Based on the results of many experimental models, a hollow fiber silicone membrane oxygenator applicable for long-term extracorporeal membrane oxygenation (ECMO) was developed. For further high performance and antithrombogenicity, this preclinical model was modified, and a new improved oxygenator was successfully developed. In addition to ECMO application, the superior biocompatibility ...

Principles of cardiovascular physiology tell us that during cardiac arrest and CPR, forward flow of blood can be generated by external compression or decompression of either the chest or the abdomen. Standard CPR utilizes only one of these modes--chest compression--and generates roughly 1 L/min forward flow in an adult human, ...

Cardiopulmonary bypass (CPB) is a safe support system during major cardiac operations because it allows the distribution of adequately oxygenated blood to the entire body. The optimal perfusion flow to be used during hypothermic CPB remains a controversial issue. In the present study, the effect of different flows and pressures ...

Peripheral cannulation for cardiopulmonary bypass (CPB) is of prime interest in minimally invasive open heart surgery. As CPB is initiated with percutaneous cannulae, venous drainage is impeded due to smaller vessel and cannula size. A new cannula was developed which can change shape in situ and therefore may improve venous ...

BACKGROUND: Continuous antegrade blood cardioplegia (CABCP) is used at different temperatures. We investigated the consequences of CABCP at 6 degrees C (COLD) vs. 28 degrees C (TEPID). METHODS: Anesthetized open-chest pigs (25 +/- 2 kg) were placed on cardiopulmonary bypass (CPB). The hearts were arrested for 30 min by 6 ...

Aortic arch hypoplasia is a common constituent of congenital heart disease. While repair of these lesions has been performed routinely during deep hypothermia and circulatory arrest, new approaches are emerging. One such approach, regional low-flow perfusion, will be described here. This technique exploits the anticipated modified Blalock-Taussig shunt as a ...

BACKGROUND: Dual-stream (DS) and standard cardiopulmonary bypass (CPB) were compared. METHODS: A DS catheter inserted into the distal ascending aorta across the arch pumps blood through an upper lumen (maximum 2.25 L/min) directed by a bloodstreaming baffle toward the arch vessels. A separate lower lumen pumps blood (maximum 3.75 L/min) ...

BACKGROUND: The effect of cardiopulmonary bypass temperature and blood gas management on the brain is still controversial. This study was designed to compare the changes in S100beta protein concentration and Mini-Mental State Examination in patients undergoing cold (28 degrees C) vs. warm (34 degrees C) cardiopulmonary bypass using different blood ...

BACKGROUND: The optimal pH strategy and hematocrit during cardiopulmonary bypass with deep hypothermic circulatory arrest (DHCA) remain controversial. We studied the interaction of pH strategy and hematocrit and their combined impact on cerebral oxygenation and neurological outcome in a survival piglet model including monitoring by near-infrared spectroscopy (NIRS). METHODS: Thirty-six ...

PURPOSE: Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children has been reported to reduce the need for postoperative blood transfusion and minimize postoperative blood loss. This study was undertaken to quantify the effects of MUF on coagulation factors in pediatric patients. METHODS: Seven children scheduled to undergo open-heart surgery ...

Pediatric myocardial related morbidity and mortality after cardiopulmonary bypass (CPB) are well documented, but the effects of pulsatile perfusion (PP) versus nonpulsatile perfusion (NPP) on myocardial blood flow during and after hypothermic CPB are unclear. After investigating the effects of PP versus NPP on myocardial flow during and after hypothermic ...

Cerebral microcirculatory changes in rat with a cardiopulmonary bypass (CPB) at normothermia was investigated in relation to cerebrovascular disorders caused by surgical operation with CPB. The mean arterial pressure was changed from 50 to 200 mmHg by changing the pump flow-rate. A non-pulsatile flow model was developed by stopping the ...

Extracranial-intracranial (EC-IC) bypass surgery had been widely performed for the treatment of internal carotid artery occlusion. However, it is presently difficult to predict how the bypass flow will contribute to intracranial circulation. We examined intracranial hemodynamics by transcranial color-coded duplex sonography (TCCD) after superficial temporal artery (STA)-middle cerebral artery (MCA) ...

The human aorta is a curved conduit with a complex three-dimensional geometry. The curvature influences axial velocity distribution and introduces transverse velocity components. Rotational flow in the aorta can be demonstrated during normal pulsatile flow using transesophageal echocardiography. Cardiopulmonary bypass may affect the pattern of rotational flow in the aorta ...

A 36-year-old sickle cell anemia patient undergoing a pulmonary thromboendarterectomy required the use of cardiopulmonary bypass incorporating deep hypothermic circulatory arrest. Being aware of reported incidences of sickling crises, a team of the surgeon, anesthesiologist, hematologist, and perfusionist met to devise a plan of treatment. Treatment included preoperative and intraoperative ...

PURPOSE: To assess and compare the effects of normothermic and mild hypothermic cardiopulmonary bypass (CPB) on hepatosplanchnic oxygenation. METHODS: We studied 14 patients scheduled for elective coronary artery bypass graft surgery who underwent normothermic (>35 degrees C; group I, n=7) or mild hypothermic (32 degrees C; group II, n=7) CPB. ...

A novel optical reflectance transducer for continuous and real time monitoring of oxygen saturation (So2) in extracorporeal tubings during cardiopulmonary bypass (CPB) is described. The optical transducer integrates 2 light-emitting diodes and a photodiode. The transducer is attached to the extracorporeal tubing by a transparent flow through a 3/8 x ...

OBJECTIVE: Cardiopulmonary bypass (CPB) triggers systemic inflammation. Recent evidence suggests that metabolic and oxygenation management can affect the outcome of patients after cardiac surgery. We investigated the influence of oxidant/antioxidant and protease/antiprotease imbalance during the course of systemic and pulmonary inflammation. METHODS: In a study of 61 patients, we measured ...

Although gravity drainage has been the standard technique for cardiopulmonary bypass (CPB), the development of min imally invasive techniques for cardiac surgery has renewed interest in using vacuum assisted venous drainage (VAVD) Dideco (Mirandola, Italy) has modified the D903 Avant oxygenator to apply a vacuum to its venous reservoir. The ...

Remifentanil is a potent opioid with a short duration of action. It has the potential for large-dose opioid anesthesia without an obligatory prolonged period of mechanical ventilation. However, because of high clearance and rapid tissue distribution, cardiopulmonary bypass (CPB) may influence its pharmacokinetics and alter drug requirements. We administered remifentanil ...

It has been suggested that aprotinin results in significantly increased risk for perioperative thrombotic complications in patients with Factor V(LEIDEN) (F5L) due to its ability to competitively inhibit activated protein C (APC) function in vitro. No clinical studies have been performed to assess the effect of aprotinin on APC function ...

During cardiopulmonary bypass (CPB) the collection of the patient's blood from the operating area is of fundamental importance. This blood is collected in the cardiotomy reservoir using field suckers and can be managed in different ways. It can be filtered in the cardiotomy reservoir and redirected to the venous reservoir, ...

BACKGROUND: Sufficient O2 delivery to meet the demand is an important factor for protecting the brain during cardiopulmonary bypass (CPB). This study was designed to investigate the influences of temperature, pulsatility of blood flow (intra-aortic balloon pump-induced) and flow rate during CPB on the cerebral oxygenation. METHODS: Patients were divided ...

OBJECTIVE: We sought to identify whether elevated PaO (2) itself can directly cause hyperglycemia in newborns and to document any additional effects of cardiopulmonary bypass on this response. METHODS: Piglets were exposed to either normoxia (88 +/- 6 mm Hg) or hyperoxia (470 +/- 28 mm Hg) in the following ...

OBJECTIVE: Open heart surgery without transfusion has been performed even in children. However, the critical limit of the hemoglobin level has not yet been ascertained. Here, we have assessed experimentally the effect of the hemoglobin level on brain metabolism under hypothermic cardiopulmonary bypass. METHODS: Brain tissue pH was measured in ...

OBJECTIVE: To determine if the Trillium Biopassive Surface (Medtronic Cardiopulmonary, Minneapolis, MN) coating added to the cardiopulmonary bypass oxygenator reduces inflammatory mediators, blood loss, and transfusion requirements. DESIGN: Prospective, randomized, and blinded human trial. SETTING: Tertiary care academic medical center. PARTICIPANTS: Thirty adult patients undergoing elective coronary artery bypass graft ...

BACKGROUND: One rationale for hemodilution during hypothermic cardiopulmonary bypass (CPB) has been improved microcirculation. However, the optimal degree of hemodilution remains unclear. We therefore studied cerebral microcirculation and tissue oxygenation in a new intravital microscopic model at 3 different hematocrit (Hct) values. METHODS AND RESULTS: Three groups of 5 piglets ...

OBJECTIVES: Open heart surgery without homologous blood transfusion remains difficult in children. The introduction of vacuum-assisted cardiopulmonary bypass circuits to reduce priming volume for pediatric patients has improved the percentage of transfusion-free operations. We retrospectively analyzed blood transfusion risk factors to further reduce blood transfusion requirements after vacuum-assisted circuit introduction. ...

OBJECTIVE: To determine the optimal venous tubing diameter for adult cardiopulmonary bypass (CPB) to improve gravity drainage and to reduce priming volume. METHODS: (A) Maximum bovine blood flow rates by gravity drainage were assessed in vitro for four different tubing diameters (1/2, 3/8, 5/16,1/4 inch) with three different lengths and ...

OBJECTIVES: Hemodilution has been applied conventionally during cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) to counteract the increase in viscosity and deleterious rheological effects caused by hypothermia. However, liver dysfunction after low-flow bypass and DHCA is common, and little is known about the effects of hematocrit (Hct). The ...

BACKGROUND: Regional low-flow perfusion has been shown to provide cerebral circulatory support during neonatal aortic arch operations. However, its ability to provide somatic circulatory support remains unknown. METHODS: Fifteen neonates undergoing arch reconstruction with regional perfusion were studied. Three techniques were used to assess somatic perfusion: abdominal aortic blood pressure, ...

OBJECTIVES: Although retrograde cerebral perfusion is being used clinically during aortic arch surgery, whether retrograde flow perfuses the brain effectively is still uncertain. METHODS: Fourteen pigs were cooled to 20 degrees C with cardiopulmonary bypass and perfused retrogradely via the superior vena cava for 30 minutes: 7 underwent standard retrograde ...

We measured the accuracy of the continuous intra-vascular blood-gas monitoring system (Paratrend 7, PT7) placed in the jugular venous bulb in 18 adult patients having cardiac or aortic surgery with hypothermic cardiopulmonary bypass (CPB). After induction of anaesthesia, a PT7 sensor was inserted through a 20-gauge venous catheter into the ...

BACKGROUND: Cardiopulmonary bypass (CPB) may decrease oxygen delivery relative to the nonbypass state. We predicted that a hierarchy of regional blood flow could be characterized under hypothermic (27 degrees C) CPB. METHODS: Ten pigs underwent bypass at 27 degrees C. Fluorescent microspheres were administered before and during CPB at four ...

BACKGROUND: Total circulatory arrest in deep hypothermia, which is used in corrective surgery of complex cardiovascular malformations, has been said to cause brain injury. Near-infrared spectroscopy (NIRS) is a new non-invasive method that potentially monitors changes in cerebral oxygenation and tissue oxygen utilisation. The aim of this experimental study in ...

BACKGROUND: Intraoperative blood salvage is an important part of blood conservation efforts in cardiac surgery. The purpose of this study is to examine the effects of three different circuit blood-salvaging techniques: centrifugation, ultrafiltration and direct infusion. METHODS: Sixty patients undergoing elective coronary bypass graft procedures were randomly assigned in a ...

OBJECTIVE: This study is the first comparative investigation of hepatic blood flow and oxygen metabolism during normothermic and hypothermic cardiopulmonary bypass. METHODS: Twenty-four patients undergoing coronary bypass operations were randomly divided into 2 groups according to their perfusion temperatures, either normothermia (36 degrees C) or hypothermia (30 degrees C). The ...

BACKGROUND: Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values ...

Challenged by the continued high mortality rates for patients in cardiac arrest, the American Heart Association and the European Resuscitation Council developed a new set of guidelines in 2000 to help advance several new and promising cardiopulmonary resuscitation (CPR) techniques and devices. This is the first time these organizations have ...

Based on the results of in vitro studies of many experimental models, a silicone hollow fiber membrane oxygenator for pediatric cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) was developed using an ultrathin silicone hollow fiber with a 300 microm outer diameter and a wall thickness of 50 microm. In ...

BACKGROUND: Contact of blood with foreign surfaces in the cardiopulmonary bypass (CPB) circuit induces an inflammatory response and immunosuppression which are associated with several organ dysfunctions following cardiac surgery. The aim of the present study was to evaluate clinical patient recovery after coronary artery bypass surgery (CABG) using CPB with ...

This study was undertaken to develop a recovery model of cardiopulmonary bypass (CPB) in rats. Twenty male Wistar rats (475-550 g) were anaesthetized, mechanically ventilated and the femoral vessels cannulated. The extracorporeal circulation circuit comprised a roller pump, a venous reservoir and a modified Capiox 308 paediatric membrane oxygenator. Priming ...

The increased interest of using ultrafiltration during cardiopulmonary bypass ICPB) has mandated a re-evaluation of the hematological effects of this blood conservation process. 'Rinse-free' ultrafiltrators can be primed using either crystalloid or blood prior to use. It is unknown whether one priming technique results in superior results in ultrafiltration quality. ...

Patients undergoing surgery with the aid of cardiopulmonary bypass (CPB) have an incidence of end-organ dysfunction, caused by embolization, regional hypoperfusion, or some combination of the two. In this article, we attempt to define the effect of mean arterial pressure (MAP) during CPB on postoperative end-organ function. Although early studies ...

BACKGROUND: This study examined whether 34 degrees C or 31 degrees C hypothermia during global cerebral ischemia with hyperglycemic cardiopulmonary bypass (CPB) in surviving pigs improves electroencephalographic (EEG) recovery and histopathologic scores when compared with normothermic animals. METHODS: Anesthetized pigs were placed on CPB and randomly assigned to 37 degrees ...

Adrenomedullin (AM), a vasodilatory peptide, increases during cardiac surgery. However, the physiological role of AM during cardiac surgery remains unclear. AM dilates cerebral arterioles and increases cerebral blood flow in rats. Therefore, we investigated whether AM is related to cerebral oxygen balance during cardiac surgery. In nine patients undergoing coronary ...

Volatile anaesthetics are often used during cardiopulmonary bypass (CPB). To understand the kinetics of inhaled anaesthetics during CPB, anaesthetists should understand changes in blood solubility caused by fluid use. We set out to predict the solubility of three volatile anaesthetics, desflurane, isoflurane and halothane, during CPB by determining: (i) their ...

OBJECTIVE: The purpose of this study was to clarify the hemodynamic features of patients who experienced improved neurological function after extracranial-intracranial arterial bypass surgery. With this aim, we retrospectively analyzed the results of their pre- and postoperative positron emission tomographic studies. METHODS: This study included 16 patients who exhibited stable ...

OBJECTIVE: Blood supply of the lungs during total cardiopulmonary bypass (CPB) is limited to flow through the bronchial arteries. This study was undertaken to assess the bronchial artery blood flow during CPB with fluorescent microspheres in a piglet model. METHODS: We subjected ten piglets (mean weight 5.0+/-0.5 kg) to 120 ...

INTRODUCTION: Cardiopulmonary bypass components need to be tested on an animal model before their clinical application. Because their weight is similar to that of man, the calf and pig are often used. This study compares the impact of prolonged perfusion on hemolysis and hematology profile in both species. METHODS: Three ...