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Paternoster G, Scolletta S. Con: Pulsatile Flow During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2023; 37:2374-2377. [PMID: 37558557 DOI: 10.1053/j.jvca.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Gianluca Paternoster
- Department of Cardiovascular Anesthesia and ICU, San Carlo Hospital, Potenza Italy.
| | - Sabino Scolletta
- Department of Emergency and Organ Transplant, University of Siena, Siena, Italy
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Wahba A, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Puis L. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2021; 57:210-251. [PMID: 31576396 DOI: 10.1093/ejcts/ezz267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
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Puis L, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Wahba A. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Interact Cardiovasc Thorac Surg 2020; 30:161-202. [PMID: 31576402 PMCID: PMC10634377 DOI: 10.1093/icvts/ivz251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Kunst G, Milojevic M, Boer C, De Somer FM, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Puis L, Wahba A, Alston P, Fitzgerald D, Nikolic A, Onorati F, Rasmussen BS, Svenmarker S. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth 2019; 123:713-757. [DOI: 10.1016/j.bja.2019.09.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Fiore G, Pennati G, Inzoli F, Mastrantonio F, Galavotti D. Effects of Blood Flow Pulse Frequency on Mass Transfer Efficiency of a Commercial Hollow Fibre Oxygenator. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical advantages achievable through pulsatile blood perfusion during cardio-pulmonary bypass have recently suggested the design of new pulsatile systems for extracorporeal circulation. Still it is not clear whether current commercial membrane oxygenators could be adopted with such systems, since their behaviour with pulsatile perfusion has not been satisfactorily documented yet. In a previous paper, we assessed that pulsatile perfusion of a widely used hollow fibre oxygenator (Sorin® Monolyth) at 60 bpm provides more time-consistent oxygen transfer than steady perfusion. The present work is aimed to evaluate how the pulse frequency influences the gas transfer performance of the same device. The oxygenator was subjected to in vitro trials using a roller pump with pulsatile module (Stöckert Instrumente®) to generate pulsed flow. Four different pulse frequencies (45, 60, 75 and 90 bpm) were investigated at a fixed blood flow rate (4.0 l/min). The experiments lasting six hours were carried out using bovine blood with inlet conditions according to AAMI standards requirements. Blood samples were withdrawn every hour and O2 and CO2 transfer rates were evaluated. The experimental findings confirm that with pulsatile blood flow no time decay take place during prolonged perfusion. Moreover, when pulse frequency increases, transition levels occur for both O2 and CO2. Over these thresholds gas transfer rates display significant increases (p < 0.05), though of little magnitude (up to 2.5% for oxygen over 60 bpm; up to 3.7% for carbon dioxide over 75 bpm).
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Affiliation(s)
- G.B. Fiore
- Dipartimento di Bioingegneria, Politecnico di Milano, and CeBITeC, Politecnico di Milano and IRCCS San Raffaele, Milano
| | - G. Pennati
- Dipartimento di Bioingegneria, Politecnico di Milano, and CeBITeC, Politecnico di Milano and IRCCS San Raffaele, Milano
| | - F. Inzoli
- Dipartimento di Energetica, Politecnico di Milano, and CeBITeC, Politecnico di Milano and IRCCS San Raffaele, Milano
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6
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Inzoli F, Pennati G, Mastrantonio F, Fini M. Influence of Membrane Oxygenators on the Pulsatile flow in Extracorporeal Circuits: An Experimental Analysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An experimental analysis was carried out to evaluate the effects induced by two typical extracorporeal circuits on the pressure and flow generated by a roller pump with a pulsatile module. The hydraulic behaviour of the patient was simulated by means of a mechanical mock-up system consisting of a few lumped parameters reproducing the physiologic vascular impedance. Pressure and flow tracings were acquired at different locations along the circuit using an automatic data acquisition system. Nine test conditions with different pulse frequency and systolic time values were examined using a mean volumetric flow rate of approximately 4 l/min. A complete analysis of the results obtained in terms of pressure drops and inflow-outflow differences across the components of the arterial line, as well as the calculation of the hydraulic pulsatile power along the circuit, allowed us to assess the influence of the various components upon the pulsatility. The results indicated that the membrane oxygenators tested slightly affect the pulsatility of the flow and the pressure; on the contrary the arterial pipe line is responsible for large damping and head losses. To optimize the use of pulsatile flow for cardiopulmonary bypass it is necessary to reduce the length of the arterial pipe lines thus integrating the circuit as much as possible.
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Affiliation(s)
- F. Inzoli
- Dept. of Energetics, Politecnico di Milano, and CeBITeC, Politecnico di Milano and IRCCS San Raffaele, Milano
| | - G. Pennati
- Dept. of Bioengineering, Politecnico di Milano, and CeBITeC, Politecnico di Milano and IRCCS San Raffaele, Milano
| | | | - M. Fini
- Dideco S.p.a., Mirandola (Modena) - Italy
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7
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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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8
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Valeri CR, MacGregor H, Ragno G, Healey N, Fonger J, Khuri SF. Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery. Perfusion 2016; 21:291-6. [PMID: 17201084 DOI: 10.1177/0267659106073976] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Either a roller pump or a centrifugal pump can be used in the extracorporeal circuit during surgery with cardiopulmonary bypass. In this study, we assessed the effect of these two pumps on the 24-h post–transfusion survival values of autologous red blood cells (RBC). Study design and methods: Fourteen male patients subjected to extracorporeal bypass procedures were studied. In seven patients, the autologous red cells were collected following the cardiopulmonary bypass procedure using the roller pump, and in seven patients, autologous red cells were collected following the cardiopulmonary procedure using the centrifugal pump. The 24-h post–transfusion survival values of the autologous RBC were measured using the 51 disodium chromate/99m technetium double isotope procedure. The effects of the extracorporeal bypass procedures using the roller pump and the centrifugal pump were also assessed by the measurements of hematocrit, platelet count, plasma hemoglobin, and serum lactate dehydrogenase levels. Results: The 51 disodium chromate 24-h post–transfusion survival values of the autologous RBC were similar whether the roller pump or the centrifugal pump was used in the extracorporeal circulation, as were the hematocrit, platelet count, plasma hemoglobin and serum lactate dehydrogenase levels. Conclusion: The 24-h post–transfusion survival values of autologous RBC, measured by the 51 disodium chromate/99m technetium double isotope procedure, were not significantly different, whether the roller pump or the centrifugal pump was used in the extracorporeal circuit using membrane oxygenators during cardiopulmonary surgical procedures.
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Affiliation(s)
- C R Valeri
- Naval Blood Research Laboratory, Boston, MA 02360, USA.
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Hauffe T, Krüger B, Bettex D, Rudiger A. Shock Management for Cardio-surgical ICU Patients - The Golden Hours. Card Fail Rev 2015; 1:75-82. [PMID: 28785436 PMCID: PMC5490875 DOI: 10.15420/cfr.2015.1.2.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/22/2015] [Indexed: 12/14/2022] Open
Abstract
Postoperative shock following cardiac surgery is a serious condition with a high morbidity and mortality. There are four types of shock: cardiogenic, hypovolemic, obstructive and distributive and these can occur alone or in combination. Early identification of the underlying diseases and understanding of the mechanisms at play are key for successful management of shock. Prompt resuscitation measures are necessary to reverse the shock state and avoid permanent organ dysfunction or death. In this review, the authors focus on the management during the first 6 hours of shock (the 'golden hours'). They discuss how to optimise preload, vascular tone, contractility, heart rate and oxygen delivery. The review incorporates the findings of recent trials on early goal-directed therapy and includes practical recommendations in areas in which the evidence is scare or controversial. While the review focuses on cardio-surgical patients, the suggested treatment algorithms might be usefully expanded to other critically ill patients with shock arising from other causes.
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Affiliation(s)
- Till Hauffe
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich,Zurich, Switzerland
| | - Bernard Krüger
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich,Zurich, Switzerland
| | - Dominique Bettex
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich,Zurich, Switzerland
| | - Alain Rudiger
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich,Zurich, Switzerland
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Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care. Crit Care Med 2015; 43:1477-97. [PMID: 25962078 DOI: 10.1097/ccm.0000000000001059] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac surgery, including coronary artery bypass, cardiac valve, and aortic procedures, is among the most common surgical procedures performed in the United States. Successful outcomes after cardiac surgery depend on optimum postoperative critical care. The cardiac intensivist must have a comprehensive understanding of cardiopulmonary physiology and the sequelae of cardiopulmonary bypass. In this concise review, targeted at intensivists and surgeons, we discuss the routine management of the postoperative cardiac surgical patient. DATA SOURCE AND SYNTHESIS Narrative review of relevant English-language peer-reviewed medical literature. CONCLUSIONS Critical care of the cardiac surgical patient is a complex and dynamic endeavor. Adequate fluid resuscitation, appropriate inotropic support, attention to rewarming, and ventilator management are key components. Patient safety is enhanced by experienced personnel, a structured handover between the operating room and ICU teams, and appropriate transfusion strategies.
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11
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Biomarkers of lung injury in cardiothoracic surgery. DISEASE MARKERS 2015; 2015:472360. [PMID: 25866435 PMCID: PMC4381722 DOI: 10.1155/2015/472360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/02/2015] [Indexed: 01/18/2023]
Abstract
Diagnosis of pulmonary dysfunction is currently almost entirely based on a vast series of physiological changes, but comprehensive research is focused on determining biomarkers for early diagnosis of pulmonary dysfunction. Here we discuss the use of biomarkers of lung injury in cardiothoracic surgery and their ability to detect subtle pulmonary dysfunction in the perioperative period. Degranulation products of neutrophils are often used as biomarker since they have detrimental effects on the pulmonary tissue by themselves. However, these substances are not lung specific. Lung epithelium specific proteins offer more specificity and slowly find their way into clinical studies.
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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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13
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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Jung JS, Son KH, Ahn CB, Lee JJ, Son HS, Sun K. Analysis of pulsatile and nonpulsatile blood flow effects in different degrees of stenotic vasculature. Artif Organs 2011; 35:1118-23. [PMID: 22023148 DOI: 10.1111/j.1525-1594.2011.01361.x] [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
Vessel lumens that have been chronically narrowed by atherosclerosis should be increased in flow velocity and intrastenotic area pressure to maintain an equal flow. This might be followed by a decrease in hemodynamic energy, leading to a reduction of tissue perfusion. In this study, we compared hemodynamic energies according to degrees of stenotic vasculature between pulsatile flow and nonpulsatile flow. Cannuale with 25, 50, and 75% diameter stenosis (DS) were located at the outlet cannula. Using the Korea Hybrid ventricular assist device (KH-VAD) (pulsatile pump: group A) and Biopump (nonpulsatile pump: group B), constant flow of 2 L/min was maintained then real-time flow and velocity in the proximal and distal part of the stenotic cannula were measured. The hemodynamic energies of two groups were compared. At 75% DS, proximal energy equivalent pressure (EEP) delivered to the distal end was only 41.9% (group A) and 42.5% (group B). As the percent EEP fell below 10%, pulsatility disappeared from the 50% stenosis in group A. The surplus hemodynamic energy (SHE) of group B at all degrees of stenosis must have been 0, which was also the case of group A at 75% stenosis. This research evaluated the hemodynamic energy on various degrees of DS in both pulsatile and nonpulsatile flow with mock system. Using a pulsatile pump, pulsatility disappeared above 50% DS while hemodynamic energy was maintained. Therefore, our results suggest that pulsatile flow has a better effect than nonpulsatile flow in reserving hemodynamic energy after stenotic lesion.
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Affiliation(s)
- Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
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15
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Gu YJ, van Oeveren W, Mungroop HE, Epema AH, den Hamer IJ, Keizer JJ, Leuvenink RP, Mariani MA, Rakhorst G. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery. Artif Organs 2011; 35:E18-26. [PMID: 21314839 DOI: 10.1111/j.1525-1594.2010.01152.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P < 0.01) and a fraction higher energy equivalent pressure (EEP, P = 0.058). The net gain of pulsatile flow, represented by the surplus hemodynamic energy (SHE), was found much higher in the CPB circuit than in patients (P < 0.01). Clinically, there was no difference between the pulsatile and nonpulsatile groups with regard to postoperative acute kidney injury, endothelial activation, or inflammatory response. Postoperative organ function and the duration of hospital stay were similar in the two patient groups. In conclusion, pulsatile CPB with the Rotaflow centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.
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Affiliation(s)
- Y John Gu
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, The Netherlands.
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16
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Murphy GS, Hessel EA, Groom RC. Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach. Anesth Analg 2009; 108:1394-417. [DOI: 10.1213/ane.0b013e3181875e2e] [Citation(s) in RCA: 233] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Différences microcirculatoires entre CEC pulsée et non pulsée. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Matot I, Weiniger CF, Zeira E, Galun E, Joshi BV, Jacobson KA. A3 adenosine receptors and mitogen-activated protein kinases in lung injury following in vivo reperfusion. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R65. [PMID: 16623960 PMCID: PMC1550918 DOI: 10.1186/cc4893] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Revised: 03/06/2006] [Accepted: 03/15/2006] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although activation of A3 adenosine receptors attenuates reperfusion lung injury and associated apoptosis, the signaling pathway that mediates this protection remains unclear. Adenosine agonists activate mitogen-activated protein kinases, and these kinases have been implicated in ischemia/reperfusion injury; the purpose of this study was therefore to determine whether A3 adenosine receptor stimulation with reperfusion modulates expression of the different mitogen-activated protein kinases. In addition, we compared the effect of the A3 adenosine agonist IB-MECA with the newly synthesized, highly selective A3 adenosine receptor agonist MRS3558 on injury in reperfused lung. METHOD Studies were performed in an in vivo spontaneously breathing cat model, in which the left lower lobe of the lung was isolated and subjected to 2 hours of ischemia and 3 hours of reperfusion. The selective A3 adenosine receptor agonists IB-MECA (0.05 mg/kg, 0.1 mg/kg, or 0.3 mg/kg) and MRS3558 (0.05 mg/kg or 0.1 mg/kg) were administered before reperfusion. RESULTS Both A3 adenosine receptor agonists administered before reperfusion markedly (P < 0.01) attenuated indices of injury and apoptosis, including the percentage of injured alveoli, wet/dry weight ratio, myeloperoxidase activity, TUNEL (in situ TdT-mediated dUTP nick end labeling)-positive cells, and caspase 3 activity and expression. The more pronounced effects at low doses were observed with MRS3558. Increases in phosphorylated c-Jun amino-terminal protein kinase (JNK), p38, and extracellular signal-regulated kinase (ERK)1/2 levels were observed by the end of reperfusion compared with controls. Pretreatment with the A3 agonists upregulated phosphorylated ERK1/2 levels but did not modify phosphorylated JNK and p38 levels. CONCLUSION The protective effects of A3 adenosine receptor activation are mediated in part through upregulation of phosphorylated ERK. Also, MRS3558 was found to be more potent than IB-MECA in attenuating reperfusion lung injury. The results suggest not only that enhancement of the ERK pathway may shift the balance between cell death and survival toward cell survival, but also that A3 agonists have potential as an effective therapy for ischemia/reperfusion-induced lung injury.
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Affiliation(s)
- Idit Matot
- Department of Anesthesiology & Critical Care Medicine, Hadassah University Medical Center, The Hebrew University, Jerusalem, Israel
| | - Carolyn F Weiniger
- Department of Anesthesiology & Critical Care Medicine, Hadassah University Medical Center, The Hebrew University, Jerusalem, Israel
| | - Evelyne Zeira
- Goldyne Savad Institute of Gene Therapy, Hadassah University Medical Center, The Hebrew University, Jerusalem, Israel
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah University Medical Center, The Hebrew University, Jerusalem, Israel
| | - Bhalchandra V Joshi
- Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth A Jacobson
- Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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19
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Hogue CW, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth Analg 2006; 103:21-37. [PMID: 16790619 DOI: 10.1213/01.ane.0000220035.82989.79] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurologic complications after cardiac surgery are of growing importance for an aging surgical population. In this review, we provide a critical appraisal of the impact of current cardiopulmonary bypass (CPB) management strategies on neurologic complications. Other than the use of 20-40 microm arterial line filters and membrane oxygenators, newer modifications of the basic CPB apparatus or the use of specialized equipment or procedures (including hypothermia and "tight" glucose control) have unproven benefit on neurologic outcomes. Epiaortic ultrasound can be considered for ascending aorta manipulations to avoid atheroma, although available clinical trials assessing this maneuver are limited. Current approaches for managing flow, arterial blood pressure, and pH during CPB are supported by data from clinical investigations, but these studies included few elderly or high-risk patients and predated many other contemporary practices. Although there are promising data on the benefits of some drugs blocking excitatory amino acid signaling pathways and inflammation, there are currently no drugs that can be recommended for neuroprotection during CPB. Together, the reviewed data highlight the deficiencies of the current knowledge base that physicians are dependent on to guide patient care during CPB. Multicenter clinical trials assessing measures to reduce the frequency of neurologic complications are needed to develop evidence-based strategies to avoid increasing patient morbidity and mortality.
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Affiliation(s)
- Charles W Hogue
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Medical School, 600 North Wolfe Street, Tower 711, Baltimore, MD 21205, USA.
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Alghamdi AA, Latter DA. Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach. J Card Surg 2006; 21:347-54. [PMID: 16846411 DOI: 10.1111/j.1540-8191.2006.00269.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To derive evidence-based recommendations for the use of pulsatile perfusion (PP) technique for the reduction of mortality and nonfatal complications after elective coronary artery bypass grafting surgery (CABG). OUTCOMES Incidence of total mortality, myocardial infarction (MI), stroke, and renal failure during hospital stay. EVIDENCE Medline, Embase, and the Cochrane controlled trial register (CCTR) on the Cochrane library were searched from the earliest achievable date of each database to March 2005. No language restrictions were applied. Retrieved reprints were evaluated according to a priori inclusion criteria, and those included were critically appraised using established internal validity criteria. BENEFITS AND HARMS: Only one fair quality randomized controlled trial demonstrated the beneficial effect of PP in reducing the incidence of total mortality and MI. No studies demonstrated the beneficial effect of PP in reducing the incidence of stoke or renal failure. One randomized controlled trial demonstrated that PP was associated with increased hemolysis compared to nonpulsatile (NP) perfusion. CONCLUSION The evidence is conflicting and therefore does not support making recommendation for or against routinely providing the PP to reduce the incidence of mortality or MI. The evidence is insufficient to recommend for or against routinely providing the pulsatile profusion to reduce the incidence of stroke or renal failure.
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Affiliation(s)
- Abdullah A Alghamdi
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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21
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Ji B, Undar A. An Evaluation of the Benefits of Pulsatile versus Nonpulsatile Perfusion during Cardiopulmonary Bypass Procedures in Pediatric and Adult Cardiac Patients. ASAIO J 2006; 52:357-61. [PMID: 16883112 DOI: 10.1097/01.mat.0000225266.80021.9b] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The controversy over the benefits of pulsatile and nonpulsatile flow during cardiopulmonary bypass procedures continues. The objective of this investigation was to review the literature in order to clarify the truths and dispel the myths regarding the mode of perfusion used during open-heart surgery in pediatric and adult patients. The Google and Medline databases were used to search all of the literature on pulsatile vs. nonpulsatile perfusion published between 1952 and 2006. We found 194 articles related to this topic in the literature. Based on our literature search, we determined that pulsatile flow significantly improved blood flow of the vital organs including brain, heart, liver, and pancreas; reduced the systemic inflammatory response syndrome; and decreased the incidence of postoperative deaths in pediatric and adult patients. We also found evidence that pulsatile flow significantly improved vital organ recovery in several types of animal models when compared with nonpulsatile perfusion. Several investigators have also shown that pulsatile flow generates more hemodynamic energy, which maintains better microcirculation compared with nonpulsatile flow. These results clearly suggest that pulsatile flow is superior to nonpulsatile flow during and after open-heart surgery in pediatric and adult patients.
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22
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Kocakulak M, Aşkin G, Kuçukaksu S, Tarcan O, Pişkin E. Pulsatile flow improves renal function in high-risk cardiac operations. Blood Purif 2005; 23:263-7. [PMID: 15838160 DOI: 10.1159/000085174] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 01/24/2005] [Indexed: 11/19/2022]
Abstract
The effects of pulsatile perfusion on microcirculation and renal function in high-risk patients were evaluated in this study. Pulsatile roller pumps with a pulsatile control module and membrane oxygenator were used in a clinical setting. 40 patients undergoing elective cardiac surgery with a high risk of either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be perfused using pulsatile or continuous flows. Blood samples were collected at induction of anesthesia, at the time of aortic clamping and declamping and 1 and 24 h following cessation of the bypass. Urea and creatinine concentrations in blood were measured and systemic vascular resistance was calculated. Urine output, crystalloid and colloid infusions were recorded. We observed that pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study improved microcirculation and renal function in high-risk patients undergoing cardiopulmonary bypass.
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Affiliation(s)
- Mustafa Kocakulak
- Başkent University, Biomedical Engineering Department, Ankara, Turkey.
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23
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Kocakulak M, Küçükaksu S, Pişkin E. Pulsatile roller pump perfusion is safe in high risk patients. Int J Artif Organs 2004; 27:433-9. [PMID: 15202823 DOI: 10.1177/039139880402700514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, controllability, safety, blood cell depletion, and hemolysis of a pulsatile roller pump in high-risk patients was evaluated. Sarns 8000 roller pump (Sams, Terumo CVS, Ann Arbor, MI, USA) with a pulsatile control module was used as arterial pump in a clinical setting. Forty patients undergoing elective open heart surgery with high-risk either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be operated on using pulsatile perfusion or non-pulsatile perfusion. Blood samples were withdrawn at induction of anesthesia, at the time of aortic clamping and de-clamping and at 1 hour and 24 hours following cessation of the bypass. Hematocrit and plasma free hemoglobin values were measured. We observed that the pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study is safe in high-risk patients undergoing cardiopulmonary bypass. We did not face any emboli, hemolysis, or technical problems. Pulsatile roller pump perfusion with Sarns 8000 heart-lung machine is a simple and reliable technique and can be easily applied during open heart surgery.
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Affiliation(s)
- M Kocakulak
- Başkent University, Biomedical Engineering Department, Ankara, Turkey.
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24
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Sohrabi F, Mispireta LA, Fiocco M, Dibos LA, Buescher PC, Sloane PJ. Effects of off-pump coronary artery bypass grafting on patient outcome. J Investig Med 2003; 51:27-31. [PMID: 12580318 DOI: 10.2310/6650.2003.33529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) is associated with postoperative myocardial stunning, hypothermia, formation of microemboli, and systemic inflammatory response syndrome, all of which may prolong recovery from coronary artery bypass grafting (CABG) surgery. This study sought to compare outcomes in patients undergoing CABG off pump versus on pump. METHODS Outcomes, including mortality and several morbidities, were reviewed in 1,623 on-pump patients and 683 off-pump patients. Morbidities assessed included postoperative bleeding, incidence of multiorgan dysfunction, and neurologic complications. Chi-square and t-test analysis were used to determine statistical significance. RESULTS Mortality was 42% lower in the off-pump group than the on-pump group. Both critical care and total hospital length of stay were significantly shorter in the off-pump group. The incidence of postoperative bleeding requiring transfusion or a return to the operating room was reduced by 29% in the off-pump group and the incidence of multiorgan dysfunction was reduced by 31%. The off-pump patients also presented a significantly lower incidence of cerebral vascular accidents and seizures than on-pump patients. CONCLUSIONS We conclude that there is an association between improved patient outcome and off-pump CABG surgery. The outcomes of this study show a statistically significant decrease in mortality, critical care length of stay, total hospital stay, incidence of bleeding requiring transfusion or return to the operating room, amount of blood transfused, incidence of multiorgan dysfunction, cerebral vascular accidents, and seizures in off-pump patients when compared with on-pump patients. Such results support the use of myocardial revascularization off pump as an alternative to CABG surgery on pump. CABG surgery off pump may allow a better postoperative clinical course in patients who are candidates for the procedure.
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Affiliation(s)
- Farrokh Sohrabi
- Department of Surgery, The Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA
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25
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Fiore GB, Redaelli A, Guadagni G, Inzoli F, Fumero R. Development of a new disposable pulsatile pump for cardiopulmonary bypass: computational fluid-dynamic design and in vitro tests. ASAIO J 2002; 48:260-7. [PMID: 12059000 DOI: 10.1097/00002480-200205000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A newly conceived blood pump for pulsatile cardiopulmonary bypass (CPB) is presented. The new device's main design features (fully disposable pumping head with ring shaped valves) were intended to overcome the factors that today limit the use of pulsatile blood pumps, i.e., the complexity and costs of devices. The pump was designed and analyzed by means of three-dimensional computational models, including solid computer assisted design of the pumping head and computational fluid-dynamic (CFD) analyses of the fluid domain and of its interaction with deformable components. A prototype of the device, integrated with the venous reservoir, was built to perform hydraulic in vitro tests with aims of both validating CFD results and verifying the new device's pumping behavior. Functional evaluation of the pump was carried out by using the device in a model circuit made with standard CPB components plus a mock hydraulic bench representing an adult patient's systemic circulation. A roller pump used in pulsatile mode (RP-PM) was used for comparison. At a 5 L/min flow rate, the pulsatile hydraulic power (<Wpuls>) delivered to the patient was approximately 15 mW for the RP-PM. The new pump proved to be able to deliver <Wpuls> up to 40 mW, thus providing a more physiological condition, closer to the <Wpuls> delivered by the natural heart (90-140 mW).
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26
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Sharony R, Porat E, Nishimura Y, Meyns B, Ozaki S, Racz R, Flameng W, Uretzky G. The intra-aortic cannula pump: A novel assist device for the acutely failing heart. J Thorac Cardiovasc Surg 1999; 118:924-9. [PMID: 10534699 DOI: 10.1016/s0022-5223(99)70063-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The intra-aortic cannula pump is a catheter pump designed to support the acutely failing heart. It expels blood from the left ventricle into the ascending aorta in a pulsatile flow pattern. The aim of the study was to analyze the hemodynamic performance of this new intracardiac support system in acute heart failure. METHODS A 24F cannula was studied in a series of 16 sheep. Hemodynamic changes were assessed in the nonfailing, the moderately failing, and the severely failing heart. Heart failure was induced by an injection of microspheres into the left anterior descending coronary artery. The cannula was inserted through the aortic arch and introduced through the aortic valve into the left ventricle. RESULTS Cannula insertion was feasible in all animals. Flow through the intra-aortic cannula flow was increased to a maximum of 3 L/min. No hemodynamic changes were observed in the nonfailing heart. A significant increase in cardiac output was observed in the moderately and severely reduced left ventricle (2.67 +/- 0.7 L to 3.51 +/- 0.83 L; P =.001; and 1.18 +/- 0.77 L to 2.43 +/- 0.44 L; P =.001, respectively). A drop in left atrial pressure was achieved in moderate and severe heart failure (14.1 +/- 5.93 mm Hg to 9.71 +/- 2.63 mm Hg; P =.0001; and 23 +/- 7.16 mm Hg to 11.2 +/- 2.55 mm Hg; P = 0.0001, respectively). Systolic and diastolic systemic blood pressures increased in the severely failing heart (57.3 +/- 12.8 mm Hg to 75.4 +/- 11.2 mm Hg; P =.0001; and 35.6 +/- 8.2 mm Hg to 60 +/- 14.3 mm Hg; P =.0006, respectively). CONCLUSIONS Hemodynamic data demonstrate the beneficial effects of the intra-aortic cannula pump in moderate and severe heart failure. The intra-aortic cannula pump represents a new modality for the treatment of acute heart failure.
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Affiliation(s)
- R Sharony
- Department of Cardiothoracic Surgery, Carmel Medical Center, Rappaport Institute, Faculty of Medicine, Technion-IIT, Haifa, Israel.
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Bauernschmitt R, Naujokat E, Mehmanesh H, Schulz S, Vahl CF, Hagl S, Lange R. Mathematical modelling of extracorporeal circulation: simulation of different perfusion regimens. Perfusion 1999; 14:321-30. [PMID: 10499647 DOI: 10.1177/026765919901400502] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Computer- and sensor-aided control of the heart-lung machine is considered a major goal for perfusion sciences for the next few years. At present, control of perfusion is achieved by surgeons, anaesthesiologists and perfusionists making short-term decisions, which leads to variations of the perfusion regimens between different centres and even between different teams in the operating theatre. As the basis for an integrated control of extracorporeal circulation (ECC), we proposed a mathematical model for simulating haemodynamics during pulsatile perfusion. This model was then modified to allow it to simulate the effects of different perfusion regimens on arterial haemodynamics and whole body oxygen consumption. The model was constructed on a PC using MATLAB/SIMULINK. The human arterial tree was divided into a multibranch structure consisting of 128 segments characterized by their particular physical properties. Peripheral branches were terminated by a resistance term representing smaller vessels like arterioles and capillaries. Flow and pressure were expressed by the intensity of current and voltage in an electrotechnical analogon; inductivity, resistance and capacitance were implemented according to the physical properties of the arterial tree and the rheology of blood. The effects of different perfusion regimens (pulsatility, flow amount, acid-base regulation) were studied. After introducing an input signal to the model, flow and pressure waves established themselves throughout the simulated arterial tree. During the simulation experiments, marked differences among different perfusion regimens were displayed by the model. Variations in acid-base management mainly influenced the distribution of perfusion: during simulation of low-flow perfusion (1.2 l/min/m2), cerebral blood flow was 6.2 ml/s using an alpha-stat regimen, while it was increased to 9.4 ml/s during pH-stat, caused by an implementation of reduced cerebral resistance. Whole body oxygen consumption was predominantly regulated by the perfusion rate. While central venous oxygen saturation was calculated to be 84.7% during simulation of high-flow perfusion (2.4 l/min/m2), it dropped to 70% during simulation of low-flow perfusion regimens. The model proved to be useful for a realistic simulation of different perfusion regimens. Therefore it can be considered a continuing step for the derivation of a 'state' observer leading to the realization of an automatically controlled heart-lung machine.
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Affiliation(s)
- R Bauernschmitt
- Department of Cardiac and Vascular Surgery, German Heart Centre, Munich
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28
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Baufreton C, Intrator L, Jansen PG, te Velthuis H, Le Besnerais P, Vonk A, Farcet JP, Wildevuur CR, Loisance DY. Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps. Ann Thorac Surg 1999; 67:972-7. [PMID: 10320237 DOI: 10.1016/s0003-4975(98)01345-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The inflammatory response in 29 patients undergoing coronary artery bypass grafting using either roller or centrifugal (CFP) pumps was evaluated in a prospective study. METHODS Patients were randomized in roller pump (n = 15) and CFP (n = 14) groups. Terminal complement complex activation (SC5b-9) and neutrophil activation (elastase) were assessed during the operation. Cytokine production (tumor necrosis factor-alpha, interleukin-6, interleukin-8) and circulating adhesion molecules (soluble endothelial-leukocyte adhesion molecule-1 and intercellular adhesion molecule-1) were assessed after the operation. RESULTS Release of SC5b-9 after stopping cardiopulmonary bypass and after protamine administration was higher in the CFP group (p = 0.01 and p = 0.004). Elastase level was higher after stopping cardiopulmonary bypass using CFP (p = 0.006). Multivariate analysis confirmed differences between roller pump and CFP groups in complement and neutrophil activation. After the operation, a significant production of cytokines was detected similarly in both groups, with peak values observed within the range of 4 to 6 hours after starting cardiopulmonary bypass. However, interleukin-8 levels were higher using CFP 2 hours after starting cardiopulmonary bypass (p = 0.02). Plasma levels of adhesion molecules were similar in both groups within the investigation period. CONCLUSIONS During the operation, CFP caused greater complement and neutrophil activation. After the operation, the inflammatory response was similar using either roller pump or CFP.
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Affiliation(s)
- C Baufreton
- Department of Thoracic and Cardiovascular Surgery, Hôpital Henri Mondor, Créteil, France
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Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg 1997; 85:766-82. [PMID: 9322454 DOI: 10.1097/00000539-199710000-00011] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R I Hall
- Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
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Iwaya F, Igari T, Hoshino S, Hikichi H. Evaluation of hemolysis in a pulsatile assist device for centrifugal pump. Artif Organs 1997; 21:700-3. [PMID: 9212942 DOI: 10.1111/j.1525-1594.1997.tb03726.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To evaluate the blood trauma caused by a new device for producing a pulsatile flow of the centrifugal pump, the pulsatile assist device for the centrifugal pump (PAD-CP) that we have developed, a hemolysis study was performed in vitro and in animal experimentation. For the in vitro testing, 2 identical sets of hemolysis test circuits were prepared with 2,400 ml of bovine blood. The 2 circuits were pumped simultaneously. Plasma total hemoglobin levels were less than 40 mg/dl after 3 h, under a pump flow of 2 L/min. Hemolysis increased to a severe level after 4 h of 4 L/min pump flow. The cause of this hemolysis was thought to be a vibration of the circuit because of incomplete compression of the polyurethane tube in the PAD-CP. Five adult sheep (average body weight, 47 kg) were used for in vivo evaluation of hemolysis. Hemolysis was less than 30 mg/dl of plasma hemoglobin after 4 h of open chest extracorporeal circulation with 3.0-3.6 L/min of flow rate using the PAD-CP. Other hematologic changes after PAD-CP driving were within normal limits. We conclude that the PAD-CP has proven to have possible clinical applications.
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Affiliation(s)
- F Iwaya
- Department of Cardiovascular Surgery, Fukushima Medical College, Japan
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32
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Tayama E, Nakazawa T, Takami Y, Makinouchi K, Ohtsubo S, Ohashi Y, Andrade AJ, Glueck J, Mueller J, Nosé Y. The hemolysis test of the Gyro C1E3 pump in pulsatile mode. Artif Organs 1997; 21:675-9. [PMID: 9304391 DOI: 10.1111/j.1525-1594.1997.tb03721.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
While a centrifugal pump is generally used for nonpulsatile blood flow, it can also produce a pulsatile flow by alternating the impeller rotational speed (rpm) periodically. However, there is a concern that this centrifugal pump pulsatile mode may induce added hemolysis as a result of the repeated acceleration and deceleration of rpm. Thus, a hemolysis study of the pulsatile modes of the Gyro C1E3 centrifugal pump (Gyro-P) was conducted. The results were then compared with the nonpulsatile mode of the same pump (Gyro-N) and the nonpulsatile BioMedicus BP-80 (Bio-N) pump. Three different conditions were simulated: left ventricular assist device (LVAD), cardiopulmonary bypass (CPB), and percutaneous cardiopulmonary support (PCPS). The beating rate of the Gyro-P was set at 40 bpm, with repetition of two different impeller speed (the lower being 70% of the higher speed). The 2 impeller speeds were set to obtain the same average flow as that of the nonpulsatile mode. The hemolysis results of the Gyro-P were comparable to or better than those of Bio-N, and no excessive hemolysis was observed, compared to the Gyro-N. In conclusion, The Gyro-P had an excellent hemolytic characteristic and generated no excessive hemolysis in most clinical usage conditions. With the concern of hemolysis eliminated, this pulsatile mode may have various possible mode advantages.
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Affiliation(s)
- E Tayama
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Cook DJ, Orszulak TA, Daly RC. The effects of pulsatile cardiopulmonary bypass on cerebral and renal blood flow in dogs. J Cardiothorac Vasc Anesth 1997; 11:420-7. [PMID: 9187988 DOI: 10.1016/s1053-0770(97)90048-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of pulsatility on cerebral blood flow, cerebral metabolism, and renal blood flow over a range of cardiopulmonary bypass temperature and flow conditions. DESIGN/SETTING The investigation was prospective, randomized, and performed in a canine physiology laboratory at the Mayo Foundation. PARTICIPANTS AND INTERVENTIONS Anesthetized dogs were studied during pulsatile (n = 9) or nonpulsatile (n = 10) cardiopulmonary bypass at two flow rates (2.4 and 1.2 L/min/m2) at each of three temperatures (37 degrees, 32 degrees, and 27 degrees C). Pulsatility was achieved by use of a pediatric intraaortic balloon pump. Cerebral blood flow and metabolic rate were determined using the sagittal sinus outflow method. Renal blood flow was determined by a periarterial ultrasonic flow probe. MEASUREMENTS AND MAIN RESULTS In the pulsatile group, a pulse pressure of 29 mmHg had no effect on cerebral blood flow or metabolism at any temperature under either flow condition. Renal blood flow was also unaffected by pulsatility, but decreased with hypothermia and reduced pump flow. Pulsatility also did not attenuate the systemic effects of normothermic hypoperfusion. CONCLUSIONS Pulsatility has no significant effect on cerebral or renal perfusion over a broad range of cardiopulmonary bypass temperature and flow conditions. Cerebral blood flow and metabolism were functions of temperature but not pulsatility or flow rate. Renal blood flow was affected by both temperature and cardiopulmonary bypass flow rate but not by pulsatility. Finally, central nervous system perfusion may be preserved under low-flow cardiopulmonary bypass conditions by shunting of perfusion from splanchnic vascular beds.
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Affiliation(s)
- D J Cook
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
After a review of the theoretical and experimental background, a history of the development of pulsatile blood pumps is presented with an attempt to understand the underlying rationale. The case for the use of pumps that simulate normal cardiac function is made by considering cardiovascular hemodynamics, the function of arterial baro-receptors, hemodynamic energy and power, tissue fluid movement, and lymph formation and flow. The pulsatile output of the heart and mechanical pumps is described in units of power and the load that they work against as a complex impedance. Many pulsatile pumps have been designed and developed for research, but few have been used during cardiac operations on human patients. The evidence in favor of using pulsatile flow for cardiopulmonary bypass is strong, but major problems have been identified such as the lack of a satisfactory definition of pulsatile flow and technical difficulties resulting from impedance mismatches in clinical applications.
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Affiliation(s)
- G Wright
- W.E. Dunn Department of Cardiology, Department of Biological Science, Keele University, Staffordshire, UK
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