1
|
Kadner A, Heinisch PP, Bartkevics M, Wyss S, Jenni HJ, Erdoes G, Eberle B, Carrel T. Initial experiences with a centrifugal-pump based minimal invasive extracorporeal circulation system in pediatric congenital cardiac surgery. J Thorac Dis 2019; 11:S1446-S1452. [PMID: 31293793 DOI: 10.21037/jtd.2019.01.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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) circuits are an established alternative to conventional extracorporeal circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac surgery, this perfusion concept appears particularly attractive to pediatric cardiac surgery. So far, there are no reports on the clinical application of a MiECC system for corrective surgery in neonates and children. We report our initial experiences by using a MiECC system in pediatric cardiac surgery. Methods A total of 38 pediatric patients underwent surgical interventions for a variety of congenital heart disease from March 2017 until August 2018 with a MiECC. Following the classification of MiECC circuits by the Minimal invasive Extra-Corporeal Technologies International Society (MiECTIS), type I and type III perfusion circuits were assembled depending on the planned intervention: type I for closed heart interventions and type III for open heart procedures. Primary outcome was conversion to CECC, secondary endpoints included major adverse cardiac or cerebrovascular events (MACCE). Results MiECC perfusion was successfully performed in all patients (100%). Median patient age was 9.5 months (range, 0.2-176 months) with a median weight of 8.1 kg (range, 2.3-49 kg). For both MiECC types no system related technical complications were encountered. Beating heart procedures were performed in 23 cases (60%) at normothermia, while in 15 (40%) interventions cardioplegic cardiac arrest was induced at mild hypothermia. All patients had an uneventful perioperative course with no in-hospital mortality. MACCE did not occur during the hospitalization period. Conclusions MiECC can be performed by using standard techniques for closed and open cardiac procedures for the correction of a variety of malformations in neonates and children with good results and uneventful postoperative course.
Collapse
Affiliation(s)
- Alexander Kadner
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Maris Bartkevics
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Serena Wyss
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Hans-Joerg Jenni
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital, University Bern, Bern, Switzerland
| | - Thierry Carrel
- Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland
| |
Collapse
|
2
|
Madrahimov N, Natanov R, Boyle EC, Goecke T, Knöfel AK, Irkha V, Solovieva A, Höffler K, Maus U, Kühn C, Ismail I, Warnecke G, Shrestha ML, Cebotari S, Haverich A. Cardiopulmonary Bypass in a Mouse Model: A Novel Approach. J Vis Exp 2017. [PMID: 28994765 DOI: 10.3791/56017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization and for minimizing organ damage resulting from prolonged extracorporal circulation. The goal of this paper was to demonstrate a fully functional and clinically relevant model of cardiopulmonary bypass in a mouse. We report on the device design, perfusion circuit optimization, and microsurgical techniques. This model is an acute model, which is not compatible with survival due to the need for multiple blood drawings. Because of the range of tools available for mice (e.g., markers, knockouts, etc.), this model will facilitate investigation into the molecular mechanisms of organ damage and the effect of cardiopulmonary bypass in relation to other comorbidities.
Collapse
Affiliation(s)
- Nodir Madrahimov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School;
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Erin C Boyle
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Tobias Goecke
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ann-Kathrin Knöfel
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Valentyna Irkha
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Anna Solovieva
- Department of Hematology, Oncology, Immunology, Rheumatology, and Pulmonology, University Hospital Tuebingen
| | - Klaus Höffler
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Issam Ismail
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Malakh-Lal Shrestha
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| |
Collapse
|
3
|
Liguori GR, Kanas AF, Moreira LFP. Managing the inflammatory response after cardiopulmonary bypass: review of the studies in animal models. Braz J Cardiovasc Surg 2014; 29:93-102. [PMID: 24896169 PMCID: PMC4389477 DOI: 10.5935/1678-9741.20140017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022] Open
Abstract
Objective To review studies performed in animal models that evaluated therapeutic
interventions to inflammatory response and microcirculatory changes after
cardiopulmonary bypass. Methods It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and
("Microcirculation" (MeSH) or "Inflammation" (MeSH) or
"Inflammation Mediators" (MeSH)). Repeated results, human studies,
non-English language articles, reviews and studies without control were
excluded. Results Blood filters, system miniaturization, specific primers regional perfusion,
adequate flow and temperature and pharmacological therapies with anticoagulants,
vasoactive drugs and anti-inflammatories reduced changes in microcirculation and
inflammatory response. Conclusion Demonstrated efficacy in animal models establishes a perspective for evaluating
these interventions in clinical practice.
Collapse
Affiliation(s)
- Gabriel Romero Liguori
- Correspondence address: Gabriel Romero Liguori, Instituto do Coração
(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
Av. Dr. Enéas de Carvalho Aguiar, 44 - 2º andar - bloco II - sala 13 - Cerqueira
César, São Paulo, SP, Brazil - Zip code: 05403-000. E-mail:
| | | | | |
Collapse
|
4
|
An in vitro model of a system of electrical potential compensation in extracorporeal circulation. Int J Artif Organs 2014; 37:109-17. [PMID: 24619901 DOI: 10.5301/ijao.5000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Extracorporeal circulation (ECC) in patients undergoing cardiac surgery induces systemic immune-inflammatory reaction that results in increased postoperative morbidity. Many factors are responsible for the adverse response after ECC. The present in vitro study aimed to investigate electric charges (ECs) generated during ECC, to set a device compensating the ECs, and checking its effect on red blood cells (RBC). MATERIALS AND METHODS The electrical signals of blood in ECC were collected by a custom developed low-noise electronic circuit, processed by a digital oscilloscope (DSO) and a dynamic signal analyzer (DSA). The compensation of ECs was performed using a compensation device, injecting a nulling charge into the blood circuit. The compensation effect of the ECs on RBCs was evaluated by scanning electron microscope (SEM). RESULTS The electrical analysis performed using both the DSO and the DSA confirmed the EC formation during ECC. The notable electric signals recorded in standard ECC circuits substantially nulled once the compensation device was used, thus confirming efficient EC compensation. After two hours of ECC, the SEM non-blended test on human RBC samples highlighted morphological changes in acanthocytes of the normal biconcave-shaped RBC. CONCLUSIONS The outcomes confirm the development of parasitic ECs during ECC and that a suppressor system may decrease the potential damage of ECs. Nevertheless, further studies are ongoing in order to investigate the complex mechanisms related to lymphocytes and platelet morphological and physiological chances during triboelectric charges in ECC.
Collapse
|
5
|
Schnoering H, Arens J, Detering SM, Sachweh JS, Goetzenich A, Schmitz-Rode T, Steinseifer U, Vazquez-Jimenez JF. Expression of inflammation in myocardial tissue of rabbits: comparison of two miniaturized heart-lung machines. Artif Organs 2013; 37:541-8. [PMID: 23578310 DOI: 10.1111/aor.12025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The majority of cases involving the surgical treatment of congenital heart disease require implementation of cardiopulmonary bypass (CPB). However, neonates and infants are particularly prone to serious complications associated with CPB as a result of capillary leak due to cardiovascular failure. These complications are related to the transfusion of foreign blood, the disproportionately large area of contact between the patient's blood and foreign material, as well as the systemic inflammatory response induced by hemolysis. To attenuate these risks, we developed a novel, highly integrative, miniaturized heart-lung machine (MiniHLM) with a static priming volume of only 102 mL. This prototype was tested in comparison with a conventional heart-lung machine (static priming volume 213 mL) using a rabbit animal model. The animals were anesthetized, sternotomized, and connected to CBP via the aorta and right atrium. The aorta was cross-clamped for 1 h. Blood samples for examination were taken at regular intervals. Biopsies of the right atrial appendage (RAA) were removed directly after initiation and after cessation of CPB. After gradual reduction of perfusion with the HLM, all rabbits were successfully weaned from CPB, and the sternum was closed. Foreign blood was not administered in all cases. After cryopreservation of the RAA tissue, de novo transcription of inflammatory cytokines was measured by means of real-time polymerase chain reaction using the comparative CT method. No significant differences in the expression of the inflammatory parameters of the myocardial tissue samples were found between the study groups.
Collapse
Affiliation(s)
- Heike Schnoering
- Department of Pediatric Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Schnoering H, Arens J, Detering SM, Stopinski T, Kuschel TJ, Tolba R, Steinseifer U, Vazquez-Jimenez JF. Development of a Rabbit Animal Model for Miniaturized Heart–Lung Machines. ASAIO J 2013; 59:152-6. [DOI: 10.1097/mat.0b013e3182857990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Undar A, Wang S, Krawiec C. Impact of a unique international conference on pediatric mechanical circulatory support and pediatric cardiopulmonary perfusion research. Artif Organs 2012; 36:943-50. [PMID: 23121202 DOI: 10.1111/j.1525-1594.2012.01563.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is no question that the International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion is a unique event that has had a significant impact on the treatment of neonatal, infantile, and pediatric cardiopulmonary patients around the globe since 2005. This annual event will continue as long as there is a need to fill the gap for underserved patient population. It will also continue to recognize promising young investigators based on their full manuscripts for young investigator awards.
Collapse
|
8
|
In Vitro Performance Testing of a Pediatric Oxygenator With an Integrated Pulsatile Pump. ASAIO J 2012; 58:420-5. [DOI: 10.1097/mat.0b013e318251dc70] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
Schoberer M, Arens J, Lohr A, Seehase M, Jellema RK, Collins JJ, Kramer BW, Schmitz-Rode T, Steinseifer U, Orlikowsky T. Fifty years of work on the artificial placenta: milestones in the history of extracorporeal support of the premature newborn. Artif Organs 2012; 36:512-6. [PMID: 22309513 DOI: 10.1111/j.1525-1594.2011.01404.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The concept of an artificial placenta has been pursued in experimental research since the early 1960s. The principle has yet to be successfully implemented in neonatal care despite the constant evolution in extracorporeal life support technology and advancements in neonatal intensive care in general. For more than three decades, the physical dimensions of the required equipment necessitated pump-driven circuits; however, recent advances in oxygenator technology have allowed exploration of the simpler and physiologically preferable concept of pumpless arteriovenous oxygenation. We expect that further miniaturization of the extracorporeal circuit will allow the implementation of the concept into clinical application as an assist device. To this end, NeonatOx (Fig. 1), a custom-made miniaturized oxygenator with a filling volume of 20 mL, designed by our own group, has been successfully implemented with a preterm lamb model of less than 2000 g body weight as an assist device. We provide an overview of milestones in the history of extracorporeal membrane oxygenation of the preterm newborn juxtaposed against current and future technological advancements. Key limitations, which need to be addressed in order to make mechanical gas exchange a clinical treatment option of prematurity-related lung failure, are also identified.
Collapse
Affiliation(s)
- Mark Schoberer
- Neonatology Section of the Department of Paediatric and Adolescent Medicine, University Hospital, RWTH Aachen, Pauwelsstrasse 30, Aachen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.
Collapse
|