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Academic literature on the topic 'Miniaturised Perfusion Circuit'

Author: Grafiati
Published: 11 March 2023

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Journal articles on the topic "Miniaturised Perfusion Circuit"

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Emery, Robert W., Goya V. Raikar, Barbara Murphy, Anton Rohan, and Kris Nielsen. "The Use of the Mini-Cardiopulmonary Bypass Circuit in Robotic Mitral Valve Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 3, no. 1 (January 2008): 16–18. http://dx.doi.org/10.1097/01.imi.0000312975.89468.8f.

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Background Computer enabled robotic mitral valve repair cases have longer cross-clamp and perfusion times because of the more technically difficult procedure. To modify some of the well-documented side effects of standard cardiopulmonary bypass (CPB), we used a new mini-circuit on three robotic mitral cases. Methods Three patients having mitral valve repair (triangular resection of P2 and annuloplasty ring) using the daVinci Robot (Intuitive Surgical, Sunnyvale, CA) had circulatory support using a modified Resting Heart System (Medtronic, Inc., Fridley, MN), a vertically oriented space saving CPB configuration incorporating a high efficiency miniaturized oxygenator, centrifugal pump, shortened heparin coated tubing and an air evacuation system with a closed circuit. Results All patients had successful mitral repair (echo = 0 to trace residual leakage) under a cross-clamp time of 161 ± 54 minutes and perfusion time of 229 ± 31 minutes. No blood was given during CPB and 0.7 ± 1.2 red cell units after the CPB run and 0.7 ± 1.2 units during the postoperative course. Conclusion Miniaturized bypass circuit reducing the level of necessary anticoagulation, hemodilation, and blood trauma can be used despite the increased perfusion time necessary for robotic mitral surgery.
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Alexander, B., M. Aslam, and I. S. Benjamin. "Hepatic function during prolonged isolated rat liver perfusion using a new miniaturized perfusion circuit." Journal of Pharmacological and Toxicological Methods 34, no. 4 (December 1995): 203–10. http://dx.doi.org/10.1016/1056-8719(95)00095-x.

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Groom, Robert C., Aaron G. Hill, Bechara Akl, Mark Kurusz, and Edward A. Lefrak. "Neonatal cardiopulmonary bypass—a review of current practice in North America." Cardiology in the Young 3, no. 4 (October 1993): 353–69. http://dx.doi.org/10.1017/s1047951100001785.

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One of the most challenging applications of cardiopulmonary bypass is corrective cardiac surgery in the neonate. The small size and high metabolic demand of these patients require miniaturized but efficient equipment. Even with the most advanced components, the volume required to prime the perfusion circuit is typically more than twice the blood volume of a neonate. Neonates have limited cardiac and pulmonary reserves and, therefore, great care is required to preserve those organs that have often already been subjected to hypoxemia, congestive heart failure, or low cardiac output prior to surgery. There is a tendency toward extravascular movement of fluids in newborns subjected to bypass that can adversely affect outcome. Careful monitoring and precise management of perfusion are essential to a successful procedure and optimal recovery of these patients.
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Boettcher, Wolfgang, Frank Dehmel, Mathias Redlin, Nicodème Sinzobahamvya, and Joachim Photiadis. "Cardiopulmonary Bypass Strategy to Facilitate Transfusion-Free Congenital Heart Surgery in Neonates and Infants." Thoracic and Cardiovascular Surgeon 68, no. 01 (November 3, 2019): 002–14. http://dx.doi.org/10.1055/s-0039-1700529.

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AbstractPriming the cardiopulmonary bypass (CPB) circuit without the addition of homologous blood constitutes the basis of blood-saving strategies in open-heart surgery. For low-weight patients, in particular neonates and infants, this implies avoidance of excessive hemodilution during extracorporeal circulation. The circuit has to be miniaturized and tubing must be cut as short as possible to reduce the priming volume to prevent unacceptable hemodilution with initiating CPB. During perfusion, measures should be taken to prevent blood loss from the primary circuit to avoid replacement by additional volume. Favorable factors such as mild hypothermia/normothermia and high heparin concentrations during extracorporeal circulation promote earlier hemostasis after coming off bypass.Lower mortality score, first chest entry, higher hemoglobin concentration before going on bypass, and shorter CPB duration support transfusion-free CPB procedure. Reduced postoperative morbidity and mortality were observed when CPB was performed without blood transfusion. In our experience, this can be achieved in at least 70% of CPBs, even in low-weight patients.Bloodless CPB circuit priming should become a widespread reality, even in neonates and young infants, in any open-heart procedure.
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Prasser, Christopher, Mohamed Abbady, Cornelius Keyl, Andreas Liebold, Magda Tenderich, Alois Philipp, and Christoph Wiesenack. "Effect of a miniaturized extracorporeal circulation (MECC™System) on liver function." Perfusion 22, no. 4 (July 2007): 245–50. http://dx.doi.org/10.1177/0267659107083242.

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Objective: To evaluate the effect of a miniaturized extracorporeal circulation system (MECC™System) compared to conventional extracorporeal circulation (ECC) regarding liver function in cardiac surgical patients. Methods: Double indicator dilution measurements were achieved by bolus injection of indocyanine green (ICG) for assessment of cardiac index (CI) and plasma disappearance rate of ICG (PDRig). Measurements were simultaneously performed preoperatively after induction of anaesthesia (T1), following admission on the ICU (T2) and 6 h postoperatively (T3). Results: CI and PDRig were markedly increased after cardiac surgery without significant differences between groups. The percentage increase in CI was significantly correlated to the percentage increase in PDRig in both groups. Conclusion: Liver function improved after cardiac surgery in both groups of patients, which may partly be explained by an increase in CI under mild inotrope support. Differences between the extracorporeal circuits with respect to PDRig appear to be minimal in a group of patients without pre-existing liver injury. Perfusion (2007) 22, 245—250.
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Tang, Bo, Mengxi Liu, and Andreas Dietzel. "Low-Cost Impedance Camera for Cell Distribution Monitoring." Biosensors 13, no. 2 (February 16, 2023): 281. http://dx.doi.org/10.3390/bios13020281.

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Electrical impedance spectroscopy (EIS) is widely recognized as a powerful tool in biomedical research. For example, it allows detection and monitoring of diseases, measuring of cell density in bioreactors, and characterizing the permeability of tight junctions in barrier-forming tissue models. However, with single-channel measurement systems, only integral information is obtained without spatial resolution. Here we present a low-cost multichannel impedance measurement set-up capable of mapping cell distributions in a fluidic environment by using a microelectrode array (MEA) realized in 4-level printed circuit board (PCB) technology including layers for shielding, interconnections, and microelectrodes. The array of 8 × 8 gold microelectrode pairs was connected to home-built electric circuitry consisting of commercial components such as programmable multiplexers and an analog front-end module which allows the acquisition and processing of electrical impedances. For a proof-of-concept, the MEA was wetted in a 3D printed reservoir into which yeast cells were locally injected. Impedance maps were recorded at 200 kHz which correlate well with the optical images showing the yeast cell distribution in the reservoir. Blurring from parasitic currents slightly disturbing the impedance maps could be eliminated by deconvolution using an experimentally determined point spread function. The MEA of the impedance camera can in future be further miniaturized and integrated into cell cultivation and perfusion systems such as organ on chip devices to augment or even replace light microscopic monitoring of cell monolayer confluence and integrity during the cultivation in incubation chambers.
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Darling, Edward, Sandra Harris-Holloway, Frank H. Kern, Ross Ungerleider, James Jaggers, Scott Lawson, and Ian Shearer. "Impact of modifying priming components and fluid administration using miniaturized circuitry in neonatal cardiopulmonary bypass." Perfusion 15, no. 1 (January 2000): 3–12. http://dx.doi.org/10.1177/026765910001500102.

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Following a succession of changes in circuitry and priming additives between 1993 and 1998, a comprehensive re-evaluation of neonatal cardiopulmonary bypass (CPB) practice was undertaken. Samples from 10 infants (Group 1) undergoing CPB were evaluated for osmolality, oncotic pressure, total protein, hematocrit, glucose, and electrolytes (Na+, K+, iCa2+). These samples were tested at six measurement points: (1) after priming, (2) patient pre-CPB, (3) CPB-start, (4) CPB-mid, (5) CPB-end, and (6) post-modified ultrafiltration (MUF). Prime volumes were also carefully measured as well as the type and amount of volume given during CPB. After evaluating the initial data, changes in protocol regarding mannitol, calcium correction, and oncotic strength on CPB were made. Following implementation of these protocol changes, a second set (Group 2) of 10 infants was identically evaluated. Group 1 prime osmolality was 379 ± 44 mOsm/kg, while Group 2 prime osmolality was 324 ± 14 mOsm/kg ( p = 0.003). There were no differences in osmolality between groups during bypass and osmolality was unaffected by modified ultrafiltration. Ionized calcium levels were significantly different at the end of bypass between Group 1, 0.6 ± 0.1 mmol/l; and Group 2, 1.17 ± 0.24 mmol/l ( p < 0.001). In Group 1, there was a 40% drop ( p = 0.001) in colloid osmotic pressure (COP) levels from pre-CPB (13.3 ± 3.4 mmHg) to CPB-end (8.8 ± 1.2 mmHg). In Group 2, there were no differences in COP during CPB. COP levels of Group 1 and Group 2 at CPB-end were 8.8 ± 1.2 mmHg and 14 ± 1.9, respectively ( p < 0.0001). Total volume addition during bypass for Group 1 was 363.5 ± 148.7 ml and for Group 2 was 245.1 ± 92.2 ml ( p < 0.05). In conclusion, progressive changes in neonatal circuits and techniques can have potentially wide-ranging effects on electrolyte and osmotic/oncotic homeostasis. An audit of perfusion management through expanded laboratory tests is recommended, especially in periods of change.
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Bell, J., Y. Yamamoto, H. Jenni, L. A. Mclean, G. Chiarella, A. El-Essawi, D. Glendza, et al. "2nd International Symposium on Minimal Invasive Extracorporeal Technologies Athens, Greece, 9-11 June 2016001SAFETY IN THE EVOLVING MINIATURIZED EXTRACORPOREAL SYSTEM002THE CHALLENGE OF CLOSED CIRCUIT SYSTEM FOR ALL CARDIOPULMONARY BYPASS CASES003THE USE OF A MINIMAL INVASIVE EXTRACORPOREAL CIRCUIT FOR REWARMING PATIENTS FROM ACCIDENTAL HYPOTHERMIA: A PROSPECTIVE STUDY004WHAT ARE THE LIMITATIONS OF MINIATURIZED ADULT CARDIOPULMONARY BYPASS? OUR FINDINGS005AORTIC VALVE SURGERY AND CORONARY BYPASS SURGERY IN DIALYZED PATIENTS. MAY MINIMAL EXTRACORPOREAL CIRCULATION BE HELPFUL IN GETTING BETTER RESULTS?006IMPACT OF MINIMAL EXTRACORPOREAL CIRCULATION IN OCTOGENARIANS UNDERGOING CORONARY ARTERY BYPASS GRAFTING. HAVE WE BEEN LOOKING IN THE WRONG DIRECTION?007CORONARY ARTERY BYPASS GRAFTING ON BEATING HEART, ON CARDIOPULMONARY BYPASS OR ON MINIMAL EXTRACORPOREAL CIRCULATION008MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IMPROVES QUALITY OF LIFE AFTER CORONARY ARTERY BYPASS GRAFTING009MINIMAL INVASIVE DETERMINATIONS OF OXYGEN DELIVERY (DO2) AND CONSUMPTION (VO2) IN CARDIAC SURGERY010CONTINUOUS MONITORING OF PERFUSION INDEX AND PULSE OXIMETRY DURING WARM PULSATILE PERFUSION IN PAEDIATRICS011CEREBRAL MICROEMBOLIZATION IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT ON MINIMAL INVASIVE OR CONVENTIONAL EXTRACORPOREAL CIRCULATION012ASSESSMENT OF AUTOMATED SOMATOSENSORY EVOKED POTENTIALS FOR DETECTION OF INTRAOPERATIVE POSITIONAL NEUROPRAXIA IN CARDIAC SURGERY013MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN MINIMALLY INVASIVE AORTIC VALVE SURGERY014MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN ENDOSCOPIC MITRAL VALVE SURGERY015AIR HANDLING CAPABILITY OF A CONVENTIONAL CARDIOPULMONARY BYPASS VERSUS MINIMIZED EXTRACORPOREAL CIRCUIT USING THE FUSION OXYGENATOR016DOES MINIMALLY INVASIVE EXTRACORPOREAL CIRCULATION AND CELL SALVAGE REDUCE INFLAMMATION AFTER CORONARY ARTERY BYPASS GRAFTING SURGERY?" Interactive CardioVascular and Thoracic Surgery 23, no. 4 (September 26, 2016): i1—i4. http://dx.doi.org/10.1093/icvts/ivw269.

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Rufa, Magdalena, Polychronis Antonitsis, Bernhard Winkler, Arndt H. Kiessling, Christian Ulrich, Mark J. Bennett, Hiromu Kehara, et al. "1st International Symposium on Minimal Invasive Extracorporeal Circulation Technologies, Thessaloniki, Greece, 13–14 June 2014001EMERGENCY CORONARY ARTERY BYPASS GRAFT SURGERY IN PATIENTS WITH OR WITHOUT ACUTE MYOCARDIAL INFARCTION USING THE MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION002IS THERE A LEARNING CURVE WHEN USING MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN CORONARY REVASCULARIZATION PROCEDURES?003MINIMAL EXTRACORPOREAL CIRCULATION ASSURES PERFORMANCE OUTCOME004CORONARY ARTERY REVASCULARIZATION WITH A MINIMAL EXTRACORPOREAL CIRCULATION TECHNIQUE: SHOTGUN ANALYSIS IN A PROSPECTIVE, RANDOMIZED TRIAL WITH THREE DIFFERENT PERFUSION TECHNIQUES005EFFECTS OF CELL SALVAGED AND DIRECTLY RETRANSFUSED MEDIASTINAL SHED BLOOD ON THE POSTOPERATIVE COMPETENCY OF THE COAGULATION SYSTEM AFTER CORONARY ARTERY BYPASS GRAFT SURGERY006THE RELATIVE INFLUENCE OF MINIATURIZED CARDIOPULMONARY BYPASS AND OTHER PERIOPERATIVE FACTORS ON BLOOD TRANSFUSION REQUIREMENT AFTER HEART SURGERY007LOWER PLATELET AGGREGATION MIGHT REDUCE PERIOPERATIVE BLEEDING IN MINI-CIRCUIT CARDIOPULMONARY BYPASS COMPARED TO CONVENTIONAL CARDIOPULMONARY BYPASS0085-YEAR EXPERIENCE OF BLOOD TRANSFUSION IN CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS USING MINIATURIZED EXTRACORPOREAL CIRCULATION009PAEDIATRIC CARDIAC EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: IMPROVED OUTCOME WITH EVOLVING TECHNOLOGY AND PRACTICE REFINEMENTS OVER 16 YEARS010THE USE OF ARTERIOVENOUS PCO2DIFFERENCE (Delta PCO2) AS AN INDEX OF THE DENSITY OF CAPILLARY PERFUSION DURING PAEDIATRIC CARDIOPULMONARY BYPASS AND EXTRACORPOREAL MEMBRANE OXYGENATION011‘ETERNAL ECMO’: THE CHALLENGE OF PROLONGED POST-CARDIOTOMY EXTRACORPOREAL MEMBRANE OXYGENATION012A VERSATILE MINIMIZED SYSTEM: THE STEP TOWARDS SAFE PERFUSION013HOW WE DEVELOPED A SAFER MINI BYPASS SYSTEM WITH THE USE OF A STOCKERT HEART LUNG BYPASS MACHINE AND MEDTRONIC FUSION OXYGENATOR014MINIMALIZING THE CARDIOPULMONARY BYPASS CIRCUIT AND THE CONSOLE015IS THREE-STAGE VENOUS CANNULA SUPERIOR TO DUAL-STAGE DURING SURGERY WITH MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION?016BENEFITS OF CLOSED MINIATURIZED CARDIOPULMONARY BYPASS017COGNITIVE BRAIN FUNCTION AFTER CORONARY BYPASS GRAFTING WITH MINIMIMAL INVASIVE EXTRACORPOREAL CIRCULATION018MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION REDUCES GASEOUS MICROEMBOLI AND PRESERVES NEUROCOGNITIVE FUNCTION: A SINGLE-CENTRE PROSPECTIVE RANDOMIZED STUDY019THE INFLUENCE OF PERIOPERATIVE FACTORS TO GENERATE ‘OUTLIERS’ IN CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY: A PRELIMINARY INVESTIGATION INCLUDING DIABETES AND METHOD OF CARDIOPULMONARY BYPASS020MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN 64 COMPLEX CARDIAC PROCEDURES: IS IT FEASIBLE AND SAFE?" Interactive CardioVascular and Thoracic Surgery 19, no. 4 (September 17, 2014): S718—S723. http://dx.doi.org/10.1093/icvts/ivu292.

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Olkowicz, Mariola, Hernando Rosales-Solano, Khaled Ramadan, Aizhou Wang, Marcelo Cypel, and Janusz Pawliszyn. "The metabolic fate of oxaliplatin in the biological milieu investigated during in vivo lung perfusion using a unique miniaturized sampling approach based on solid-phase microextraction coupled with liquid chromatography-mass spectrometry." Frontiers in Cell and Developmental Biology 10 (August 25, 2022). http://dx.doi.org/10.3389/fcell.2022.928152.

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Adjuvant chemotherapy after pulmonary metastasectomy for colorectal cancer may reduce recurrence and improve survival rates; however, the benefits of this treatment are limited by the significant side effects that accompany it. The development of a novel in vivo lung perfusion (IVLP) platform would permit the localized delivery of high doses of chemotherapeutic drugs to target residual micrometastatic disease. Nonetheless, it is critical to continuously monitor the levels of such drugs during IVLP administration, as lung injury can occur if tissue concentrations are not maintained within the therapeutic window. This paper presents a simple chemical-biopsy approach based on sampling with a small nitinol wire coated with a sorbent of biocompatible morphology and evaluates its applicability for the near-real-time in vivo determination of oxaliplatin (OxPt) in a 72-h porcine IVLP survival model. To this end, the pigs underwent a 3-h left lung IVLP with 3 doses of the tested drug (5, 7.5, and 40 mg/L), which were administered to the perfusion circuit reservoir as a bolus after a full perfusion flow had been established. Along with OxPt levels, the biocompatible solid-phase microextraction (SPME) probes were employed to profile other low-molecular-weight compounds to provide spatial and temporal information about the toxicity of chemotherapy or lung injury. The resultant measurements revealed a rather heterogeneous distribution of OxPt (over the course of IVLP) in the two sampled sections of the lung. In most cases, the OxPt concentration in the lung tissue peaked during the second hour of IVLP, with this trend being more evident in the upper section. In turn, OxPt in supernatant samples represented ∼25% of the entire drug after the first hour of perfusion, which may be attributable to the binding of OxPt to albumin, its sequestration into erythrocytes, or its rapid nonenzymatic biotransformation. Additionally, the Bio-SPME probes also facilitated the extraction of various endogenous molecules for the purpose of screening biochemical pathways affected during IVLP (i.e., lipid and amino acid metabolism, steroidogenesis, or purine metabolism). Overall, the results of this study demonstrate that the minimally invasive SPME-based sampling approach presented in this work can serve as (pre)clinical and precise bedside medical tool.
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Dissertations / Theses on the topic "Miniaturised Perfusion Circuit"

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MORJAN, MOHAMMED. "Modular Miniaturised Perfusion Circuits. From In Vitro Study to “Universal Heart Lung Machine”." Doctoral thesis, 2015. http://hdl.handle.net/11562/901384.

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La circolazione extracorporea convenzionale (cCEC) è un trigger per una risposta infiammatoria sistemica cosí come per l´emodiluizione, coagulopatie e disfunzione d´organo. La circolazione extracorporea miniaturizzata (MECC) ha il potenziale vantaggio di ridurre questi effetti deleteri. I dubbi sulla sua sicurezza sono stati uno dei principali motivi che hanno impedito la sua accettazione e la sua diffusione persino nei grandi centri dove il suo uso è limitato agli interventi di bypass aortocoronarico (CABG). Dopo una larga esperienza nella MECC abbiamo apportato delle modifiche tali da fugare i dubbi sulla sua sicurezza e tali da rendere il sistema ROCsafe (The Reservoir Optional Minimized perfusion circuits, Terumo Europe, Leuven, Belgium) una circolazione extracorporea universale per tutte le procedure in Cardiochirurgia. Da Gennaio 2013 a Dicembre 2013 abbiamo effettuato un totale di 113 procedure chirurgiche. Tra queste 100 sono state condotte con la ROCsafe. Se si escludono gli interventi con arresto di circolo o che potenzialmente ne avrebbero avuto bisogno, la ROCsafe è stata usata nell´88% degli interventi. Questi includono 62 operazioni classificate come procedure semplici (CABG, AVR, CABG+AVR) con un tempo di CEC medio di 85±28min ed un tempo di clampaggio medio di 55±24min, e 38 procedure complesse (inclusi 15 reinterventi) con un tempo di CEC medio di 141±59 min ed un clampaggio medio di 97+-42min. Delle procedure semplici l´82% erano non elettive, il 10% dei pazienti aveva una FE < 30% e la maggioranza una disfunzione renale. Delle procedure complesse 37% erano urgenze, 15% dei pazienti aveva una FE < 30% e la maggioranza una disfunzione renale. Nella totalitá dei casi è stato utilizzato un priming retrogrado autologo, la cardioplegia ematica è stata utilizzata nelle procedure semplici mentre la cristalloide nella maggioranza delle complesse ma drenata attraverso l´atrio di destra. La tecnica di cannulazione è stata adattata in base alle singole procedure ponendo particolare attenzione all´ingresso di aria e al rischio di sanguinamento. La mortalitá a 30 giorni si è assestata al 5% per le procedure semplici, i pazienti deceduti avevano un Euroscore logistico medio del 36%. La mortalitá a 30 giorni per i casi complessi è stata del 2,6%, i pazienti deceduti avevano un Euroscore logistico medio > 60% mentre nessun paziente con un Euroscore logistico < 40% è deceduto. L´incidenza di fibrillatione atriale postoperatoria è stata del 13% nei casi semplici e del 16% nei casi complessi. Un “Optimum outcome” definito come libertá da tutte le complicanze e da trasfusioni è stato del 52% e del 42% rispettivamente.
Conventional Cardiopulmonary Bypass (cCPB) is a trigger of systemic inflammatory response, hemodilution, coagulopathy, and organ failure. Miniaturised extra corporeal circulation (MECC) has the potential to reduce these deleterious effects. Safety concerns have been one of the main reasons opposing a wider acceptance of miniaturised perfusion circuits and impeding their wider applicability. Even centers with extensive experience have limited their use to simple coronary artery bypass (CABG). Following an extensive experience with MECC and a multitude of modifications that have negligated safety concerns we have set out to employ the Reservoir Optional Minimized Perfusion Circuit (ROCsafe, Terumo Europe, Leuven, Belgium) as a universal heart lung machine for all cardiac procedures. In the present series, we reported our experience From January 2013 to December 2013 with a total of 113 cardiac surgical procedures. Thereof 100 operations were done using the ROCsafe. Excluding procedures done under circulatory arrest or with the potential need for circulatory arrest, the ROCsafe was employed in 88% of surgeries. These included 62 operations classified as simple surgical operations (CABG, Aortic valve replacement (AVR) and CABG +AVR) with a mean bypass time of 85±28 min. and a mean clamping time of 55±24 min. and 38 operations classified as complex operations (including 15 re-interventions) with a mean bypass time of 141 ±59 min. and a mean clamping time of 97±42 min. Of the simple procedures 82% were non elective, 10% of patients had an EF<30% and the majority had an impaired renal function. Of the complex procedure 37% were urgent, 15% had an EF <30% and the majority had an impaired renal function. Retrograde autologous priming was used in all cases, blood cardioplegia was used in simple cases while crystalloid cardioplegia was used in most complex cases but drained via the right atrium. The cannulation technique was tailored to the needs of each procedure with special emphasis on avoidance of bleeding or air leaks. The 30 day mortality amounted to 5% in simple procedures, the patients who died having had a mean log Euroscore of 36%. The 30 day mortality of the complex cases was 2, 6% while their cumulative log Euroscore was>600%, no patient with a log Euroscore <40% having died. Postoperative atrial fibrillation occurred in 13% of simple cases and 16% of complex cases while Optimum outcome defined as freedom of all complications and blood transfusions was achieved in 52% and 42% respectively.
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