Pre-clinical laboratory evaluation of the new ‘AF’ arterial line filter range

Perfusion ◽  
2010 ◽  
Vol 25 (4) ◽  
pp. 267-276 ◽  
Author(s):  
Gemma Yarham ◽  
John Mulholland
Keyword(s):  
Pressure Drop ◽  
Surface Area ◽  
Heart Surgery ◽  
Clinical Laboratory ◽  
Open Heart Surgery ◽  
Global Market ◽  
Individual Characteristics ◽  
Laboratory Evaluation ◽  
Arterial Line ◽  
Experimental Conditions

Introduction: The presence of emboli was recognised relatively early in the history of open heart surgery. The emboli produced during cardiopulmonary bypass have the predisposition to distribute into, and ultimately obstruct, microvessels of all tissues. The Sorin Group has recently developed a new range of arterial line filters. Before the Sorin AF range of filters was released for pre-launch clinical trials, our group performed in vitro laboratory testing of the AF range against a selection of commercially available filters on the global market. Results: The Sorin AF620 and AF640 demonstrate both the smallest prime volume and smallest surface contact area (92ml and 290cm2, respectively).The results of the GME Handling Efficiency experiments ranged by 39.6%, from 95.9% to 56.3%. In terms of an air bolus handling, the results of the Limit Bolus experiment ranged by 97ml, from 147.5ml down to 50ml. The pressure drop across all the filters was measured under steady state experimental conditions. All of the above investigations were considered against surface area and prime volume. Conclusion: It is clear from the results that some commercially available arterial line filters perform better than others, not only in overall performance, but also with regard to individual characteristics. Evaluating arterial line filters for hospital-specific use has to balance pressure drop, surface area, micro air handling, prime volume and gross air handling; all points need to be considered. In the AF620 and AF640, Sorin boast that they are the two smallest prime and smallest surface area filters commercially available on the global market. The Sorin AF filter range performs well in all of the areas we investigated and will be a competitive option for centres, irrespective of which characteristics they use to evaluate and select their arterial line filter.

Experience with prostacyclin in cardiopulmonary bypass in dog and man

1981 ◽  
Vol 294 (1072) ◽  
pp. 399-412 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Mouse Heart ◽  
Arterial Line ◽  
Coronary Vein ◽  
Double Blind ◽  
Vein Grafts ◽  
Double Blind Clinical Trial ◽  
Consequent Reduction

The activation and disruption of platelets resulting from contact with bypass equipment is responsible for bleeding problems after open-heart surgery and for vascular injury leading to cerebral damage. This paper presents experimental and clinical evidence for the benefits of the preservation of platelets by prostacyclin (PGI 2 ) during cardiopulmonary bypass operations. Work with dogs showed that PGI 2 was more effective than heparin in maintaining the numbers and aggregability of the platelet population, but by far the most effective was a combination of the two agents. A subsequent double-blind clinical trial on 24 patients undergoing coronary vein grafts, in which the combination was compared with heparin alone, confirmed these findings in man. In the presence of PGI 2 , platelet numbers and aggregability were preserved, with a consequent reduction in blood loss. Significantly fewer reinforcing doses of heparin were required by the PGI 2 group. The integrity of platelets in the presence of PGI 2 was reflected by the lack of micro-aggregates and fibrin deposits on arterial line filters. In both the human and dog studies, PGI 2 was shown, by the cultured foetal mouse heart test, to prevent the release of circulating cardiotoxic factors during bypass. The known vasodilator effect of PGI 2 was observed but caused no clinical problems. An unexpected feature was the maintenance of perfusion pressure without the need for additional fluid. This may indicate that PGI 2 reduces capillary permeability.

A clinical evaluation of the performance characteristics of one membrane and five bubble oxygenators: gas transfer and gaseous microemboli production

Perfusion ◽  
1986 ◽  
Vol 1 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Derek T Pearson ◽  
Michael P Holden ◽  
Stefan J Poslad ◽  
Alan Murray ◽  
Philip S Waterhouse
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
The Other ◽  
Gas Transfer ◽  
Arterial Line ◽  
Open Heart ◽  
Blood Gas ◽  
Membrane Oxygenator ◽  
Normal Range ◽  
Meaningful Data

The gas transfer characteristics and gaseous microemboli (GME) production of five different bubble oxygenators (Polystan Venotherm, Harvey H-1700, Bentley BIO-10, Gambro 10 and Shiley S-100A HED) and one membrane oxygenator (Cobe CML) have been assessed during standardized clinical perfusion for open-heart surgery in 60 adult patients. The perfusionist attempted to maintain physiological levels of PaCO 2 (5 ± 1 kPa) and PaO2 (12 ± 2 kPa). Only 3% of blood gas values were within the normal range in the Bentley BIO-10 group compared with 17% for the Gambro 10, 20% for the Shiley S-100A HED, 31% for the Polystan Venotherm, 33% for the Cobe CML and 36% for the Harvey H-1700. The number of GME detected in the arterial line was significantly lower in the Cobe CML membrane oxygenator when compared with any of the five different bubble oxygenators (p < 0·001). The Polystan Venotherm released significantly less GME (p < 0·02) than the other oxygenators and the Shiley S-100A HED released significantly more GME (p < 0·02) than the other oxygenators except the Gambro 10. Low gas-blood flow ratios were not necessarily associated with low GME levels and inadequate oxygenation. This study provides meaningful data on which to base the choice of oxygenator, for clinical perfusions.

Diagnostic Value of Different Noninvasive Criteria of Latent Myocarditis in Comparison with Myocardial Biopsy

Cardiology ◽  
2019 ◽  
Vol 142 (3) ◽  
pp. 167-174
Author(s):  
Olga Blagova ◽  
Yuliya Osipova ◽  
Alexander Nedostup ◽  
Evgeniya Kogan ◽  
Alexander Zaitsev ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Comparison Group ◽  
Clinical Laboratory ◽  
Heart Diseases ◽  
Open Heart Surgery ◽  
Diagnostic Value ◽  
Study Group ◽  
Predictive Values ◽  
Morphological Studies ◽  
Noninvasive Markers

Purpose: The aim of this study was to quantify the value of various clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: In 100 patients (65 men, 44.7 ± 12.5 years old) with “idiopathic” arrhythmias (n = 20) and dilated cardiomyopathy (DCM; n = 80), we performed the following: 71 endomyocardial biopsies (EMB), 13 intraoperative biopsies, 5 studies of explanted hearts, and 11 autopsies with virus investigation (real-time PCR) of the blood and myocardium. Antiheart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), and coronary angiography (n = 47). The comparison group included 50 patients (25 men, 53.7 ± 11.7 years old) with noninflammatory heart diseases who underwent open heart surgery. Results: Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients in the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients in the comparison group than in the study group (65.0 and 40.2%; p < 0.01). We evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of AHA had the greatest importance in the identification of myocarditis: sensitivity was 81.5%, and the positive and negative predictive values were 75.0 and 60.5%. This defined the diagnostic value of noninvasive markers of myocarditis and established a diagnostic algorithm providing an individual assessment of the likelihood of myocarditis development. Conclusion: AHA have the greatest significance in the diagnosis of latent myocarditis in patients with “idiopathic” arrhythmias and DCM. The use of a complex of noninvasive criteria allows the probability of myocarditis to be estimated and the indications for EMB to be determined.

The use of a newly developed pediatric arterial perfusion cannula for neonates

1997 ◽  
Vol 7 (1) ◽  
pp. 71-73 ◽  
Author(s):  
Toshihide Asou ◽  
Hisataka Yasui ◽  
Hideaki Kado ◽  
Yutaka Imoto ◽  
Yuichi Shiokawa ◽  
...  
Keyword(s):  
Pressure Drop ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Diameter Ratio ◽  
External Diameter ◽  
Open Heart ◽  
Selective Cerebral Perfusion ◽  
Bypass Flow

AbstractWe report our experience using an originally designed thin walled metal-tipped arterial cannula for neonatal open heart surgery. Its external diameter is 2.1 mm and its internal diameter is 1.7 mm, it has a high internal – external diameter ratio. It was used on 36 patients, who were either neonates or small infants. In 32 of the patients, it was inserted into the ascending aorta for systemic perfusion. In the other 4, it was inserted into the brachiocephalic artery for selective cerebral perfusion during repair of the aortic arch. The relationship between the pressure drop and the bypass flow was obtained for the 7 most recently treated patients. The pressure drop at a bypass flow of 500 ml/min was 150 mmHg. Due to the high internal – external diameter ratio of this cannula, and its excellent flow characteristics, we consider it to be particularly useful in neonatal open heart surgery, while it also allows for successful selective cerebral perfusion during repair of the aortic arch in neonates.

Clinical evaluation of the LeukoGuard (LG-6) arterial line filter for routine open-heart surgery

Perfusion ◽  
1993 ◽  
Vol 8 (6) ◽  
pp. 489-496 ◽  
Author(s):  
David A Palanzo ◽  
Norman J Manley ◽  
Ralph M Montesano ◽  
Geary L Yeisley ◽  
David Gordon
Keyword(s):  
Clinical Evaluation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cost Effective ◽  
The Body ◽  
Experimental Investigations ◽  
Arterial Line ◽  
X Rays ◽  
Open Heart ◽  
Activated Neutrophils

Research has demonstrated that leucocyte depletion diminishes the deleterious effects that activated neutrophils have on the body following cardiopulmonary bypass (CPB). A clinical evaluation involving 36 patients (18 in each group) was conducted to compare the use of the Pall LG-6 (leucocyte-depleting) arterial line filter with the Pall EC PLUS filter for postoperative complications and lung function on routine open-heart cases. No differences were found between the groups for postoperative chest tube drainage, urine output, on bypass platelet drop, chest X-rays, blood usage and circulating elastase levels. Statistically significant differences were observed between immediately post-CPB pO 2 values and ventilator hours (EC PLUS = 13.3, LG-6 = 9.2). Many of the advantages of using leucocyte depletion that have been illustrated through experimental investigations were comparable to our clinical observations. We conclude that using the LG-6 leucocyte-depleting arterial line filter is a cost-effective method to reduce the complications known as 'postperfusion' syndrome.

scholarly journals Clinical, laboratory and instrumental criteria for myocarditis, established in comparison with myocardial biopsy: A non-invasive diagnostic algorithm

2017 ◽  
Vol 89 (9) ◽  
pp. 30-40 ◽  
Author(s):  
O V Blagova ◽  
Yu V Osipova ◽  
A V Nedostup ◽  
E A Kogan ◽  
V A Sulimov
Keyword(s):  
Heart Surgery ◽  
Comparison Group ◽  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Open Heart Surgery ◽  
Diagnostic Algorithm ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Study Group ◽  
Morphological Examination

Aim. To determine the diagnostic value of different clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in patients with the picture of idiopathic arrhythmias, dilated cardiomyopathy (DCM) and in a comparison group when comparing with myocardial morphological examination. Subjects and methods. A study group included 100 patients (35 women; mean age, 44.7±12.5 years) with idiopathic arrhythmias (n=20) and DCM as a syndrome (n=100). All underwent myocardial morphological examination: endomyocardial biopsy (EMB) (n=71), intraoperative biopsy (n=13), study of the explanted heart (n=6), and autopsy (n=11). A comparison group consisted of 50 patients (25 women; mean age, 53.7±11.7 years) with non-inflammatory diseases of the heart (left ventricular end-diastolic dimension 50%) who underwent open-heart surgery (n=47), EMB (n=2), or autopsy (n=1). The investigators also performed polymerase chain reaction for cardiotropic viral DNA in the blood and myocardium, anticardiac antibody (ACA) identification, myocardial scintigraphy (n=26), coronary angiography (n=47), magnetic resonance imaging (MRI) (n=25), and multislice computed tomography of the heart (n=45). The diagnostic value of the extended spectrum of clinical, laboratory, and instrumental markers for myocarditis was estimated. Results. Active/borderline myocarditis was diagnosed in 76% of the patients in the study group (75.5% in the arrhythmia subgroup and 76.3% in the DCM one) and in 24.3% of those in the comparison group (p

Enhanced Effective Fibrinolysis following the Neutralization of Heparin in Open Heart Surgery Increases the Risk of Post-Surgical Bleeding

1990 ◽  
Vol 63 (02) ◽  
pp. 241-245 ◽  
Author(s):  
Jørgen Gram ◽  
Thomas Janetzko ◽  
Jørgen Jespersen ◽  
Hans Dietrich Bruhn
Keyword(s):  
Blood Loss ◽  
Plasminogen Activator ◽  
Heart Surgery ◽  
Degradation Products ◽  
Open Heart Surgery ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Chest Tube Drain ◽  
Median Blood Loss

SummaryThe tissue-type plasminogen activator related fibrinolytic system was studied in 24 patients undergoing cardiopulmonary bypass surgery. The degradation of fibrinogen and fibrin was followed during and after surgery by means of new sensitive and specific assays and the changes were related to the blood loss measured in the chest tube drain during the first 24 postoperative hours. Although tissue-type plasminogen activator was significantly released into the circulation during the period of extracor-poreal circulation (p <0.01), constantly low levels of fibrinogen degradation products indicated that a systemic generation of plasmin could be controlled by the naturally occurring inhibitors. Following extracorporeal circulation heparin was neutralized by protamine chloride, and in relation to the subsequent generation of fibrin, there was a short period with increased concentrations of fibrinogen degradation products (p <0.01) and a prolonged period of degradation of cross-linked fibrin, as detected by increased concentrations of D-Dimer until 24 h after surgery (p <0.01). Patients with a higher than the median blood loss (520 ml) in the chest tube drain had a significantly higher increase of D-Dimer than patients with a lower than the median blood loss (p <0.05).We conclude that the incorporation of tissue-type plasminogen activator into fibrin and the in situ activation of plasminogen enhance local fibrinolysis, thereby increasing the risk of bleeding in patients undergoing open heart surgery

The Hemostatic Mechanism after Open-Heart Surgery

1978 ◽  
Vol 39 (02) ◽  
pp. 474-487 ◽  
Author(s):  
E R Cole ◽  
F Bachmann ◽  
C A Curry ◽  
D Roby
Keyword(s):  
Extracorporeal Circulation ◽  
Heart Surgery ◽  
Polyacrylamide Gel Electrophoresis ◽  
Open Heart Surgery ◽  
Coagulation System ◽  
Open Heart ◽  
Time Activity ◽  
Post Surgery ◽  
Plasma Fractions ◽  
The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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