H Weitkemper | PubMed Health

PubMed1997

Pulsatile and nonpulsatile extracorporeal circulation using Capiox E terumo oxygenator: a comparison study with Ultrox and Maxima membrane oxygenators.

An open randomised, prospective study was undertaken on 90 patients who underwent routine myocardial revascularization. The aim of the study was to demonstrate that the Capiox E polypropylene fiber membrane oxygenator with a conventional single pulsatile/nonpulsatile blood pump for cardiopulmonary bypass (CPB) was comparable in performance to that of the Maxima and the Ultrox membrane oxygenators using a double pump system. The patients were divided into six groups according to perfusion mode and oxygenator type. Laboratory parameters, fluid balance and oxygenation was examined at set times before during and after cardiopulmonary bypass. Net fluid input was lower in the Capiox E groups regardless of perfusion mode: 2932 +/- 562 ml (Capiox E), compared to 3646 +/- 531 ml (Ultrox) and 3593 +/- 582 ml (Maxima). Net fluid balance 1288 +/- 534 ml was lowest in the Capiox/NP group, compared to 1604 +/- 460 ml (Ultrox/NP) and 1881 +/- 594 ml (Maxima/NP), (p < 0.05). The higher net fluid balance in the Capiox E/PP group 1649 +/- 580 ml compared to 1592 +/- 583 ml (Ultrox E/PP) and 1494 +/- 542 ml (Maxima/PP) was attributed to a technicality whereby the recommended priming volume of the Capiox E oxygenator was exceeded for safety reasons. The values of plasma free Hb were slightly higher in the PP than NP groups: Maxima/PP 80 mg/dl, /NP 50 mg/dl; Ultrox/PP 62 mg/dl, /NP 48 mg/dl; Capiox E/PP 55 mg/dl, /NP 48 mg/dl. The FiO2 was higher in the Capiox E groups 0.77 (PP) and 0.88 (NP) compared to Maxima/PP (0.66), /NP (0.65) and Ultrox/PP (0.64), /NP (0.63). Reciprocally, the venous saturation was higher in the Ultrox and Maxima groups compared to Capiox E at end of CPB. The study demonstrated that the CapioxE oxygenator with a single blood pump system can compare to the Maxima and Ultrox oxygenators with a double blood pump for CPB with regard to blood handling, oxygenation and fluid balance in routine cardiac surgery.

Blood Gas Analysis↗

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Heart transplantation in children after mechanical circulatory support: comparison of heart transplantation with ventricular assist devices and elective heart transplantation.

Heart transplantation (HTx) is an ultimate treatment for children with end-stage heart failure or inoperable congenital heart disease. The supply of hearts is inadequate; therefore, different mechanical support systems must be used as bridge to HTx in pediatric patients with postoperative low output. The use of ventricular assist devices (VADs) as bridge to HTx in children is limited because of size differences. The purpose of this study was to evaluate the overall long-term outcome of pediatric circulatory support before pediatric HTx. From 1989 through 2004, 91 pediatric patients underwent isolated HTx. Seven of them required mechanical support before transplantation. We reviewed retrospectively the course of 91 children (mean age 14.7 years) who underwent HTx. Group A consisted of elective HTx patients who were treated as outpatients before HTx, whereas group B was the VAD-HTx bridging group (n=7; mean age 12.31 +/- 2.8 years). Mean duration of VAD support was 108 +/- 98 days (minimum 1 day, maximum 258 days). Overall survival rate after HTx was 80% at 1 year without significant differences between groups. Five of seven patients survived and could be discharged after successful HTx, for a survival rate of 77%. The mean follow-up period was 16.76 +/- 10.6 months. No differences in posttransplantation long-term survival and rejection episodes occurred between patients transplanted with or without VAD. VAD therapy can keep pediatric patients with end-stage heart failure alive until successful HTx, and bridge to HTx is a safe procedure in pediatric patients. After HTx, survival rates of these children are similar to those of patients awaiting elective HTx.

Adolescent↗