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Ündar A, Kunselman AR, Barbaro RP, Alexander P, Patel K, Thomas NJ. The authors reply. Pediatr Crit Care Med 2024; 25:e60-e61. [PMID: 38169342 DOI: 10.1097/pcc.0000000000003401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
- Department of Surgery, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Divisions of Critical Care and Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA
| | - Allen R Kunselman
- Department of Pediatrics, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Ryan P Barbaro
- Divisions of Critical Care and Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Krishna Patel
- Department of Pediatrics, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
- Department of Surgery, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
| | - Neal J Thomas
- Department of Pediatrics, Penn State College of Medicine, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Health Children's Hospital, Hershey, PA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA
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Patel K, Dan Y, Kunselman AR, Clark JB, Myers JL, Ündar A. The effects of pulsatile versus nonpulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous microemboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery. JTCVS Open 2023; 16:786-800. [PMID: 38204706 PMCID: PMC10775072 DOI: 10.1016/j.xjon.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/30/2023] [Accepted: 08/18/2023] [Indexed: 01/12/2024]
Abstract
Objective The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients. Methods This retrospective study included 284 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass support utilizing nonpulsatile (n = 152) or pulsatile (n = 132) flow. Intraoperative cerebral gaseous microemboli counts, pulsatility index, and mean blood flow velocity at the right middle cerebral artery were assessed using transcranial Doppler ultrasound. Clinical outcomes were compared between groups. Results Patient demographics and cardiopulmonary bypass characteristics between groups were similar. Although the pulsatility index during aortic crossclamping was consistently higher in the pulsatile group (P < .05), a significant degree of pulsatility was also observed in the nonpulsatile group. No significant differences in mean cerebral blood flow velocity, regional cerebral oxygen saturation, or gaseous microemboli counts were observed between the perfusion modality groups. Clinical outcomes, including intubation duration, intensive care unit and hospital length of stay, and mortality within 180 days were similar between groups. Conclusions Although the pulsatility index was greater in the pulsatile group, other measures of intraoperative cerebral perfusion and short-term outcomes were similar to the nonpulsatile group. These findings suggest that while pulsatile perfusion represents a safe modality for cardiopulmonary bypass support, its use may not translate into detectably superior clinical outcomes.
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Affiliation(s)
- Krishna Patel
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Yongwook Dan
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Allen R. Kunselman
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Public Health Sciences, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Joseph B. Clark
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - John L. Myers
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Akif Ündar
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Biomedical Engineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
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Ündar A, Kunselman AR, Barbaro RP, Alexander P, Patel K, Thomas NJ. Centrifugal or Roller Blood Pumps for Neonatal Venovenous Extracorporeal Membrane Oxygenation: Extracorporeal Life Support Organization Database Comparison of Mortality and Morbidity. Pediatr Crit Care Med 2023; 24:662-669. [PMID: 37102713 PMCID: PMC11069414 DOI: 10.1097/pcc.0000000000003251] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES To investigate outcomes associated with conventional roller or centrifugal pumps during neonatal venovenous extracorporeal membrane oxygenation (ECMO). Our primary hypothesis is that in comparison with conventional roller-pump support, centrifugal pump use is associated with greater odds of survival. Our secondary hypothesis is that centrifugal pump use is associated with lesser odds of complications. DESIGN Retrospective cohort identified using the Extracorporeal Life Support Organization (ELSO) registry 2016 to 2020 dataset. SETTING All ECMO centers reporting to the ELSO registry. PATIENTS All neonates (≤ 28 d) supported with venovenous ECMO and cannulated via right internal jugular vein using dual-lumen venovenous cannulas and polymethyl pentene membrane oxygenators. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 612 neonates (centrifugal, n = 340; conventional roller, n = 272) were included in the analysis. Using a multivariable logistic regression model, centrifugal pump use-as opposed to roller pump use-was associated with lesser odds of survival (odds ratio [OR], 0.53; 95% CI, 0.33-0.84; p < 0.008). Thrombosis and clots in the circuit components were also associated with lesser odds of survival (OR, 0.28; 95% CI, 0.16-0.60; p < 0.001). We failed to show that hemolysis was an independent variable for survival (OR, 0.60; 95% CI, 0.31-1.19; p = 0.14). The primary diagnosis of neonatal aspiration/meconium aspiration is associated with more than seven-fold greater odds of survival (OR, 7.57; 95% CI, 4.02-15.74; p < 0.001). CONCLUSIONS Contrary to our hypotheses, conventional roller pump use was associated with greater odds of survival. While thrombosis and clots in circuit components were independent variables for lesser odds of survival, further research is needed better to understand the use of centrifugal pumps in neonatal practice.
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Affiliation(s)
- Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, and Surgery, PA, USA
- Penn State College of Medicine, Penn State Health Children’s Hospital, Hershey, PA, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Allen R. Kunselman
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, and Surgery, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ryan P. Barbaro
- Divisions of Critical Care & Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Peta Alexander
- Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Krishna Patel
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, and Surgery, PA, USA
- Penn State College of Medicine, Penn State Health Children’s Hospital, Hershey, PA, USA
| | - Neal J. Thomas
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, and Surgery, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children’s Hospital, Hershey, PA, USA
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Abstract
INTRODUCTION Modified ultrafiltration (MUF) is employed at the termination of cardiopulmonary bypass (CPB) in pediatric and neonatal patients undergoing congenital heart surgery to reduce the accumulation of total body water thus increasing the concentration of red blood cells and the other formed elements in the circulation. Modified ultrafiltration has been reported to remove circulating pro-inflammatory mediators that result in systemic inflammatory response syndrome (SIRS) postoperatively. METHODS Four hundred patients undergoing cardiac surgery requiring cardiopulmonary bypass and weighing less than or equal to 12 kg were retrospectively evaluated for the effectiveness of MUF. After the termination of CPB, blood was withdrawn through the aortic cannula and passed through a hemoconcentrator attached to the blood cardioplegia set and returned to the patient through the venous cannula. The entire CPB circuit volume in addition to the patient's circulating blood volume were concentrated until the hematocrit value displayed on the CDI cuvette within the MUF circuit reached 45% or there was no more volume to safely remove. At the same time a full unit of FFP can be infused as water is being removed, thus maintaining euvolemia. RESULTS MUF was performed in all 400 patients with no MUF-related complications. Following the conclusion of MUF, anecdotal observations included improved surgical hemostasis, improved hemodynamic parameters, decreased transfusion requirements, and decreased ventilator times. CONCLUSIONS Complete MUF enables the clinician to safely raise the post-CPB hematocrit to at least 40% while potentially removing mediators that could result in SIRS. In addition a full unit of FFP can be administered while maintaining euvolemia.
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Affiliation(s)
- David A Palanzo
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Robert K Wise
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Karl R Woitas
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery and Biomedical Engineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Joseph B Clark
- Pediatric Cardiac Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Pediatric Cardiac Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Patel K, Ündar A. Centrifugal Pump Generates Superior Hemodynamic Performance Compared to a new Diagonal Blood Pump in Neonatal and Pediatric ECMO Circuits. World J Pediatr Congenit Heart Surg 2022; 13:235-241. [PMID: 35238708 DOI: 10.1177/21501351211057426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE With newer generation diagonal and centrifugal blood pumps gaining popularity, the objective of this study was to compare the DP3-i-cor diagonal and RotaFlow centrifugal pumps in terms of hemodynamic performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits. DESCRIPTION The DP3-i-cor diagonal pump is a part of the newly FDA-approved NovaLung system. The experimental circuit consisted of either the DP3-i-cor diagonal or RotaFlow centrifugal pump, a polymethylpentene membrane oxygenator, neonatal and pediatric arterial/venous cannulae, and 1/4-inch ID tubing. Three circuits were tested using combinations of either the DP3-i-cor or RotaFlow pump and varying arterial/venous cannulae sizes. Real-time pressure and flow data were collected. EVALUATION The new DP3-i-cor diagonal pump exhibited lower flow rate and pressure head when compared to the RotaFlow centrifugal pump at similar rotational speeds and identical experimental conditions. Large-caliber arterial cannulae expectedly generated higher flow rates and pressures. CONCLUSIONS The RotaFlow centrifugal pump demonstrated superior hemodynamic performance when compared to the DP3-i-cor diagonal pump in simulated neonatal and pediatric ECMO circuits. Translational research of all ECMO components is crucial.
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Affiliation(s)
- Krishna Patel
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, 12310Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, 12310Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Morales DLS, Lorts A, Greenberg JW, Reagor JA, Ündar A. Highlights of the Sixteenth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. World J Pediatr Congenit Heart Surg 2022; 13:217-219. [PMID: 35238701 DOI: 10.1177/21501351211065360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason W Greenberg
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Akif Ündar
- Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Patel K, Ündar A. Impact of a Multidisciplinary Research Team Approach to Prevent Avoidable Mistakes for Neonatal CPB Population. World J Pediatr Congenit Heart Surg 2022; 13:220-230. [PMID: 35238709 DOI: 10.1177/21501351211064182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant progress has been made in neonatal cardiopulmonary bypass (CPB) over the years. At Penn State Health Children's Hospital, we have established a multidisciplinary research team that brings clinicians, engineers, scientists, research nurses, neuromonitoring technicians, perfusionists, and students from various departments to help reduce adverse outcomes following CPB in neonates. With the help of this team, we evaluate each CPB component in simulated conditions identical to those used in clinical practice. The objective of this review is to demonstrate the results of these translational projects and present critical mistakes to avoid for neonatal CPB patients.
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Affiliation(s)
- Krishna Patel
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
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Holcomb RM, Ündar A. Are outcomes in congenital cardiac surgery better than ever? J Card Surg 2022; 37:656-663. [PMID: 35023592 DOI: 10.1111/jocs.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? METHODS The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. RESULTS The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. CONCLUSIONS Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected.
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Affiliation(s)
- Ryan M Holcomb
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
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Ündar A. Frequency domain analysis and clinical outcomes of pulsatile and non-pulsatile blood flow energy during cardiopulmonary bypass. Perfusion 2021; 36:786-787. [PMID: 33944634 DOI: 10.1177/02676591211013639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA
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Ündar A, Dan Y. Optimization of CPB Circuits and Techniques Minimize the Total Number of Intraoperative Emboli Delivery in Congenital Heart Surgery Patients. World J Pediatr Congenit Heart Surg 2021; 12:562. [PMID: 33888027 DOI: 10.1177/21501351211007803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA Department of Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yongwook Dan
- Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA Department of Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA
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Ündar A. Impact of the Sixteen International Conferences on pediatric mechanical circulatory support systems and pediatric cardiopulmonary bypass procedures in congenital heart surgery patients. Artif Organs 2020; 45:3-5. [PMID: 33345372 DOI: 10.1111/aor.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Akif Ündar
- Penn State Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Penn State Pediatric Cardiovascular Research Center, Department of Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Penn State Pediatric Cardiovascular Research Center, Department of Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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12
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Ündar A. Evidence-based translational research approach may help to select the best femoral arterial cannula for adolescent/adult extracorporeal life support population. Perfusion 2020; 36:322-323. [PMID: 32757715 DOI: 10.1177/0267659120947376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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13
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Ündar A. Pressure and flow properties of dual-lumen cannulae for extracorporeal membrane oxygenation. Perfusion 2020; 35:745-746. [PMID: 32627656 DOI: 10.1177/0267659120937546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA
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Thangappan K, Barnes A, Lorts A, Morales DLS, Ündar A. Welcome to the 16th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2020; 44:355-360. [DOI: 10.1111/aor.13672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Karthik Thangappan
- Department of Cardiothoracic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Allison Barnes
- Department of Cardiothoracic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Angela Lorts
- Department of Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - David L. S. Morales
- Department of Cardiothoracic Surgery Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Akif Ündar
- Penn State Pediatric Cardiovascular Research Center Department of Pediatrics, Surgery, and Bioengineering Penn State College of Medicine Penn State Health Children's Hospital Hershey PA USA
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Law S, Chai P, Ündar A. Outcomes of the Fifteenth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2019; 44:5-11. [DOI: 10.1111/aor.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sabrina Law
- Division of Pediatric Cardiology Program for Pediatric Cardiomyopathy Heart Failure and Transplantation Morgan Stanley Children’s Hospital Columbia University Medical Center New York NY USA
| | - Paul Chai
- Division of Cardiac Thoracic & Vascular Surgery Columbia University Medical Center New York NY USA
- Pediatric Cardiac Surgery at Morgan Stanley Children’s Hospital and New York–Presbyterian Hospital New York NY USA
| | - Akif Ündar
- Penn State Pediatric Cardiovascular Research Center Department of Pediatrics, Surgery, and Bioengineering Penn State College of Medicine Penn State Health Children’s Hospital Hershey PA USA
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16
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Ündar A. Impact of Istanbul Symposiums and Artificial Organs on education and training of young clinicians and the outcomes of congenital heart surgery patients in Turkey. Artif Organs 2019; 43:1130-1134. [PMID: 31429092 DOI: 10.1111/aor.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics, Penn State Pediatric Cardiovascular Research Center, Hershey, Pennsylvania.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania.,Department of Bioengineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania
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Trivedi P, Glass K, Clark JB, Myers JL, Cilley RE, Ceneviva G, Wang S, Kunselman AR, Ündar A. Clinical outcomes of neonatal and pediatric extracorporeal life support: A seventeen‐year, single institution experience. Artif Organs 2019; 43:1085-1091. [DOI: 10.1111/aor.13512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Payal Trivedi
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Kristen Glass
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Joseph B. Clark
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
- Department of Surgery Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - John L. Myers
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
- Department of Surgery Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Robert E. Cilley
- Department of Surgery Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Gary Ceneviva
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Shigang Wang
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Allen R. Kunselman
- Department of Public Health Sciences Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
| | - Akif Ündar
- Department of Pediatrics Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
- Department of Surgery Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
- Department of Bioengineering Penn State Health Children’s Hospital, Penn State College of Medicine Hershey Pennsylvania
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18
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Ündar A, Moroi MK. Pulsatile flow is not a magic bullet for congenital heart surgery patients during CPB procedures. Artif Organs 2019; 43:943-946. [DOI: 10.1111/aor.13511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
- Department of Surgery and Bioengineering Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
| | - Morgan K. Moroi
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey Pennsylvania
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19
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Law S, Chai P, Ündar A. Welcome to the Fifteenth International conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2019; 43:329-333. [PMID: 30912153 DOI: 10.1111/aor.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Sabrina Law
- Division of Pediatric Cardiology, Program for Pediatric Cardiomyopathy, Heart Failure and Transplantation, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - Paul Chai
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Medical Center, New York, NY.,Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital and NewYork-Presbyterian Hospital, New York, NY
| | - Akif Ündar
- Department of Pediatrics, Surgery, and Bioengineering, Penn State Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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20
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Wang S, Moroi MK, Kunselman AR, Myers JL, Ündar A. Evaluation of centrifugal blood pumps in term of hemodynamic performance using simulated neonatal and pediatric ECMO circuits. Artif Organs 2019; 44:16-27. [DOI: 10.1111/aor.13436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
| | - Morgan K. Moroi
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
| | - Allen R. Kunselman
- Public Health and Sciences Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
| | - John L. Myers
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
- Department of Surgery and Bioengineering Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
- Department of Surgery and Bioengineering Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital Hershey PA USA
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21
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Sathianathan S, Nasir R, Wang S, Kunselman AR, Ündar A. In vitro evaluation of Capiox FX05 and RX05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum‐assisted venous drainage levels. Artif Organs 2019; 44:28-39. [DOI: 10.1111/aor.13404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/30/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shyama Sathianathan
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Rafay Nasir
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Shigang Wang
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Allen R. Kunselman
- Department of Public Health and Sciences Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Akif Ündar
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
- Department of Surgery and Bioengineering Penn State Health Children’s Hospital Hershey Pennsylvania
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22
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Wang S, Kunselman AR, Ündar A. Impact of cannula size and line length on venous line pressure in pediatric VA-/VV-ECLS circuits. Artif Organs 2018; 43:E165-E177. [PMID: 30589448 DOI: 10.1111/aor.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to do an in vitro evaluation of venous line pressure using different venous line lengths and venous cannula sizes in pediatric venoarterial extracorporeal life support (VA-ECLS) and venovenous ECLS (VV-ECLS) circuits. The pediatric VA-ECLS circuit consisted of a Xenios i-cor diagonal pump, a Maquet Quadrox-i pediatric oxygenator, a Medtronic Biomedicus arterial cannula, a Biomedicus venous cannula, and 1/4″ ID arterial and venous tubing. The pediatric VV-ECLS circuit was similar, except it included a Maquet Avalon ELITE bi-caval dual lumen cannula. Circuits were primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). Trials were conducted at various flow rates (VA-ECLS: 250-1250 mL/min, VV-ECLS: 250-2000 mL/min) using different venous tubing lengths (2, 4, and 6 feet) and cannula sizes (VA-ECLS: A8Fr/V10Fr, A10Fr/V12Fr and A12Fr/V14Fr, VV-ECLS: 13Fr, 16Fr, 19Fr, 20Fr and 23Fr) at 36°C. Real-time pressure and flow data were recorded for analysis. The use of a small-caliber venous cannula significantly increased the venous line pressure in the 2 pediatric circuits (P < 0.01). Shorter venous tubing lengths significantly reduced the venous line pressure at high flow rates (P < 0.01). The VV-ECLS circuit had larger negative pre-pump pressure drops (7.2 to -102.2 mm Hg) when compared to the VA-ECLS circuit (0.7 to -60.7 mm Hg). Selecting an appropriate venous cannula and a shorter venous tubing when feasible may significantly reduce the pressure drop of the venous line in pediatric VA-ECLS and VV-ECLS circuits and improve venous drainage.
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Affiliation(s)
- Shigang Wang
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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23
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Wang S, Force M, Moroi MK, Patel S, Kunselman AR, Ündar A. Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis. Artif Organs 2018; 43:60-75. [PMID: 30374991 DOI: 10.1111/aor.13284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022]
Abstract
The objective of this study is to compare hemodynamic performances under different pulsatile control algorithms between Medos DeltaStream DP3 and i-cor diagonal pumps in simulated pediatric and adult ECLS systems. An additional pilot study was designed to test hemolysis using two pumps during 12h-ECLS. The experimental circuit consisted of parallel combined pediatric and adult ECLS circuits using an i-cor pump head and either an i-cor console or Medos DeltaStream MDC console, a Medos Hilite 2400 LT oxygenator for the pediatric ECLS circuit, and a Medos Hilite 7000 LT oxygenator for the adult ECLS circuit. The circuit was primed with lactated Ringer's solution and human packed red blood cells (hematocrit 40%). Trials were conducted at various flow rates (pediatric circuit: 0.5 and 1L/min; adult circuit: 2 and 4L/min) under nonpulsatile and pulsatile modes (pulsatile amplitude: 1000-5000rpm [1000 rpm increments] for i-cor pump, 500-2500rpm [500 rpm increments] for Medos pump) at 36°C. In an additional protocol, fresh whole blood was used to test hemolysis under nonpulsatile and pulsatile modes using the two pump systems in adult ECLS circuits. Under pulsatile mode, energy equivalent pressures (EEP) were always greater than mean pressures for the two systems. Total hemodynamic energy (THE) and surplus hemodynamic energy (SHE) levels delivered to the patient increased with increasing pulsatile amplitude and decreased with increasing flow rate. The i-cor pump outperformed at low flow rates, but the Medos pump performed superiorly at high flow rates. There was no significant difference between two pumps in percentage of THE loss. The plasma free hemoglobin level was always higher in the Medos DP3 pulsatile group at 4 L/min compared to others. Pulsatile control algorithms of Medos and i-cor consoles had great effects on pulsatility. Although high pulsatile amplitudes delivered higher levels of hemodynamic energy to the patient, the high rotational speeds increased the risk of hemolysis. Use of proper pulsatile amplitude settings and intermittent pulsatile mode are suggested to achieve better pulsatility and decrease the risk of hemolysis. Further optimized pulsatile control algorithms are needed.
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Affiliation(s)
- Shigang Wang
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Madison Force
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Morgan K Moroi
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Sunil Patel
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, 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 Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, 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 Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
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24
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Mongé MC, Backer CL, Myers JL, Ündar A. Outcomes of the Fourteenth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2018; 43:5-8. [DOI: 10.1111/aor.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael C. Mongé
- Division of Cardiovascular Surgery; Ann & Robert H. Lurie Children’s Hospital of Chicago, and Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Carl L. Backer
- Division of Cardiovascular Surgery; Ann & Robert H. Lurie Children’s Hospital of Chicago, and Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - John L. Myers
- Penn State Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery, and Bioengineering; Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Akif Ündar
- Penn State Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery, and Bioengineering; Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
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25
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Wang S, Force M, Kunselman AR, Palanzo D, Brehm C, Ündar A. Hemodynamic Evaluation of Avalon Elite Bi-Caval Dual Lumen Cannulas and Femoral Arterial Cannulas. Artif Organs 2018; 43:41-53. [DOI: 10.1111/aor.13318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Madison Force
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - David Palanzo
- Department of Perfusion; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Christoph Brehm
- Department of Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
- Department of Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
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26
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Wang S, Moroi MK, Force M, Kunselman AR, Ündar A. Impact of Heart Rate on Pulsatile Hemodynamic Performance in a Neonatal ECG-Synchronized ECLS System. Artif Organs 2018; 43:81-89. [PMID: 30151915 DOI: 10.1111/aor.13273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The experimental circuit consisted of an i-cor diagonal pump, a Medos Hilite 800 LT oxygenator, an 8Fr Biomedicus arterial cannula, a 10Fr Biomedicus venous cannula, and six feet of 1/4 in ID tubing for arterial and venous lines. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). Trials were conducted at various heart rates (90, 120, and 150 bpm) and flow rates (200, 400, and 600mL/min) under nonpulsatile and pulsatile mode with pulsatile amplitudes of 1000-4000rpm (1000 rpm increments). Real-time pressure and flow data were recorded for analysis. The i-cor pump was capable of creating nonpulsatile and electrocardiography (ECG)-synchronized pulsatile flow, and automatically reducing pulsatile frequency by increasing the assist ratio at higher heart rates. Reduced pulsatile frequency led to lower hemodynamic energy generation but did not affect circuit pressure drop. Pulsatile flow delivered more hemodynamic energy to the pseudopatient when compared with nonpulsatile flow. The pump generated more hemodynamic energy with higher pulsatile amplitudes. The i-cor pump can automatically adjust the pulsatile assist ratio to create pulsatile flow at higher heart rates, although this caused some hemodynamic energy loss. Compared with nonpulsatile flow, pulsatile flow generated and transferred more hemodynamic energy to the neonate during ECLS (200-600mL/min), especially at high pulsatile amplitudes and low flow rates.
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Affiliation(s)
- Shigang Wang
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Morgan K Moroi
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Madison Force
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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27
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Wang S, Force M, Kunselman AR, Brehm C, Ündar A. Evaluation of Two Femoral Arterial Cannulae With Conventional Non-Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit. Artif Organs 2018; 43:30-40. [PMID: 30129978 DOI: 10.1111/aor.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/31/2018] [Accepted: 08/14/2018] [Indexed: 12/01/2022]
Abstract
The objective of this study is to evaluate the hemodynamic characteristics of two femoral arterial cannulae in terms of circuit pressure, pressure drop, and hemodynamic energy transmission under non-pulsatile and pulsatile modes in a simulated adult extracorporeal life support (ECLS) system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr or 16 Fr femoral arterial cannula (Xenios AG), and a 23/25 Fr Estech remote access perfusion (RAP) femoral venous cannula (San Ramon, CA, USA). The circuit was primed with lactated Ringer's solution and packed red blood cells to achieve a hematocrit of 35%. All trials were conducted at room temperature with flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 bpm and pulsatile amplitudes of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom data acquisition system. Total hemodynamic energy (THE) is calculated by multiplying the ratio between the area under the hemodynamic power curve (∫flow × pressure dt) and the area under the pump flow curve (∫flow dt) by 1332. The pressure drop across the arterial cannula increased with increasing flow rate and decreasing cannula size. The pressure drops of 18 Fr and 16 Fr cannulae were 19.4-24.5 and 38.4-45.3 mm Hg at 1 L/min, 55.2-56.8 and 110.9-118.3 mm Hg at 2 L/min, 94.1-105.1 and 209.7-215.1 mm Hg at 3 L/min, and 169.2-172.6 and 376.4 mm Hg at 4 L/min, respectively. Pulsatile flow created more hemodynamic energy than non-pulsatile flow, especially at lower flow rates. The percentages of THE loss across 18 Fr and 16 Fr cannula were 16.0-18.7 and 27.5-30.8% at 1 L/min, 35.1-35.7 and 52.3-53.8% at 2 L/min, 48.3-50.3 and 67.3-68.4% at 3 L/min and 62.9-63.1 and 79.0% at 4 L/min. The hemodynamic performance of the arterial cannula should be evaluated before use in clinical practice. The pressure drops and percentages of THE loss across two cannulae tested using human blood were higher compared to the manufacturer's data tested using water. The cannula size should be chosen to match the expected flow rate. In addition, this novel i-cor ECLS system can provide non-pulsatile and ECG-synchronized pulsatile flow without significantly increasing the cannula pressure drop and hemodynamic energy loss.
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Affiliation(s)
- Shigang Wang
- Departments of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Madison Force
- Departments of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Allen R Kunselman
- Public and Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christoph Brehm
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Akif Ündar
- Departments of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.,Surgery and Bioengineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Hershey, PA, USA
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28
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Caneo LF, Matte GS, Guimarães DP, Viotto G, Mazzeto M, Cestari I, Neirotti RA, Jatene MB, Wang S, Ündar A, Chang Junior J, Jatene FB. Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits. Braz J Cardiovasc Surg 2018; 33:224-232. [PMID: 30043914 PMCID: PMC6089135 DOI: 10.21470/1678-9741-2018-0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options. METHODS Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C. RESULTS Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively. CONCLUSION A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.
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Affiliation(s)
- Luiz Fernando Caneo
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Gregory S Matte
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Daniel Peres Guimarães
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Guilherme Viotto
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo Mazzeto
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Idagene Cestari
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Rodolfo A Neirotti
- Clinical Professor of Surgery and Pediatrics, Emeritus Michigan State University, MI, USA
| | - Marcelo B Jatene
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Shigang Wang
- Pediatric Cardiovascular Research Center, Department of Pediatrics; Public Health Sciences; Surgery and Bioengineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center, Department of Pediatrics; Public Health Sciences; Surgery and Bioengineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - João Chang Junior
- Department of Industrial Engineering, FEI University Center, São Paulo, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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29
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Wang S, Moroi M, Brehm CE, Kunselman AR, Ündar A. In Vitro Hemodynamic Evaluation of an Adult Pulsatile Extracorporeal Membrane Oxygenation System. Artif Organs 2018; 42:E234-E245. [PMID: 29774551 DOI: 10.1111/aor.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 01/02/2023]
Abstract
The objective of this study was to evaluate a pulsatile extracorporeal membrane oxygenation (ECMO) system in terms of hemodynamic energy generation and transmission under various pulsatile amplitudes, flow rates, and pseudopatient pressures in a simulated adult ECMO circuit. Surplus hemodynamic energy (SHE), a measure of the quality of pulsatility, was used to quantify pulsatile flow. The circuit consisted of an i-cor diagonal pump, an adult XLung oxygenator, a 21 Fr Medtronic Biomedicus femoral arterial cannula, a 23/25 Fr Sorin RAP femoral venous cannula, and 3/8 in ID tubing for both arterial and venous lines. The circuit was primed with lactated Ringer's solution and then packed red blood cells (hematocrit 37%). Trials were conducted at 36°C with flow rates of 2-5 L/min (1 L/min increments) under nonpulsatile and pulsatile mode with pulsatile amplitudes of 1000-5000 rpm (1000 rpm increments). The pseudopatient pressure was maintained at 40-100 mm Hg (20 mm Hg increments). Real-time pressure and flow data were recorded for analysis using a custom-made data acquisition system. There was no SHE generated by the pump under nonpulsatile mode. Under pulsatile mode, SHE levels increased with increasing pulsatile amplitude and pseudopatient pressure (P < 0.01) but decreased with increasing flow rate. SHE levels were significantly higher at flow rates of 2-4 L/min. In addition, the XLung oxygenator had acceptable pressure drops (36.1-104.9 mm Hg) and percentages of total hemodynamic energy loss (19.6-43.9%) during all trials. The novel pulsatile ECMO system can create nonpulsatile and pulsatile flow in an adult ECMO model. However, pulsatility gradually weakened with increasing flow rates. Pulsatile amplitude settings were found to have a great impact on pulsatility.
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Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Morgan Moroi
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Christoph E Brehm
- Heart and Vascular Institute Critical Care Unit and Adult ECMO Program, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Department of Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Force M, Moroi M, Wang S, Kunselman AR, Ündar A. In Vitro Hemodynamic Evaluation of ECG-Synchronized Pulsatile Flow Using i-Cor Pump as Short-Term Cardiac Assist Device for Neonatal and Pediatric Population. Artif Organs 2018; 42:E153-E167. [PMID: 29682761 DOI: 10.1111/aor.13136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/19/2017] [Accepted: 01/11/2018] [Indexed: 01/30/2023]
Abstract
The objective of this study was to assess the hemodynamic properties of the i-cor ECG-synchronized cardiac assist system for off-label use as a short-term cardiac assist device for neonatal and pediatric patients and compare nonpulsatile to pulsatile flow with different amplitudes. The circuit consisted of the i-cor diagonal pump with 3 feet of ¼ inch arterial and venous tubing and a soft-shell reservoir, primed with lactated Ringer's solution and human packed red blood cells (hematocrit 42%). Trials were conducted with three different sets of cannulas (8-Fr arterial 10-Fr venous, 10-Fr arterial 12 Fr-venous, and 12-Fr arterial 14-Fr venous) with increasing flow rates at varying pseudo-patient pressures (40, 60, 80, and 100 mm Hg) and under nonpulsatile mode and pulsatile mode with pulsatile amplitudes 2000, 2500, and 3000 rpm at 36°C. Pressure and flow waveforms were recorded using a custom-made data acquisition device for each trial. Energy equivalent pressure (EEP) was higher than mean pressure under pulsatile mode, and increased with increasing pseudo-patient's pressure and flow rate while EEP was the same as the mean pressure under nonpulsatile mode. Total hemodynamic energy (THE) levels increased with pressure and pulsatile amplitude and slightly decreased with increasing flow rate. The percent THE lost throughout the circuit increased with flow rate and pulsatile amplitude and decreased with pseudo-patient's pressure. SHE levels also increased with pseudo-patient pressure and pulsatile amplitude and decreased with increasing flow rate. The i-cor diagonal pump can be used as a short term cardiac assist device for neonatal and pediatric patients and is able to provide nonpulsatile as well as pulsatile flow. Compared with nonpulsatile flow, pulsatile flow can generate and deliver more hemodynamic energy to the patients.
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Affiliation(s)
- Madison Force
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Morgan Moroi
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery and Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Izer JM, Wilson RP, Clark JB, Myers JL, Weiss WW, Ündar A. Animal Models for Pediatric Mechanical Circulatory Support Research at Penn State Health. Artif Organs 2018; 42:347-353. [PMID: 29667251 DOI: 10.1111/aor.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Jenelle M Izer
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Comparative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Ronald P Wilson
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Comparative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Joseph B Clark
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - William W Weiss
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Wang S, Patel S, Izer JM, Clark JB, Kunselman AR, Wilson RP, Ündar A. Impact of Different Perfusion Modalities on Coronary and Carotid Blood Flow Velocities in an Adult ECLS Swine Model. Artif Organs 2018; 42:918-921. [PMID: 29660857 DOI: 10.1111/aor.13141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/19/2018] [Accepted: 02/13/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to compare the effects of nonpulsatile and ECG-synchronized pulsatile extracorporeal life support on coronary and carotid blood flow velocities using transthoracic echocardiography and vascular ultrasound, respectively. Nine adult swine were randomly separated into nonpulsatile (NP, n = 5) and pulsatile (P, N = 4) groups and placed on ECLS for 24 h using an i-cor ECLS system. Noninvasive transthoracic images of the left and right coronary artery and the left carotid artery were acquired at the pre-ECLS (baseline), 30 min, 3, 6, 9, 12, and 24 h on-ECLS stages. The mean diastolic velocity of the left and right coronary arteries in the NP group significantly decreased after 24 h on ECLS compared to the baseline and 30 min ECLS stages (P < 0.05). There was no statistical difference in the mean diastolic velocity of the coronary arteries in the P group at 30 min, 3-, 6-, 9-, 12-, and 24-h ECLS compared to baseline. The P group showed a smaller decrease in the mean diastolic velocity of coronary arteries between the 30-min ECLS and 3-, 6-, 9-, 13-, 24-h ECLS stages compared to the NP group. The diastolic velocity of the left carotid artery in the NP group significantly decreased during 24-h ECLS compared to the P group (P < 0.05). An ECG-synchronized pulsatile ECLS system appeared to maintain coronary and carotid artery diastolic velocities better than conventional nonpulsatile ECLS. Further investigation of the perfusion modes during ECLS is warranted.
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Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Sunil Patel
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Jenelle M Izer
- Department of Comparative Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Joseph B Clark
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey Children's Hospital, Hershey, PA, USA.,Department of Surgery, 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 Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Ronald P Wilson
- Department of Comparative Medicine, Penn State 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 Hershey Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
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Ündar A, Wang S, Moroi M, Kunselman AR, Brehm CE. Evaluation and Comparison of Hemodynamic Performance of Three ECLS Systems in a Simulated Adult Cardiogenic Shock Model. Artif Organs 2018; 42:776-785. [DOI: 10.1111/aor.13126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Morgan Moroi
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Christoph E. Brehm
- Heart & Vascular Intensive Care Unit, Penn State Milton S. Hershey Medical Center; Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
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Ündar A, Runge T, Miller O, Felger M, Lansing R, Korvick D, Bohls F, Ottmers S, O'dell B, Ybarra J, Howelton R, Mireles R, Benson C, Holland M, Calhoon J. Design of a Physiologic Pulsatile Flow Cardiopulmonary Bypass System for Neonates and Infants. Int J Artif Organs 2018. [DOI: 10.1177/039139889601900306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary bypass surgical techniques that allow a surgeon to operate on the infant's heart use an extracorporeal circuit consisting of a pump, oxygenator, arterial and venous reservoirs, cannulae, an arterial filter, and tubing. The extracorporeal technique currently used in infants and neonates is sometimes associated with neurologic damage. We are developing a modified cardiopulmonary bypass system for neonates that has been tested in vitro and in one animal in vivo. Unlike other extracorporeal circuits which use steady flow, this system utilizes pulsatile flow, a low prime volume (500ml) and a closed circuit. During in vitro experiments, the pseudo patient's mean arterial pressure was kept constant at 40 mmHg and the extracorporeal circuit pressure did not exceed a mean pressure of 200 mmHg. In our single in vivo experiment, the primary objective was to determine whether physiologic pulsatility with a 10F (3.3 mm) aortic cannula could be achieved. The results suggest that this is possible.
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Affiliation(s)
- A. Ündar
- Biomedical Engineering Program, College of Engineering, The University of Texas at Austin, Austin, Texas
| | - T.M. Runge
- Biomedical Engineering Program, College of Engineering, The University of Texas at Austin, Austin, Texas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - O.L. Miller
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - M.C. Felger
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - R. Lansing
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - D.L. Korvick
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - F.O. Bohls
- Biomedical Engineering Program, College of Engineering, The University of Texas at Austin, Austin, Texas
| | - S.E. Ottmers
- Biomedical Engineering Program, College of Engineering, The University of Texas at Austin, Austin, Texas
| | - B.J. O'dell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - J.R. Ybarra
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - R.V. Howelton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - R.Z. Mireles
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - C.K. Benson
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
| | - M.C. Holland
- Biomedical Engineering Program, College of Engineering, The University of Texas at Austin, Austin, Texas
| | - J.H. Calhoon
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas - USA
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Moroi M, Force M, Wang S, Kunselman AR, Ündar A. In Vitro Evaluation of ECG-Synchronized Pulsatile Flow Using the i-cor Diagonal Pump in Neonatal and Pediatric ECLS Systems. Artif Organs 2018; 42:E127-E140. [PMID: 29473652 DOI: 10.1111/aor.13103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 01/02/2023]
Abstract
The objective was to assess the i-cor electrocardiogram-synchronized diagonal pump in terms of hemodynamic energy properties for off-label use in neonatal and pediatric extracorporeal life support (ECLS) circuits. The neonatal circuit consisted of an i-cor pump and console, a Medos Hilite 800 LT oxygenator, an 8Fr arterial cannula, a 10Fr venous cannula, 91 cm of 0.6-cm ID arterial tubing, and 91 cm of 0.6-cm ID venous tubing. The pediatric circuit was identical except it included a 12Fr arterial cannula, a 14Fr venous cannula, and a Medos Hilite 2400 LT oxygenator. Neonatal trials were conducted at 36°C with hematocrit 40% using varying flow rates (200-600 mL/min, 200 mL increments) and postarterial cannula pressures (40-100 mm Hg, 20 mm Hg increments) under nonpulsatile mode and pulsatile mode with various pulsatile amplitudes (1000-4000 rpm, 1000 rpm increments). Pediatric trials were conducted at different flow rates (800-1600 mL/min, 400 mL/min increments). Mean pressure and energy equivalent pressure increased with increasing postarterial cannula pressure, flow rate, and pulsatile amplitude. Physiologic-like pulsatility was achieved between pulsatile amplitudes of 2000-3000 rpm. Pressure drops were greatest across the arterial cannula. Pulsatile flow generated significantly higher total hemodynamic energy (THE) levels than nonpulsatile flow. THE levels at postarterial cannula site increased with increasing postarterial cannula pressure, pulsatile amplitude, and flow rate. No surplus hemodynamic energy (SHE) was generated under nonpulsatile mode. Under pulsatile mode, preoxygenator SHE increased with increasing postarterial cannula pressure and pulsatile amplitude, but decreased with increasing flow rate. The i-cor system can provide nonpulsatile and pulsatile flow for neonatal and pediatric ECLS. Pulsatile amplitudes of 2000-3000 rpm are recommended for use in neonatal and pediatric patients.
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Affiliation(s)
- Morgan Moroi
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Madison Force
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Moroi M, Force M, Wang S, Kunselman AR, Ündar A. In Vitro Comparison of Pediatric Oxygenators With and Without Integrated Arterial Filters in Maintaining Optimal Hemodynamic Stability and Managing Gaseous Microemboli. Artif Organs 2018; 42:420-431. [DOI: 10.1111/aor.13090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/25/2017] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Morgan Moroi
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Madison Force
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Surgery, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
- Department of Bioengineering, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
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Force M, Moroi M, Wang S, Palanzo DA, Kunselman AR, Ündar A. In Vitro Comparison of Two Neonatal ECMO Circuits Using a Roller or Centrifugal Pump With Three Different In-Line Hemoconcentrators for Maintaining Hemodynamic Energy Delivery to the Patient. Artif Organs 2018; 42:354-364. [PMID: 29323409 DOI: 10.1111/aor.13073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/05/2017] [Accepted: 10/05/2017] [Indexed: 01/02/2023]
Abstract
The objective of this study was to compare three different hemoconcentrators (Hemocor HPH 400, Mini, and Junior) with two different neonatal ECMO circuits using a roller or a centrifugal pump at different pseudo-patient pressures and flow rates in terms of hemodynamic properties. This evidence-based research is necessary to optimize the ECMO circuitry for neonates. The circuits used a 300-mL soft-shell reservoir as a pseudo-patient approximating the blood volume of a 3 kg neonate, two blood pumps, and a Quadrox-iD Pediatric oxygenator with three different in-line hemoconcentrators (Hemocor HPH 400, Mini, and Junior). One circuit used a Maquet H20 roller pump and another circuit used a Maquet RotaFlow centrifugal pump. The circuit was primed with lactated Ringer's solution followed by heparinized packed red blood cells with a hematocrit of 40%. The pseudo-patient's pressure was manually maintained at 40, 60, or 80 mm Hg and the flow rate was maintained at 200, 400, or 600 mL/min with a circuit temperature of 36°C. Pressure and flow data was recorded using a custom-made data acquisition device. Mean pressures, diverted blood flow, pressure drops, and total hemodynamic energy (THE) were calculated for each experimental condition. The roller pump and centrifugal pump performed similarly for all hemodynamic properties with all experimental conditions. The Hemocor HPH Junior hemoconcentrator added the highest resistance to the circuit. The Hemocor HPH Junior provided the highest circuit pressures, lowest diverted blood flow, highest pressure drop across the circuit, and highest THE generated by the pump. The Hemocor HPH 400 added the least resistance to the circuit, providing the lowest circuit pressures, more diverted flow, lowest pressure drop, and the lowest THE generated by the pump. However, the THE delivered to the patient was the same for the three hemoconcentrators. While the three hemoconcentrators performed differently in terms of hemodynamic properties throughout the circuit, the THE transmitted to the patient was similar for all three hemoconcentrators due to the consistent pseudo-patient's pressure that was manually maintained for each trial. While the THE delivered to the patient indicates similar perfusion for these patients with any of the three hemoconcentrators, the differences in added resistance to the circuit may impact the decision of which hemoconcentrator is used. There was no clinically significant difference between the two circuits with the roller versus centrifugal pump in terms of hemodynamic properties in this study. Further in vivo research is warranted to confirm our findings.
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Affiliation(s)
- Madison Force
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Morgan Moroi
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - David A Palanzo
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Affiliation(s)
- A. Ündar
- Departments of Pediatrics, Surgery, and Bioengineering, Penn State College of Medicine, Penn State Children's Hospital, Milton S. Hershey Medical Center, Hershey, Pennsylvania - USA
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Ündar A. Translational Research on Evaluation of Pediatric Cardiopulmonary Bypass Oxygenators. Artif Organs 2018; 42:103. [PMID: 29314116 DOI: 10.1111/aor.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Ündar A. The Relative Citation Ratio: Measuring Impact of Publications From an International Conference With a New NIH Metric. Artif Organs 2017; 41:1085-1091. [DOI: 10.1111/aor.13079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics - H085. Penn State College of Medicine; Penn State Health Children's Hospital, 500 University Drive; Hershey PA 17033-0850 USA
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Shank KR, Profeta E, Wang S, O'Connor C, Kunselman AR, Woitas K, Myers JL, Ündar A. Evaluation of Combined Extracorporeal Life Support and Continuous Renal Replacement Therapy on Hemodynamic Performance and Gaseous Microemboli Handling Ability in a Simulated Neonatal ECLS System. Artif Organs 2017; 42:365-376. [PMID: 28940550 DOI: 10.1111/aor.12987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
The objective of this study was to evaluate the hemodynamic performance and gaseous microemboli (GME) handling ability of a simulated neonatal extracorporeal life support (ECLS) circuit with an in-line continuous renal replacement therapy (CRRT) device. The circuit consisted of a Maquet RotaFlow centrifugal pump or HL20 roller pump, Quadrox-iD Pediatric diffusion membrane oxygenator, 8-Fr arterial cannula, 10-Fr venous cannula, and Better-Bladder (BB) with "Y" connector. A second Quadrox-I Adult oxygenator was added postarterial cannula for GME experiments. The circuit and pseudo-patient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 40%). All hemodynamic trials were conducted at ECLS flow rates ranging from 200 to 600 mL/min and CRRT flow rate of 75 mL/min at 36°C. Real-time pressure and flow data were recorded with a data acquisition system and GME were detected and characterized using the Emboli Detection and Classification Quantifier System. CRRT was added at distinct locations such that blood entered CRRT between the pump and oxygenator (A), recirculated through the pump (B), or bypassed the pump (C). With the centrifugal pump, all CRRT positions had similar flow rates, mean arterial pressure (MAP), and total hemodynamic energy (THE) loss. With the roller pump, C demonstrated increased flow rates (293.2-686.4 mL/min) and increased MAP (59.4-75.5 mm Hg) (P < 0.01); B had decreased flow rates (129.7-529.7 mL/min), and MAP (34.2-45.0 mm Hg) (P < 0.01); A maintained the same when compared to without CRRT. At 600 mL/min C lost more THE (81.4%) (P < 0.01) with a larger pressure drop across the oxygenator (95.6 mm Hg) (P < 0.01) than without CRRT (78.3%; 49.1 mm Hg) (P < 0.01). C also demonstrated a poorer GME handling ability using the roller pump, with 87.1% volume and 17.8% count reduction across the circuit, compared to A and B with 99.9% volume and 65.8-72.3% count reduction. These findings suggest that, in contrast to A and B, adding CRRT at position C is unsafe and not advised for clinical use.
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Affiliation(s)
- Kaitlyn R Shank
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Elizabeth Profeta
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Shigang Wang
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Christian O'Connor
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Public Health and Sciences, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Karl Woitas
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.,Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Health Children's Hospital, Hershey, PA, USA
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42
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Amodeo A, Ündar A. Welcome to the Thirteen International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2017. [DOI: 10.1111/aor.13014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Profeta E, Shank K, Wang S, O'Connor C, Kunselman AR, Woitas K, Myers JL, Ündar A. Evaluation of Hemodynamic Performance of a Combined ECLS and CRRT Circuit in Seven Positions With a Simulated Neonatal Patient. Artif Organs 2017. [PMID: 28621839 DOI: 10.1111/aor.12907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As it is common for patients treated with extracorporeal life support (ECLS) to subsequently require continuous renal replacement therapy (CRRT), and neonatal patients encounter limitations due to lack of access points, inclusion of CRRT in the ECLS circuit could provide advanced treatment for this population. The objective of this study was to evaluate an alternative neonatal ECLS circuit containing either a Maquet RotaFlow centrifugal pump or Maquet HL20 roller pump with one of seven configurations of CRRT using the Prismaflex 2000 System. All ECLS circuit setups included a Quadrox-iD Pediatric diffusion membrane oxygenator, a Better Bladder, an 8-Fr arterial cannula, a 10-Fr venous cannula, and 6 feet of ¼-inch diameter arterial and venous tubing. The circuit was primed with lactated Ringer's solution and packed human red blood cells resulting in a total priming volume of 700 mL for both the circuit and the 3-kg pseudopatient. Hemodynamic data were recorded for ECLS flow rates of 200, 400, and 600 mL/min and a CRRT flow rate of 50 mL/min. When a centrifugal pump is used, the hemodynamic performance of any combined ECLS and CRRT circuit was not significantly different than that of the circuit without CRRT, thus any configuration could potentially be used. However, introduction of CRRT to a circuit containing a roller pump does affect performance properties for some CRRT positions. The circuits with CRRT positions B and G demonstrated decreased total hemodynamic energy (THE) levels at the post-arterial cannula site, while positions D and E demonstrated increased post-arterial cannula THE levels compared to the circuit without CRRT. CRRT positions A, C, and F did not have significant changes with respect to pre-arterial cannula flow and THE levels, compared to the circuit without CRRT. Considering hemodynamic performance, for neonatal combined extracorporeal membrane oxygenation (ECMO) and CRRT circuits with both blood pumps, we recommend the use of CRRT position A due to its hemodynamic similarities to the ECMO circuit without CRRT.
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Affiliation(s)
- Elizabeth Profeta
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Kaitlyn Shank
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Christian O'Connor
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Allen R Kunselman
- Department of Public Health and Sciences, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Karl Woitas
- Penn State Heart and Vascular Institute, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA.,Department of Surgery, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Hershey, PA, USA.,Department of Surgery, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Wang S, Caneo LF, Jatene MB, Jatene FB, Cestari IA, Kunselman AR, Ündar A. In Vitro Evaluation of Pediatric Hollow-Fiber Membrane Oxygenators on Hemodynamic Performance and Gaseous Microemboli Handling: An International Multicenter/Multidisciplinary Approach. Artif Organs 2017; 41:865-874. [PMID: 28597590 DOI: 10.1111/aor.12912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr arterial cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P <0.01). GME count and volume at pre-/post oxygenator and pre-cannula sites in the Quadrox were lower than the Braile group at high flow rates (P < 0.05). In the additional experiment, an arterial filter captured a significant number of microemboli at all flow rates. The Braile Infant oxygenator has a matched hemodynamic characteristic with the Quadrox-i Pediatric oxygenator. The Quadrox-i has a better GME handling ability compared with the Braile Infant oxygenator. Regardless of type of oxygenator an additional arterial filter decreases the number of GME.
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Affiliation(s)
- Shigang Wang
- Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Luiz F Caneo
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo B Jatene
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Fábio B Jatene
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Idagene A Cestari
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Allen R Kunselman
- Public Health Sciences, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Surgery and Bioengineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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45
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Glass K, Trivedi P, Wang S, Woitas K, Kunselman AR, Ündar A. Building a Better Neonatal Extracorporeal Life Support Circuit: Comparison of Hemodynamic Performance and Gaseous Microemboli Handling in Different Pump and Oxygenator Technologies. Artif Organs 2017; 41:392-400. [DOI: 10.1111/aor.12908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/20/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Kristen Glass
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Payal Trivedi
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- Neonatal Intensive Care Unit, 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 Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Karl Woitas
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Public Health and Sciences, 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 Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- Surgery and Bioengineering, 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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Ündar A, Wang S, Palanzo DA, Wise R, Woitas K, Baer LD, Kunselman AR, Clark JB, Myers JL. Impact of Translational Research on Optimization of Neonatal Cardiopulmonary Bypass Circuits and Techniques-The Penn State Health Approach. Artif Organs 2017; 41:218-223. [DOI: 10.1111/aor.12906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Akif Ündar
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Surgery, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
- Department of Bioengineering,Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
| | - David A. Palanzo
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Perfusion, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Robert Wise
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Perfusion, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Karl Woitas
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Perfusion, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Larry D. Baer
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Perfusion, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Public Health and Sciences, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - Joseph B. Clark
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Surgery, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
| | - John L. Myers
- Department of Pediatrics; Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
- Department of Surgery, Penn State College of Medicine; Penn State Health Children's Hospital; Hershey PA USA
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47
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Ündar A, Rubatti M. Dr. Yves Durandy, February 20, 1947-October 6, 2016. Artif Organs 2017; 41:5-6. [PMID: 28093808 DOI: 10.1111/aor.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Akif Ündar
- Penn State College of Medicine, Department of Pediatrics-H085, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
| | - Marina Rubatti
- Centre chirurgical Marie Lannelongue, Département d'anesthésie, 133 avenue de la resistance, 92160, Le Plessis Robinson, France
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48
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Wang S, Spencer SB, Kunselman AR, Ündar A. Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study. Artif Organs 2017; 41:55-65. [DOI: 10.1111/aor.12904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/30/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
| | - Shannon B. Spencer
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
| | | | - Akif Ündar
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
- Surgery and Bioengineering, Penn State Hershey College of Medicine, Penn State Milton S. Hershey Medical Center; Penn State Hershey Children's Hospital; Hershey PA USA
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49
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Bacha EA, Chai P, Ündar A. Outcomes of the Twelfth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2017; 41:7-10. [DOI: 10.1111/aor.12896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Emile A. Bacha
- Division of Cardiac, Thoracic & Vascular Surgery; Columbia University Medical Center; New York NY USA
- Pediatric Cardiac Surgery at Morgan Stanley Children's Hospital and New York-Presbyterian Hospital; New York NY USA
| | - Paul Chai
- Division of Cardiac, Thoracic & Vascular Surgery; Columbia University Medical Center; New York NY USA
| | - Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery, and Bioengineering; Penn State College of Medicine, Penn State Health Children's Hospital; Hershey PA USA
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50
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Izer J, Wilson R, Hernon K, Ündar A. Ultrasound-guided vessel catheterization in adult Yorkshire cross-bred pigs. Vet Anaesth Analg 2017; 44:133-137. [DOI: 10.1111/vaa.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
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