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Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Shahandashti FJ, Asadian S, Habibi N, Gorjipour F, Jalali A, Toloueitabar Y. Pulsatile versus non-pulsatile perfusion in coronary artery bypass operation: The comparison of laboratory and clinical outcomes. Perfusion 2022:2676591221096224. [PMID: 35536726 DOI: 10.1177/02676591221096224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The superiority of pulsatile or non-pulsatile perfusion in cardiopulmonary bypass (CPB) regarding morbidity and mortality is still debated. Therefore, we aimed to investigate the effect of different pulse rates in pulsatile perfusion in patients undergoing coronary artery bypass graft (CABG) and compared it with non-pulsatile perfusion. MATERIALS AND METHODS In this randomized clinical trial, 90 patients who were all candidates for CABG under CPB were enrolled. Patients in groups A and B received pulsatile perfusion with 30 and 70 pulses per minute, and group C received non-pulsatile perfusion. The biochemical and clinical parameters in the ICU were evaluated in the study groups. RESULTS There was no statistically significant difference between patients' clinical outcomes and kidney and liver function markers (all Ps> 0.05). Mean serum lactate level increased but did not show a statistically significant difference between the study groups (p = 0.8). The mean urine volume at 12 and 24 h after surgery was higher in group A, but there was no statistically significant difference between the three groups during the study period (p = 0.3). No significant difference was found in the length of the ICU stay between the study groups (p = 0.2). CONCLUSION Our studied parameters demonstrated no significant difference between pulsatile and non-pulsatile and between 30 and 70 pulse rate pulsatile perfusion methods. Our findings support that pulsatile perfusion with different pulse rates has no advantages over non-pulsatile perfusion in selected CABG cases.
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Affiliation(s)
- Farshad Jalili Shahandashti
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Asadian
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Neda Habibi
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Gorjipour
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Jalali
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Toloueitabar
- Iranian Scientific Society Of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
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Moosaeifar S, Mousavizadeh M, Najafi Ghezeljeh T, Hosseinian A, Babaee T, Hosseini S, Mestres CA. The effect of pulsatile versus non-pulsatile flow during cardiopulmonary bypass on cerebral oxygenation: A randomized trial. Asian Cardiovasc Thorac Ann 2021; 30:441-448. [PMID: 34904903 DOI: 10.1177/02184923211045915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aims to compare regional oxygen supply determined by Near-Infrared Spectroscopy in the course of pulsatile perfusion with non-pulsatile perfusion during cardiopulmonary bypass in patients undergoing valvular heart surgery. METHODS In this prospective randomized single-blinded trial, we enrolled adult subjects aged 18-65 years scheduled for elective valvular heart repair/replacement surgery with non-stenotic carotid arteries, employing a consecutive sampling method. Eligible patients were then randomly assigned in a 1:1 ratio to pulsatile or non-pulsatile perfusion during aortic cross-clamp. The primary outcome was regional cerebral oxygenation monitored by Near-Infrared Spectroscopy in each group. RESULTS Seventy patients were randomly assigned, and each group comprised 35 patients. Mean age was 46.8 and 46.5 years in pulsatile and non-pulsatile groups, respectively. There were no significant between-group differences in regional cerebral oxygen saturation at different time points of cardiopulmonary bypass (p-value for analysis of variance repeated measures: 0.923 and 0.223 for left and right hemispheres, respectively). Moreover, no significant differences in regional cerebral oxygen saturation levels from baseline between pulsatile and non-pulsatile groups at all desired time points for the left (p = 0.51) and right (p = 0.22) hemispheres of the brain were detected. CONCLUSION Pulsatile perfusion during cardiopulmonary bypass does not offer superior regional cerebral oxygenation measured by Near-Infrared Spectroscopy than non-pulsatile perfusion during cardiopulmonary bypass. Nonetheless, the efficacy of pulsatile flow in the subgroup of patients in whom cerebral blood flow is impaired due to carotid artery stenosis needs to be explored and evaluated by this method in future studies.
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Affiliation(s)
- Samira Moosaeifar
- Department of Critical Care Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mousavizadeh
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Center for Nursing Care Research, Department of Critical Care Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Hosseinian
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Touraj Babaee
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Carlos-A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
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Miyamoto T, Sunagawa G, Dessoffy R, Karimov JH, Grady P, Naber JP, Vincent D, Sale SM, Kvernebo K, Tran VNP, Moazami N, Fukamachi K. Hemodynamic evaluation of a new pulsatile blood pump during low flow cardiopulmonary bypass support. Artif Organs 2021; 46:643-652. [PMID: 34780074 DOI: 10.1111/aor.14119] [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: 04/13/2021] [Revised: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The VentriFlo® True Pulse Pump (VentriFlo, Inc, Pelham, NH, USA) is a new pulsatile blood pump intended for use during short-term circulatory support. The purpose of this study was to evaluate the feasibility of the VentriFlo and compare it to a conventional centrifugal pump (ROTAFLOW, Getinge, Gothenberg, Sweden) in acute pig experiments. METHODS Pigs (40-45 kg) were supported by cardiopulmonary bypass (CPB) with the VentriFlo (n = 9) or ROTAFLOW (n = 5) for 6 h. Both VentriFlo and ROTAFLOW circuits utilized standard CPB components. We evaluated hemodynamics, blood chemistry, gas analysis, plasma hemoglobin, and microcirculation at the groin skin with computer-assisted video microscopy (Optilia, Sollentuna, Sweden). RESULTS Pigs were successfully supported by CPB for 6 h without any pump-related complications in either group. The VentriFlo delivered an average stroke volume of 29.2 ± 4.8 ml. VentriFlo delivered significantly higher pulse pressure (29.1 ± 7.2 mm Hg vs. 4.4 ± 7.0 mm Hg, p < 0.01) as measured in the carotid artery, with mean aortic pressure and pump flow comparable with those in ROTAFLOW. In blood gas analysis, arterial pH was significantly lower after five hours support in the VentriFlo group (7.30 ± 0.07 vs. 7.43 ± 0.03, p = 0.001). There was no significant difference in plasma hemoglobin level in both groups after six hours of CPB support. In microcirculatory assessment, VentriFlo tended to keep normal capillary flow, but it was not statistically significant. CONCLUSIONS VentriFlo-supported pigs showed comparable hemodynamic parameters with significantly higher pulse pressure compared to ROTAFLOW without hemolysis.
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Affiliation(s)
- Takuma Miyamoto
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gengo Sunagawa
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raymond Dessoffy
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamshid H Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Grady
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Shiva M Sale
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Knut Kvernebo
- Department of Cardio-thoracic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Van N P Tran
- Department of Cardio-thoracic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Nader Moazami
- Department of Cardiothoracic surgery, New York University's Langone Health, New York, New York, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Sunagawa G, Koprivanac M, Karimov JH, Moazami N, Fukamachi K. Is a pulse absolutely necessary during cardiopulmonary bypass? Expert Rev Med Devices 2016; 14:27-35. [DOI: 10.1080/17434440.2017.1265445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Gengo Sunagawa
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nader Moazami
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Wang S, Krawiec C, Patel S, Kunselman AR, Song J, Lei F, Baer LD, Ündar A. Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems. Artif Organs 2015; 39:774-81. [DOI: 10.1111/aor.12466] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shigang Wang
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Conrad Krawiec
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Pediatric Critical Care Unit; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Sunil Patel
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Pediatric Cardiology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health Sciences; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jianxun Song
- Department of Microbiology & Immunology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Fengyang Lei
- Department of Microbiology & Immunology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Larry D. Baer
- Heart and Vascular Institute; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Surgery and Bioengineering; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
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Örmeci T, Alkan-Bozkaya T, Özyüksel A, Ersoy C, Ündar A, Akçevin A, Türkoğlu H. Correlation Between Cerebral-Renal Near-Infrared Spectroscopy and Ipsilateral Renal Perfusion Parameters as Clinical Outcome Predictors After Open Heart Surgery in Neonates and Infants. Artif Organs 2015; 39:53-8. [DOI: 10.1111/aor.12455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tuğrul Örmeci
- Department of Radiology; Istanbul Medipol University; Istanbul Turkey
| | - Tijen Alkan-Bozkaya
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Arda Özyüksel
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Cihangir Ersoy
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Akif Ündar
- Department of Pediatrics, Surgery & Bioengineering; Penn State Hershey College of Medicine; Hershey PA USA
| | - Atıf Akçevin
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
| | - Halil Türkoğlu
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul Turkey
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Caluk S, Caluk J, Osmanovic E. Nonthyroidal illness syndrome in off-pump coronary artery bypass surger. Anatol J Cardiol 2015; 15:836-42. [PMID: 25592105 PMCID: PMC5336971 DOI: 10.5152/akd.2014.5732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Non-thyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or 'beating-heart surgery.' The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS. METHODS Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery. RESULTS The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values. CONCLUSION NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.
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Affiliation(s)
- Selma Caluk
- Department of Nuclear Medicine, University Clinical Center Tuzla, Tuzla-Bosna-Herzeg.
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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.
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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
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Lim CH, Nam MJ, Lee JS, Kim HJ, Kim JY, Shin HW, Lee HW, Sun K. A Meta-Analysis of Pulmonary Function With Pulsatile Perfusion in Cardiac Surgery. Artif Organs 2014; 39:110-7. [DOI: 10.1111/aor.12312] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Choon-Hak Lim
- Department of Anesthesiology and Pain Medicine; Korea University Medical Center; Seoul Korea
| | - Myung-Ji Nam
- College of Medicine; Korea University; Seoul Korea
| | - Ji-Sung Lee
- Biostatistical Consulting Unit; Soonchunhyang University Medical Center; Seoul Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine; College of Medicine; Korea University; Seoul Korea
| | - Ji-Yeon Kim
- Department of Anesthesiology and Pain Medicine; Ilsan Paik Hospital; Inje University; Seoul Korea
| | - Hye-Won Shin
- Department of Anesthesiology and Pain Medicine; Korea University Medical Center; Seoul Korea
| | - Hye-Won Lee
- Department of Anesthesiology and Pain Medicine; Korea University Medical Center; Seoul Korea
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery; Korea University Medical Center; Seoul Korea
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Wang S, Evenson A, Chin BJ, Kunselman AR, Ündar A. Evaluation of Conventional Nonpulsatile and Novel Pulsatile Extracorporeal Life Support Systems in a Simulated Pediatric Extracorporeal Life Support Model. Artif Organs 2014; 39:E1-9. [DOI: 10.1111/aor.12290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shigang Wang
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Alissa Evenson
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Brian J. Chin
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health Sciences; Penn State Hershey College of Medicine; Hershey PA USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Bioengineering; College of Engineering; Pennsylvania State University; University Park PA USA
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Evenson A, Wang S, Kunselman AR, Ündar A. Use of a Novel Diagonal Pump in an In Vitro Neonatal Pulsatile Extracorporeal Life Support Circuit. Artif Organs 2013; 38:E1-9. [DOI: 10.1111/aor.12240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alissa Evenson
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Shigang Wang
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health Sciences; Penn State Hershey College of Medicine; Hershey PA USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Bioengineering; College of Engineering; Pennsylvania State University; University Park PA USA
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Aĝirbaşli M, Ündar A. Monitoring Biomarkers After Pediatric Heart Surgery: A New Paradigm on the Horizon. Artif Organs 2013; 37:10-5. [DOI: 10.1111/j.1525-1594.2012.01573.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang S, Durandy Y, Kunselman AR, Ündar A. A Nonocclusive, Inexpensive Pediatric Pulsatile Roller Pump for Cardiopulmonary Bypass, Extracorporeal Life Support, and Left/Right Ventricular Assist Systems. Artif Organs 2013; 37:48-56. [DOI: 10.1111/aor.12026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics, 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
| | - Yves Durandy
- Institut Cardiovasculaire Paris-Sud; Massy; France
| | - Allen R. Kunselman
- Public Health and Sciences; 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, 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
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Alkan-Bozkaya T, Akçevin A, Türkoğlu H, Ündar A. Impact of Pulsatile Perfusion on Clinical Outcomes of Neonates and Infants With Complex Pathologies Undergoing Cardiopulmonary Bypass Procedures. Artif Organs 2012; 37:82-6. [DOI: 10.1111/j.1525-1594.2012.01552.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tijen Alkan-Bozkaya
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul; Turkey
| | - Atıf Akçevin
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul; Turkey
| | - Halil Türkoğlu
- Department of Cardiovascular Surgery; Istanbul Medipol University; Istanbul; Turkey
| | - Akif Ündar
- Departments of Pediatrics, Surgery and Bioengineering; Penn State Hershey College of Medicine, Pediatric Cardiovascular Research Center; Hershey; PA; USA
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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.
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Karaci AR, Sasmazel A, Aydemir NA, Saritas T, Harmandar B, Tuncel Z, Undar A. Comparison of parameters for detection of splanchnic hypoxia in children undergoing cardiopulmonary bypass with pulsatile versus nonpulsatile normothermia or hypothermia during congenital heart surgeries. Artif Organs 2012; 35:1010-7. [PMID: 22097978 DOI: 10.1111/j.1525-1594.2011.01378.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study is to evaluate gastric mucosal oxygenation together with whole-body oxygen changes in infants undergoing congenital heart surgery with cardiopulmonary bypass (CPB) procedure and the use of either pulsatile or nonpulsatile mode of perfusion with normothermia and pulsatile or nonpulsatile moderate hypothermia. Sixty infants undergoing congenital cardiac surgery were randomized into four groups as: nonpulsatile normothermia CPB (NNCPB, n = 15), pulsatile normothermia CPB (PNCPB, n = 15), nonpulsatile moderate hypothermia CPB (NHCPB, n = 15), and pulsatile moderate hypothermia CPB (PHCPB, n = 15) groups. In NNCPB and PNCPB groups, mild hypothermia was used (35°C), whereas in NHCPB and PHCPB groups, moderate hypothermia (28°C) was used. Gastric intramucosal pH (pHi), whole-body oxygen delivery (DO(2)) and consumption (VO(2)), and whole-body oxygen extraction fraction were measured at sequential time points intraoperatively and up to 2 h postoperatively. The measurement of continuous tonometry data was collected at desired intervals. The values of DO(2), VO(2), and whole-body oxygen extraction fraction were not different between groups before CPB and during CPB, whereas the PNCPB group showed higher values of DO(2), VO(2), and whole-body oxygen extraction fraction compared to the other groups at the measurement levels of 20 and 60 min after aortic cross clamp, end of CPB, and 2 h after CPB (P < 0.0001). Between groups, no difference was observed for pHi, lactate, and cardiac index values (P > 0.05). This study shows that the use of normothermic pulsatile perfusion (35°C) provides better gastric mucosal oxygenation as compared to other perfusion strategies in neonates and infants undergoing congenital heart surgery with CPB procedures.
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Affiliation(s)
- Ali Riza Karaci
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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De Buysscher P, Moerman A, Bové T, De Pauw M, Wouters P, De Hert S. Value of cerebral oxygen saturation monitoring during cardiopulmonary bypass in an adult patient with moyamoya disease. J Cardiothorac Vasc Anesth 2011; 27:740-3. [PMID: 22209176 DOI: 10.1053/j.jvca.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Indexed: 11/11/2022]
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Ündar A, Haydin S, Yivli P, Weaver B, Pauliks L, Cicek AE, Erek E, Saşmazel A, Ağirbaşli MA, Alkan-Bozkaya T, Akçevin A, Bakir I. Istanbul Symposiums on Pediatric Extracorporeal Life Support Systems. Artif Organs 2011; 35:983-8. [DOI: 10.1111/j.1525-1594.2011.01368.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Ündar A, Palanzo D, Qiu F, Alkan-Bozkaya T, Akcevin A, Talor J, Baer L, Woitas K, Wise R, McCoach R, Guan Y, Haines N, Wang S, Clark JB, Myers JL. Benefits of pulsatile flow in pediatric cardiopulmonary bypass procedures: from conception to conduction. Perfusion 2011; 26 Suppl 1:35-9. [DOI: 10.1177/0267659111404468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review on the benefits of pulsatile flow includes not only experimental and clinical data, but also attempts to further illuminate the major factors as to why this debate has continued during the past 55 years. Every single component of the cardiopulmonary bypass (CPB) circuitry is equally important for generating adequate quality of pulsatility, not only the pump. Therefore, translational research is a necessity to select the best components for the circuit. Generation of pulsatile flow depends on an energy gradient; precise quantification in terms of hemodynamic energy levels is, therefore, a necessity, not an option. Comparisons between perfusion modes should be done after these basic steps have been taken. We have also included experimental and clinical data for direct comparisons between the perfusion modes. In addition, we included several suggestions for future clinical trials for other interested investigators.
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Affiliation(s)
| | | | - F Qiu
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - T Alkan-Bozkaya
- Dept. of Cardiovascular Surgery, American Hospital, Istanbul, Turkey
| | - A Akcevin
- Dept. of Cardiovascular Surgery, American Hospital, Istanbul, Turkey
| | - J Talor
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - L Baer
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - K Woitas
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - R Wise
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - R McCoach
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - Y Guan
- Dept. of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | - N Haines
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - S Wang
- Dept. of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | - J B Clark
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
| | - J L Myers
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania, USA
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21
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Su XW, Guan Y, Barnes M, Clark JB, Myers JL, Undar A. Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass. Pediatr Res 2011; 70:181-5. [PMID: 21544006 DOI: 10.1203/pdr.0b013e3182226b75] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO2) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n = 77) or nonpulsatile (n = 34) perfusion. No significant differences in demographic and intraoperative data, including surgical risk stratification, existed between groups. Patients undergoing pulsatile perfusion had numerically lower decreases in rSO2 from baseline for all time points analyzed compared with the nonpulsatile group, with significant ∼12% lower decreases at 40 and 60 min after crossclamp. Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ∼30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes.
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Affiliation(s)
- Xiaowei W Su
- Department of Pediatrics, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania 17033, USA
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22
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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.
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Qiu F, Talor J, Zahn J, Pauliks L, Kunselman AR, Palanzo D, Baer L, Woitas K, Wise R, McCoach R, Weaver B, Carney E, Haines N, Uluer MC, Aran K, Sasso LA, Alkan-Bozkaya T, Akcevin A, Guan Y, Wang S, Aĝirbaşli M, Clark JB, Myers JL, Ündar A. Translational Research in Pediatric Extracorporeal Life Support Systems and Cardiopulmonary Bypass Procedures: 2011 Update. World J Pediatr Congenit Heart Surg 2011; 2:476-81. [DOI: 10.1177/2150135111402226] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over the past 6 years at Penn State Hershey, we have established the pediatric cardiovascular research center with a multidisciplinary research team with the goal to improve the outcomes for children undergoing cardiac surgery with cardiopulmonary bypass (CPB) and extracorporeal life support (ECLS). Due to the variety of commercially available pediatric CPB and ECLS devices, both in vitro and in vivo translational research have been conducted to achieve the optimal choice for our patients. By now, every component being used in our clinical settings in Penn State Hershey has been selected based on the results of our translational research. The objective of this review is to summarize our translational research in Penn State Hershey Pediatric Cardiovascular Research Center and to share the latest results with all the interested centers.
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Affiliation(s)
- Feng Qiu
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Jonathan Talor
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Jeffrey Zahn
- Department of Bioengineering, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Linda Pauliks
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Allen R. Kunselman
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - David Palanzo
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Larry Baer
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Karl Woitas
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Robert Wise
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Robert McCoach
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Bonnie Weaver
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Elizabeth Carney
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Nikkole Haines
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Mehmet C. Uluer
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Kiana Aran
- Department of Bioengineering, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Lawrance A. Sasso
- Department of Bioengineering, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | | - Atif Akcevin
- Department of Cardiovascular Surgery, American Hospital, Istanbul, Turkey
| | - Yulong Guan
- Department of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | - Shigang Wang
- Department of Cardiopulmonary Bypass, The Fuwai Hospital, Beijing, China
| | | | - J. Brian Clark
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - John L. Myers
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, Bioengineering, Public Health Sciences, and Comparative Medicine, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
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24
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Abstract
This current review describes how components of the cardiopulmonary bypass (CPB) circuit are selected and examines the benefits of pulsatile perfusion for use during CPB. Pulsatile flow generates significantly greater surplus hemodynamic energy (SHE) than nonpulsatile flow; higher SHE values have been associated with better microcirculation perfusion, lower rates of systemic inflammatory response, and better vital organ protection. Pulsatile perfusion may have a positive effect on clinical outcomes, play a role in preserving homeostasis, and help to decrease morbidity associated with CPB.
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Affiliation(s)
- Jonathan J. Talor
- Penn State Hershey Pediatric Cardiovascular Research Center and Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Children’s Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center and Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Children’s Hospital, Hershey, PA, USA
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