Heparin-bonded circuits without a cardiotomy: a description of a minimally invasive technique of cardiopulmonary bypass

The deleterious effects of cardiotomy suction have been well recognized and well documented for some time. The use of cardiotomy suction results in the exposure of blood to the defoaming sock, aspiration of stagnant pericardial blood into the systemic circulation, and the entrainment of both fatty and gaseous microemboli. The purpose of this paper is to describe a technique using heparin-bonded cardiopulmonary circuits (HBCs) without the use of a cardiotomy reservoir or cardiotomy suction. Our group has previously demonstrated improved clinical outcomes using HBCs and a low-dose anti-coagulation protocol. It is our goal to further improve clinical outcomes and further attenuate the deleterious effects of cardiopulmonary bypass by eliminating the potential complications attributed to the use of cardiotomy suction.

[1]  Christopher M. Munsch,et al.  Techniques in Extracorporeal Circulation 4E , 2004 .

[2]  G. Gravlee,et al.  Cardiopulmonary Bypass: Principles and Practice , 2000 .

[3]  R. Shemin,et al.  Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume. , 1998, The Annals of thoracic surgery.

[4]  R. Shemin,et al.  Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits. , 1998, The Annals of thoracic surgery.

[5]  R. Shemin,et al.  Heparin‐bonded Circuits Improve Clinical Outcomes in Emergency Coronary Artery Bypass Grafting , 1997, Journal of cardiac surgery.

[6]  R. Shemin,et al.  Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study. , 1996, The Annals of thoracic surgery.

[7]  P. Everts,et al.  Systemic blood activation with open and closed venous reservoirs. , 1995, The Annals of thoracic surgery.

[8]  W. van Oeveren,et al.  Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis. , 1995, The Annals of thoracic surgery.

[9]  L. Eysman,et al.  Reduced platelet activation and improved hemostasis after controlled cardiotomy suction during clinical membrane oxygenator perfusions. , 1985, The Journal of thoracic and cardiovascular surgery.

[10]  J. Orenstein,et al.  Microemboli observed in deaths following cardiopulmonary bypass surgery: silicone antifoam agents and polyvinyl chloride tubing as sources of emboli. , 1982, Human pathology.

[11]  A. Marty.  Techniques in Extracorporeal Circulation, Second Edition , 1982 .

[12]  A. Starr,et al.  Effects of infusion of cardiotomy suction blood during extracorporeal circulation for coronary artery bypass surgery. , 1977, The Journal of thoracic and cardiovascular surgery.

[13]  A. W. Nelson,et al.  Blood volume measurement: concepts and technology. , 1971, The Journal of cardiovascular surgery.

[14]  W. van Oeveren,et al.  Retransfusion of thoracic wound blood during heart surgery obscures biocompatibility of the extracorporeal circuit. , 1996, The Journal of thoracic and cardiovascular surgery.

[15]  田渕典之.  Activation of Fibrinolysis in the Pericardial Cavity during Cardiopulmonary Bypass(体外循環中の心嚢腔内における線溶系異常活性の検討) , 1996 .