1
|
Weber E, Chong A, Liebold A, Hoenicka M. A novel pulsatile blood pump design for cardiothoracic surgery: Proof-of-concept in a mock circulation. Artif Organs 2023; 47:512-525. [PMID: 36300590 DOI: 10.1111/aor.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulsatile perfusion during extracorporeal circulation is a promising concept to improve perfusion of critical organs. Clinical benefits are limited by the amount of pulsatile energy provided by standard pumps. The present study investigated the properties of a novel positive displacement blood pump in a mock circulation. METHODS The pump was attached to an aortic model with a human-like geometry and compliance as a pseudo patient. Hemodynamic data were recorded while the pump settings were adjusted systematically. RESULTS Using a regular oxygenator, maximum flow was 2.6 L/min at a pressure of 27 mm Hg and a frequency (F) of 90 bpm. Pulse pressure (PP; 28.9 mm Hg) and surplus hemodynamic energy (SHE; 26.1% of mean arterial pressure) were highest at F = 40 bpm. Flow and pressure profiles appeared sinusoid. Using a low-resistance membrane ventilator to assess the impact of back pressure, maximum flow was 4.0 L/min at a pressure of 58.6 mm Hg and F = 40 bpm. At F = 40 bpm, PP was 58.7 mm Hg with an SHE of 33.4%. SHE decreased with increasing flow, heart rate, and systolic percentage but surpassed 10% with reasonable settings. CONCLUSIONS The present prototype achieved sufficient flow and pressure ranges only in the presence of a low-resistance membrane ventilator. It delivered supraphysiologic levels of pulse pressure and SHE. Further modifications are planned to establish this concept for adult pulsatile perfusion.
Collapse
Affiliation(s)
- Elena Weber
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Albert Chong
- Triphasic Cardiac Pump Pty Ltd, Nedlands, Western Australia, Australia
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
2
|
A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients. Ann Thorac Surg 2022; 114:1404-1411. [PMID: 35292258 DOI: 10.1016/j.athoracsur.2022.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The objective of this randomized clinical trial was to investigate the effects of perfusion modalities on cerebral hemodynamics, vital organ injury, quantified by the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score, and clinical outcomes in risk-stratified congenital cardiac surgery patients. METHODS This randomized clinical trial included 159 consecutive congenital cardiac surgery patients in whom pulsatile (n = 83) or nonpulsatile (n = 76) perfusion was used. Cerebral hemodynamics were assessed using transcranial Doppler ultrasound. Multiple organ injury was quantified using the PELOD-2 score at 24, 48, and 72 hours. Clinical outcomes, including intubation time, intensive care unit length of stay (LOS), hospital LOS, and mortality, were also evaluated. RESULTS The Pulsatility Index at the middle cerebral artery and in the arterial line during aortic cross-clamping was consistently better maintained in the pulsatile group. Demographics and cardiopulmonary bypass characteristics were similar between the 2 groups. While risk stratification with The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Categories was similar between the groups, Mortality Categories 1 to 3 demonstrated more patients than Mortality Categories 4 and 5. There were no differences in clinical outcomes between the groups. The PELOD-2 scores showed a progressive improvement from 24 hours to 72 hours, but the results were not statistically different between the groups. CONCLUSIONS The Pulsatillity Index for the pulsatile group demonstrated a more physiologic pattern compared with the nonpulsatile group. While pulsatile perfusion did not increase plasma-free hemoglobin levels or microemboli delivery, it also did not demonstrate any improvements in clinical outcomes or PELOD-2 scores, suggesting that while pulsatile perfusion is a safe method, it not a "magic bullet" for congenital cardiac operations.
Collapse
|
3
|
Patel K, Ündar A. Impact of a Multidisciplinary Research Team Approach to Prevent Avoidable Mistakes for Neonatal CPB Population. World J Pediatr Congenit Heart Surg 2022; 13:220-230. [PMID: 35238709 DOI: 10.1177/21501351211064182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant progress has been made in neonatal cardiopulmonary bypass (CPB) over the years. At Penn State Health Children's Hospital, we have established a multidisciplinary research team that brings clinicians, engineers, scientists, research nurses, neuromonitoring technicians, perfusionists, and students from various departments to help reduce adverse outcomes following CPB in neonates. With the help of this team, we evaluate each CPB component in simulated conditions identical to those used in clinical practice. The objective of this review is to demonstrate the results of these translational projects and present critical mistakes to avoid for neonatal CPB patients.
Collapse
Affiliation(s)
- Krishna Patel
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
| |
Collapse
|
4
|
Graßler A, Bauernschmitt R, Guthoff I, Kunert A, Hoenicka M, Albrecht G, Liebold A. Effects of pulsatile minimal invasive extracorporeal circulation on fibrinolysis and organ protection in adult cardiac surgery-a prospective randomized trial. J Thorac Dis 2019; 11:S1453-S1463. [PMID: 31293794 DOI: 10.21037/jtd.2019.02.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimal invasive extracorporeal circulation (MiECC) reduces the impact of cardiopulmonary bypass during cardiac surgery on inflammation and hemostasis. Pulsatile perfusion may enhance organ perfusion and help to prevent renal and neuronal damage. The present study investigated the impact of pulsatile MiECC in low-risk coronary artery bypass grafting (CABG) patients. Methods CABG patients were prospectively randomized for non-pulsatile (np: n=19) and pulsatile (p: n=21) MiECC. Blood and urine samples were collected at several time points until 72 h post-operative and analyzed for biochemical markers of fibrinolytic capacity, renal damage, and neuronal damage. Results Although intraoperative tissue plasminogen activator (tPA) levels tended to be higher in the p group, none of the fibrinolysis markers including plasminogen activator inhibitor (PAI-1) and the PAI-1/tPA ratio were significantly affected by pulsation. Hemolysis and markers of renal and neuronal damage were comparable between groups. Intraoperative urinary excretion [np: 400 mL (355 to 680) vs. p: 530 mL (360 to 900)] and cumulative 24 h volume intake [np: 7,090 mL (5,492 to 7,544) vs. p: 7,155 mL (6,682 to 8,710)] were increased by pulsation whereas blood losses up to 12 h post-operative [np: 365 mL (270 to 515) vs. p: 310 mL (225 to 470)] and up to 24 h post-operative [np: 760 mL (555 to 870) vs. p: 520 mL (460 to 670)] were attenuated. Conclusions The present study did not find evidence for a beneficial effect of pulsation on markers of fibrinolysis, renal damage, and neuronal damage. However, pulsatile perfusion increased intraoperative urinary secretion and reduced post-operative blood losses.
Collapse
Affiliation(s)
- Angelika Graßler
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.,RoMed Clinical Center Rosenheim, Department of Internal Medicine III, Rosenheim, Germany
| | - Robert Bauernschmitt
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.,MediClin Herzzentrum, Department of Cardiothoracic and Vascular Surgery, Lahr, Germany
| | - Irene Guthoff
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Andreas Kunert
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Günter Albrecht
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| |
Collapse
|
5
|
Ündar A, Moroi MK. Pulsatile flow is not a magic bullet for congenital heart surgery patients during CPB procedures. Artif Organs 2019; 43:943-946. [DOI: 10.1111/aor.13511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
- Department of Surgery and Bioengineering Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
| | - Morgan K. Moroi
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
| |
Collapse
|
6
|
Lawson PJ, Moore HB, Moore EE, Gerich ME, Stettler GR, Banerjee A, Schulick RD, Nydam TL. Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability. J Surg Res 2018; 231:54-61. [PMID: 30278969 DOI: 10.1016/j.jss.2018.04.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/07/2018] [Accepted: 04/24/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Elevated clot strength (maximum amplitude [MA]) measured by thrombelastography (TEG) is associated with thrombotic complications. However, it remains unclear how MA translates to thrombotic risks, as this measurement is independent of time, blood flow, and clot degradation. We hypothesize that under flow conditions, increased clot strength correlates to time-dependent measurements of coagulation and resistance to fibrinolysis. MATERIALS AND METHODS Surgical patients at high risk of thrombotic complications were analyzed with TEG and total thrombus-formation analysis system (T-TAS). TEG hypercoagulability was defined as an r <10.2 min, angle >59, MA >66 or LY30 <0.2% (based off of healthy control data, n = 141). The T-TAS AR and PL chips were used to measure clotting at arterial shear rates. T-TAS measurements include occlusion start time, occlusion time (OT), occlusion speed (OSp), and total clot generation (area under the curve). These measurements were correlated to TEG indices (R time, angle, MA, and LY30). Both T-TAS and TEG assays were challenged with tissue plasminogen activator (t-PA) to assess clot resistance to fibrinolysis. RESULTS Thirty subjects were analyzed, including five controls. TEG-defined hypercoagulability by MA was detected in 52% of the inflammatory bowel disease/cancer patients; 0% was detected in the controls. There were no TEG measurements that significantly correlated with T-TAS AR and PL chip. However, in the presence of t-PA, T-TAS AR determined OSp to have an inverse relationship with TEG angle (-0.477, P = 0.012) and LY30 (-0.449, P = 0.019), and a positive correlation with R time (0.441 P = 0.021). In hypercoagulability determined by TEG MA, T-TAS PL had a significantly reduced OT (4:07 versus 6:27 min, P = 0.043). In hypercoagulability defined by TEG LY30, T-TAS PL had discordant findings, with a significantly prolonged OT (6:36 versus 4:30 min, P = 0.044) and a slower OSp (10.5 versus 19.0 kPa/min, P = 0.030). CONCLUSIONS Microfluidic coagulation assessment with T-TAS has an overall poor correlation with most TEG measurements in a predominantly hypercoagulable patient population, except in the presence of t-PA. The one anticipated finding was an elevated MA having a shorter time to platelet-mediated microfluidic occlusion, supporting the role of platelets and hypercoagulability. However, hypercoagulability defined by LY30 had opposing results in which a low LY30 was associated with a longer PL time to occlusion and slower OSp. These discordant findings warrant ongoing investigation into the relationship between clot strength and fibrinolysis under different flow conditions.
Collapse
Affiliation(s)
- Peter J Lawson
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Hunter B Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Ernest E Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Denver Health Medical Center, Denver, Colorado
| | - Mark E Gerich
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Gregory R Stettler
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Trevor L Nydam
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
7
|
Pierce RW, Giuliano JS, Pober JS. Endothelial Cell Function and Dysfunction in Critically Ill Children. Pediatrics 2017; 140:peds.2017-0355. [PMID: 28759412 PMCID: PMC9923607 DOI: 10.1542/peds.2017-0355] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/24/2022] Open
Abstract
Endothelial cells (ECs) line the lumen of the entire vascular system and actively regulate blood flow; maintain blood fluidity; control water, solute, and macromolecular transfer between blood and tissue; and modulate circulating immune cell recruitment and activation. These vital functions, combined with the broad anatomic distribution of ECs, implicate them in all forms of critical illness. The present article discusses how ECs adapt and break down during the course of critical illness. We first review the biology of ECs, highlighting the vascular segmental differences and their specific roles in the maintenance of homeostasis. We then discuss how ECs acquire new functions to restore local and systemic homeostasis (activation) as well as how breakdowns in EC functions (dysfunction) contribute to local and systemic pathologic responses, with clinical correlations. Lastly, how these processes have been studied in critically ill children is discussed.
Collapse
Affiliation(s)
- Richard W. Pierce
- Departments of Pediatrics and,Address correspondence to Richard W. Pierce, MD, MS, Department of Pediatrics, Section of Critical Care Medicine, Yale University, 333 Cedar St, PO Box 208064, New Haven, CT 06520. E-mail:
| | | | | |
Collapse
|
8
|
Abstract
Extracorporeal membrane oxygenation (ECMO) is a pivotal bridge to recovery for cardiopulmonary failure in children. Besides its life-saving quality, it is often associated with severe system-related complications, such as hemolysis, inflammation, and thromboembolism. Novel oxygenator and pump systems may reduce such ECMO-related complications. The ExMeTrA oxygenator is a newly designed pediatric oxygenator with an integrated pulsatile pump minimizing the priming volume and reducing the surface area of blood contact. The aim of our study was to investigate the feasibility and safety of this new ExMeTrA (expansion mediated transport and accumulation) oxygenator in an animal model. During 6 h of extracorporeal circulation (ECC) in pigs, parameters of the hemostatic system including coagulation, platelets and complement activation, and flow rates were investigated. A nonsignificant trend in C3 consumption, thrombin-antithrombin-III (TAT) complex formation and a slight trend in hemolysis were detected. During the ECC, the blood flow was constantly at 500 ml/min using only flexible silicone tubes inside the oxygenator as pulsatile pump. Our data clearly indicate that the hemostatic markers were only slightly influenced by the ExMeTrA oxygenator. Additionally, the oxygenator showed a constant quality of blood flow. Therefore, this novel pediatric oxygenator shows the potential to be used in pediatric and neonatal support with ECMO.
Collapse
|
9
|
Ündar A, Wang S, Palanzo DA, Wise RK, Woitas K, Baer LD, Kunselman AR, Song J, Alkan-Bozkaya T, Akcevin A, Spencer S, Agirbasli M, Clark JB, Myers JL. Impact of Pulsatile Flow on Vital Organ Recovery During Cardiopulmonary Bypass in Neonates and Infants. Artif Organs 2016; 40:14-8. [DOI: 10.1111/aor.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics; Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Bioengineering; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Shigang Wang
- Department of Pediatrics; Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - David A Palanzo
- Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Robert K. Wise
- Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Karl Woitas
- Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Larry D. Baer
- Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Allen R. Kunselman
- Public Health Sciences; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Jianxun Song
- Microbiology & Immunology; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Tijen Alkan-Bozkaya
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Atif Akcevin
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Shannon Spencer
- Department of Pediatrics; Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Mehmet Agirbasli
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| | - Joseph B. Clark
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - John L. Myers
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| |
Collapse
|
10
|
Aĝirbaşli M, Song J, Lei F, Wang S, Kunselman AR, Clark JB, Myers JL, Ündar A. Apolipoprotein E levels in pediatric patients undergoing cardiopulmonary bypass. Artif Organs 2015; 39:28-33. [PMID: 25626577 DOI: 10.1111/aor.12444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Apolipoprotein E (apoE) may play a critical role in modulating the response to neurological injury after cardiopulmonary bypass (CPB) in children. Plasma samples were collected from 38 pediatric patients. Half of the patients received nonpulsatile flow and the other half underwent pulsatile flow during CPB. Plasma samples were collected at three time points: at baseline prior to incision (T1), 1 h after CPB (T2), and 24 h after CPB (T3). The study included 38 pediatric patients undergoing heart surgery (mean age 2.5 ± 2.1 years). Baseline apoE levels were low (<30 μg/mL) in 21 patients (55%). ApoE levels were significantly decreased at 1 h after CPB compared with baseline (22 ± 14 vs. 34 ± 18 μg/mL, P = 0.001). At 24 h after CPB, apoE levels were significantly increased compared with baseline (47 ± 25 vs. 34 ± 18 μg/mL, P = 0.002). Pulsatile mode was associated with lower apoE levels at 24 h after CPB compared with nonpulsatile mode (38 ± 14 vs. 57 ± 29 μg/mL, P = 0.018). ApoE levels correlated negatively with pump time (r = -0.525, P = 0.021) and cross-clamp time (r = -0.464, P = 0.045) at 24 h following CPB for the nonpulsatile group but not for the pulsatile group. In this cohort of young children with congenital heart disease, baseline apoE levels were low in the majority of patients prior to surgery. ApoE levels decreased further at 1 h after CPB, and then significantly increased by 24 h. The mode of perfusion and the duration of pump time and clamp time influence the apoE levels after CPB. An improved understanding of these mechanisms may translate into the development of new techniques to improve the clinical outcomes after pediatric CPB.
Collapse
Affiliation(s)
- Mehmet Aĝirbaşli
- Department of Cardiology, Marmara University College of Medicine, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Liebold A. Extrakorporale Zirkulation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Wang S, Izer JM, Clark JB, Patel S, Pauliks L, Kunselman AR, Leach D, Cooper TK, Wilson RP, Ündar A. In Vivo Hemodynamic Performance Evaluation of Novel Electrocardiogram-Synchronized Pulsatile and Nonpulsatile Extracorporeal Life Support Systems in an Adult Swine Model. Artif Organs 2015; 39:E90-E101. [DOI: 10.1111/aor.12482] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Jenelle M. Izer
- Department of Comparative Medicine; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Sunil Patel
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Linda Pauliks
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Donald Leach
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Timothy K. Cooper
- Department of Comparative Medicine; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Pathology; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Ronald P. Wilson
- Department of Comparative Medicine; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Comparative Medicine; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| |
Collapse
|
13
|
|
14
|
Patel S, Wang S, Pauliks L, Chang D, Clark JB, Kunselman AR, Ündar A. Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance. Artif Organs 2015; 39:67-76. [DOI: 10.1111/aor.12454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sunil Patel
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Linda Pauliks
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Dennis Chang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| |
Collapse
|
15
|
Protective effects of pulsatile flow during cardiopulmonary bypass. Ann Thorac Surg 2014; 99:192-9. [PMID: 25440278 DOI: 10.1016/j.athoracsur.2014.07.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with congenital heart disease are often operated at a very young age. Cardiopulmonary bypass (CPB) has become indispensable for these sometimes very complex operations, but one cannot neglect a possible negative impact of CPB on organ function. Traditionally, CPB was developed with non-pulsatile flow but there are clinical observations that pulsatile flow might be superior with improved patient outcomes. Therefore, we attempted to elucidate whether CPB with pulsatile flow preserves organ integrity compared with nonpulsatile flow. METHODS We studied 27 piglets of 4 weeks age and divided them into 3 experimental groups: control group (no CPB); non-pulsatile and pulsatile-CBP with 90-minutes CPB and 120-minutes recovery and reperfusion. Thereafter, histology of kidney, liver, and hippocampus was performed. Moreover, we measured adenosine triphosphate (ATP) content in these organs. RESULTS Histologic evaluation revealed that laminar flow produced significant cellular edema in the kidney and hippocampus. Additionally, markers for hypoxia, apoptosis, and nitrosative stress were elevated but predominately in the hippocampus and proximal tubules of the kidney. Most of these alterations were reduced to or near control levels with pulsatile CPB. Moreover, ATP content of all 3 organs examined was higher and kidney and liver enzymes were lower in the pulsatile group compared with the non-pulsatile CPB. With regard to histologic changes, the liver seemed to be a less sensitive organ. CONCLUSIONS In our study during pulsatile CPB, organ damage was significantly attenuated as compared with non-pulsatile CPB. Therefore, in pediatric patients pulsatile CPB may improve clinical outcomes.
Collapse
|
16
|
Adedayo P, Wang S, Kunselman AR, Ündar A. Impact of Pulsatile Flow Settings on Hemodynamic Energy Levels Using the Novel Diagonal Medos DP3 Pump in a Simulated Pediatric Extracorporeal Life Support System. World J Pediatr Congenit Heart Surg 2014; 5:440-8. [DOI: 10.1177/2150135114526760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/10/2014] [Indexed: 11/15/2022]
Abstract
Background: The objective of this study was to evaluate the pump performance of the novel diagonal Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, , Stolberg, Germany) under nonpulsatile to pulsatile mode with varying differential speed values in a simulated pediatric extracorporeal life support system. Methods: The experimental circuit consisted of a Medos Deltastream DP3 pump head and console, a Medos Hilite 2400 LT hollow fiber membrane oxygenator (MEDOS Medizintechnik AG), a 14F Medtronic DLP arterial cannula (Medtronic Inc, Minnesota), and a 20F Terumo TenderFlow Pediatric venous return cannula (Terumo Corporation, Michigan). Trials were conducted at flow rates ranging from 500 mL/min to 2,000 mL/min (500 mL/min increments) and pulsatile differential speed values ranging from 500 rpm to 2,500 rpm (500 rpm increments) using human blood (hematocrit 35%). The postcannula pressure was maintained constantly at 60 mm Hg. Real-time pressure and flow data were recorded using a custom-made data acquisition system and Labview software. Results: Under all experimental conditions, pulsatile flow (P) generated significantly greater energy equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE) than those of nonpulsatile flow (NP). Under NP, SHE was zero. Higher differential speed values generated greater EEP, SHE, and THE values. There was little variation in the oxygenator pressure drop and the cannula pressure drop in P, compared to NP. Conclusions: The novel Medos Deltastream DP3 diagonal pump is able to generate physiological quality of P, without backflow. With increased differential rpm, the pump generated greater EEP, SHE, and THE. Physiological quality of pulsatility may be associated with better microcirculation because of greater EEP, SHE, and THE.
Collapse
Affiliation(s)
- Pelumi Adedayo
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
- Department of Surgery and Bioengineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| |
Collapse
|