) of 10 pigs were exposed and equipped with piezoelectric crystals sutured onto the artery as axial position detectors. An echo-tracking system was used to simultaneously measure the CCA diameter. For each animal, data for pressure, length, and diameter were collected at a frequency of 457 Hz. At a mean pulse pressure of 33 +/- 8 mmHg, the mean systolodiastolic length difference was 0.3 +/- 0.01 mm for a mean arterial segment of 11.35 +/- 1.25 mm. Systolic and diastolic diameters were 4.1 +/- 0.3 and 3.9 +/- 0.2 mm, respectively. The examined CCA segment displayed a mean axial systolic shortening of 2.7%. This study clearly demonstrates, for the first time, that the length of a segment of the CCA changes during the cardiac cycle and that this movement is inversely correlated with pulse pressure. It is also apparent that the segmental axial strain is significantly smaller than the diameter variation during the cardiac cycle and that the impact of the axial strain for compliance computation should be further evaluated.

Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses

OBJECTIVE

An animal model has been developed to compare the effects of suture technique on the luminal dimensions and compliance of end-to-side vascular anastomoses.

METHODS

Carotid and internal mammalian arteries (IMAs) were exposed in three pigs (90 kg). IMAs were sectioned distally to perform end-to-side anastomoses on carotid arteries. One anastomosis was performed with 7/0 polypropylene running suture. The other was performed with the automated suture delivery device (Perclose/Abbott Labs Inc.) that makes a 7/0 polypropylene interrupted suture. Four piezoelectric crystals were sutured on toe, heel and both lateral sides of each anastomosis to measure anastomotic axes. Anastomotic cross-sectional area (CSAA) was calculated with: CSAA = pi x mM/4 where m and M are the minor and major axes of the elliptical anastomosis. Cross-sectional anastomotic compliance (CSAC) was calculated as CSAC=Delta CSAA/Delta P where Delta P is the mean pulse pressure and Delta CSAA is the mean CSAA during cardiac cycle.

RESULTS

We collected a total of 1200000 pressure-length data per animal. For running suture we had a mean systolic CSAA of 26.94+/-0.4 mm(2) and a mean CSAA in diastole of 26.30+/-0.5 mm(2) (mean Delta CSAA was 0.64 mm(2)). CSAC for running suture was 4.5 x 10(-6)m(2)/kPa. For interrupted suture we had a mean CSAA in systole of 21.98+/-0.2 mm(2) and a mean CSAA in diastole of 17.38+/-0.3 mm(2) (mean Delta CSAA was 4.6+/-0.1 mm(2)). CSAC for interrupted suture was 11 x 10(-6) m(2)/kPa.

CONCLUSIONS

This model, even with some limitations, can be a reliable source of information improving the outcome of vascular anastomoses. The study demonstrates that suture technique has a substantial effect on cross-sectional anastomotic compliance of end-to-side anastomoses. Interrupted suture may maximise the anastomotic lumen and provides a considerably higher CSAC than continuous suture, that reduces flow turbulence, shear stress and intimal hyperplasia. The Heartflo anastomosis device is a reliable instrument that facilitates performance of interrupted suture anastomoses.

Benefits of endoscopic vein harvesting

The purpose of this study was to evaluate and compare the benefits of endoscopic saphenous vein harvesting (EVH) with the traditional incision technique (TIT) for coronary artery bypass grafting (CABG) in respect to the technical procedure and clinical outcome. In a prospective nonrandomized, case-matched study the greater saphenous vein was harvested for CABG in 22 patients using the endoscopic technique and in 18 patients with the traditional method. Comparisons were made for the operating time, length of incision and vein harvested, graft quality, postoperative complications, and pain assessment. Patient demographics were well matched. EVH required smaller incisions than did the TIT (10.5 +/- 6.6 vs. 31.2 +/- 7.8 cm, respectively; p < 0.0001). Harvest time and vein quality were comparable in the two groups. Total vein operating time was shorter following the endoscopic technique (60 +/- 24 vs. 100 +/- 35 minutes, respectively; p < 0.0001). EVH had fewer complications (NS), and postoperative pain was significantly less (p = 0.0034). The major advantages of endoscopic vein harvesting are a significant reduction of postoperative pain and strikingly better cosmetic results. Wound complications seem to be less frequent.

Decreased compliance on arterial anastomoses

The present study was undertaken to examine the cross-sectional vascular compliance at the anastomotic site.

METHODS AND MATERIAL

We performed end-to-end anastomosis on the carotid artery of six pigs using continuous 6/0 polypropylene. Four carotid arteries were excised and mounted in a perfusion chamber while the remaining two were left in living animals. We used pulsed ultrasound (NIUS 02) to generate detailed longitudinal profiles of diameter and compliance in the proximity and on the anastomosis.

RESULTS

On the anastomosis, the vessel diameter decreases (-1 to -2.6% of diastolic diameter) when blood pressure increases with an exponential correlation (R2 = 0.75). The arterial compliance at the anastomosis was negative: the vessel cross-section reduction for a pulse pressure of 1 up to 32 mmHg was 0.9 to 2% of diastolic vessel cross-section.

CONCLUSIONS

Vessel movement generated a dynamic stenosis whose magnitude seems to depend on blood pressure level. Increasing blood pressure causes the retraction of vessel ends which causes vessel lumen reduction. These results suggest that continuous suture does not provide the continuity of mechanical properties of the artery.

Anastomotic longitudinal stress due to modification of arterial longitudinal properties after anastomosis

BACKGROUND

In our hands, in vivo segmental vessel length changes up to 5% because of blood pressure: increasing in arterial pressure is associated to decrease in segmental vessel length.

METHODS AND MATERIAL

Using two piezoelectric crystals sutured on vessel wall and a high fidelity pressure probe, we recorded artery length variations as function of blood pressure, before and after an end-to-end anastomosis on four pigs carotid arteries.

RESULTS

Mean arterial pressure before anastomosis = 73 mmHg (+/- 12); mean arterial pressure after anastomosis = 91 mmHg (+/- 14); mean crystals displacement before anastomosis during systole = -0.21 mm; mean crystals displacement after anastomosis during systole = +0.24 mm; mean distance between crystals before anastomosis = 12.3 mm (+/- 0.8) and after anastomosis = 11.2 mm (+/- 0.5).

CONCLUSIONS

In the acute phase following an end-to-end anastomosis, an increase in blood pressure causes increasing in vessel length, with an exponential correlation. The anastomosis is constantly subjected to a longitudinal traction whose magnitude depends on blood pressure.

[Endothelial lesions caused by intra-aortic counterpulsation balloons]

Intra-aortic balloon pump (IABP) is the most frequently used mechanical circulatory support. Repeated trauma on the aortic wall has been reported as a cause of balloon perforation by endothelial denudation of atheromatous plaque. This study analyses the effect of IABP on the endothelium of the calf aorta. In 12 calves (mean weight: 72 +/- 6 kg) an IABP was inserted by femoral route and left during 6 hours on internal mode with a frequency of 80 cycles/min. The animals were sacrificed after the procedure (n = 4), at postoperative day (POD) 7 (n = 4), and at POD 14 (n = 4). In the aorta facing the balloon, nine transmural samples were taken proximally (n = 3), at mid height (n = 3) and distally (n = 3), for histological analysis of the percentage of aortic surface covered with endothelium. The percentage of aortic surface covered with endothelium at POD 0, 7 and 14 was proximally: 72.5 +/- 27.5%, 83.7 +/- 16.9% and 93.3 +/- 8.9% respectively; at mid-height: 50.8 +/- 30.7%, 65 +/- 25% and 95 +/- 5%; and distally: 31.4 +/- 20.1%, 48.3 +/- 34.4% and 85 +/- 10%. A large portion of the aortic endothelium is abraded after 6 hours of IAB pumping. This effect is more important at the distal level of the aorta. After two weeks, most of the endothelium has regenerated.

Intravascular ultrasound underestimates vessel dimensions

The information gathered with intravascular ultrasound (IVUS) are of great value in endovascular techniques. The aim of this study was to evaluate the reliability of IVUS when measuring vessel dimensions by comparison with an established reference method. The left carotid artery was exposed in 4 pigs (45-55 kg) and two piezoelectric crystals were sutured on the adventitia in the same cross-sectional plane. The distance between them was measured either by IVUS and by sonomicrometers. The mean distance between the two crystals calculated by the sonomicrometer was 4.7+/-0.4 mm (mean systolic distance was 4.9+/-0.2 mm, mean diastolic distance was 4.6+/-0.1 mm). The mean distance between the two targets calculated by IVUS was 4. 5+/-0.2 mm (mean systolic distance was 4.6+/-0.2 mm and mean diastolic 4.4+/-0.2 mm). Regression analysis of the two series of data shows a R(2)=0.9984. IVUS measurements are an average 5% smaller than sonomicrometer measurements (3.6% up to 8.3%) and the difference is statistically significant ( p <0.05). The underestimation of IVUS measurements will affect the accuracy, and probably the long-term outcome, of endovascular procedures.

A siliconized hollow fiber membrane oxygenator

Most membrane oxygenators are built with microporous fibers known for plasma leakage in long-term use such as extracorporeal life support or extracorporeal membrane oxygenation. The current study was designed to evaluate the Quadrox oxygenator in which the fibers have been coated with silicone (Jostra). Six calves (mean weight, 62 +/- 4 kg) were connected to cardiopulmonary bypass (CPB) by jugular venous and carotid arterial cannulation, with a mean flow rate of 3 L/min for 6 hours. They were randomly assigned to a standard Quadrox oxygenator (standard group, n = 3) or a siliconized Quadrox oxygenator (silicone group, n = 3). After 7 days, the animals were sacrificed. A standard battery of blood samples was taken before bypass, after mixing for 10 minutes, and after 1, 2, 5, and 6 hours of perfusion. Analysis of variance was used for repeated measurements. Total oxygen transfer and carbon dioxide transfer did not differ between groups (p = 0.5 for comparison). Blood trauma, evaluated by plasma hemoglobin (Hb), did not detect any significant hemolysis in either group. Thrombocyte and white blood cell count profiles in both groups were parallel and without significant differences (p = 0.1 and 0.6, respectively). At the end of testing no clot deposition was found in the oxygenator. At postmortem, there were no signs of peripheral emboli. The results of this study suggest that this silicone coating of hollow fibers allows for good gas transfer, while preserving all the mechanical advantages of a conventional hollow fiber oxygenator.