062004 - sha-education.com

2/13/2014
Resting Heart CABG
For Sever LV Dysfunction Patient
Miss. Huda ALBishi
E. C. Perfusion
SBCC, Dammam, KSA
Cross-Clamp
No Cross-Clamp
Cardioplegia
No Cardioplegia
CPB Adverse
No CPB Adverse
No Conversion
Risk of Conversion
No Surgeon Stress
Surgeon stress
Adverse
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Adverse Effects of CPB
Cause
Effect
Hemodilution
Fluid retention, interstitial fluid accumulati
Neutrophil activation, decrease in surfactant
Pulmonary dysfunction
Platelet destruction by CPB platelet aggregation
Thrombocytopenia
Destruction by cardiopulmonary bypass
Hemoglobinemia
Embolus formation, bypass >2 hours
Stroke, neurological dysfunction
Cannulation, bubble oxygenator
Air emboli
Cannulation of femoral artery
Aortic dissection
Release of catecholamines (epinephrine,
norepinephrine) due to hypothermia
Hypertension
Release of tumor necrosis factor-@
Hypotension, tachycardia
Diuresis
Hypokalemia
Hypothermia
Myocardial depression
Glucagon release
Hyperglycemia
Systemic heparinization
bleeding
Leukocyte release
Capillary leakage
Leukocyte release, microemboli
Organ failure Renin- angiotensin
activation, vasopressin release, hypothermia
Oliguria
Recently, there have been attempts to
decrease these adverse effects (inflammatory
reaction) caused by the use of CPB by
developing better, more effective systems
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Resting Heart
Resting Heart is On
Pump Beating CABG
using a Minibypass
Benefits of Resting
•
•
•
•
1- Closed System (no blood activation).
2- No Cardiotomy Suction.
3- Low Prime Circuit (reduce hemodilution).
4- Venous Air Removal Device (VARD)
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SBCC Experience
First OPCABG SBCC
25/07/2003
OPCABG Today
2000
Resting Heart
100
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Our Technique
• Literature
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•
Circulation. 2007;116:1761-1767
Published online before print September 17, 2007, doi:
10.1161/CIRCULATIONAHA.107.697482
• Prospective Randomized Comparison of Coronary Bypass Grafting
With Minimal Extracorporeal Circulation System (MECC) Versus OffPump Coronary Surgery
•
Valerio Mazzei, MD; Giuseppe Nasso, MD; Giovanni Salamone, MD; Filippo
Castorino, MD; Antonello Tommasini, MD; Amedeo Anselmi, MD From the Division
of Cardiac Surgery, Ospedale Papardo (V.M., G.S., F.C., A.T.), Messina, Italy, and the
Division of Cardiac Surgery, Catholic University (G.N., A.A.), Rome, Italy.
• Conclusions— Clinical results of coronary revascularization
with MECC are optimal when this procedure is performed by
experienced teams. Postoperative morbidity is comparable
to that with OPCABG. MECC is associated with little pumprelated systemic and organ injury. It may achieve the
benefits of OPCABG (less morbidity in high-risk patients)
while facilitating complete revascularization in the case of
complex lesions unsuitable for OPCABG.
•
Extracorporeal circulation 2008
Microbubble activity in miniaturized and in conventional extracorporeal
circulation
Camboni D.1, Schmid S.1, Phillipp A.1, Flörchinger B.1, Harenski K.1, Arlt M.2, Hilker M.1, Wiebe K.1, Schmid C.1
1Universitätsklinik Regensburg, Herz-, Thorax und herznahe Gefäßchirurgie, Regensburg, Germany, 2Universitätsklinik Regensburg, Abteilung
für Anästhesiologie, Regensburg, Germany
Background: Ever since the establishment of miniaturized extracorporeal circulation (MECC), there has been a great controversy about
a possible increased risk of gaseous microembolism as compared to conventional extracorporeal circulation (ECC).
Methods: From March 2005 to June 2006, a prospective, randomized study, comparing three different miniaturized extracorporeal
systems (MECC®, PRECiSe®, Resting Heart ä) with a conventional extracorporeal circulation system (HL30® Maquet) was performed.
Ninety-three patients undergoing elective bypass surgery were included. The amount and size of microbubbles during perfusion was detected
in the arterial lines utilizing the Doppler principle (Bubblecounter BC100®). In addition, the effect of a venous bubble trap on the quantity
of microbubbels was assessed.
Results: The highest microbubble activity was measured in all systems during the first 10 minutes after initiation of extracorporeal circulation.
The amount of microbubbles was lower in the Resting Heart-Systemä(p = 0.011), and higher using the PRECiSe®-System as compared to
the conventional ECC (p=0.002). All systems had similar sized air bubbles with an average diameter of 0.03-0.12μm. The smallest
microbubbles appeared using the Resting Heart Systemä(p=ns). There was a trend towards larger microbubbles in miniaturized systems
in contrast to the conventional ECC. The integration of a venous bubble trap did insignificantly reduce the activity of microbubbles.
[Progression Microbubble Volume over Perfusion Time]
Conclusion: Miniaturized extracorporeal systems are as safe as
conventional extracorporeal systems with regard to the occurrence
of microbubbles.
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Resting Heart for Impaired LV Function
32 cases of resting heart for severely impaired
left ventricle
Table (1): Preoperative demographic and laboratory results.
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Table (2): Operative data of the patients.
CABG: Coronary arteries bypass grafting
CPB: Cardio-pulmonary bypass.
Min: minute.
Table (3): Clinical outcome and Postoperative laboratory results.
SD: standard deviation; ICU: intensive care Unit; FFP: fresh frozen Plasma;
PRBCS: packed red blood cells.
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New Studies should be done to find the real
position of Resting Heart Technique
our personal opinion: Resting Heart should be
located very close to the OPCAB
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• Resting Heart is a safe CABG technique that
combines all the benefits of OPCAB and OnPump Beating CABG almost without the
adverse of the CPB.
• Resting Heart is very beneficial specially for
patients with significant co morbidities and
patients with severe LV dysfunction.
• Take seriously in consideration Resting Heart
Technique.
• Start a Learning Curve in Beating Heart with
this very safe Technique for the patient, for
the surgeon & for the perfusion.
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