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 1 2/13/2014 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 2 2/13/2014 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) 3 2/13/2014 SBCC Experience First OPCABG SBCC 25/07/2003 OPCABG Today 2000 Resting Heart 100 4 2/13/2014 Our Technique • Literature 5 2/13/2014 • 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. 6 2/13/2014 Resting Heart for Impaired LV Function 32 cases of resting heart for severely impaired left ventricle Table (1): Preoperative demographic and laboratory results. 7 2/13/2014 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. 8 2/13/2014 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 9 2/13/2014 • 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. 10 2/13/2014 11
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