Hemoglobin-based oxygen carriers (HBOCs) is a kind of blood substitutes. It is a separated, ultra-purified, modified human or bovine hemoglobin in a balanced saline solution. After modification, it has longer half-time, less renal toxicity, and better delivery of O2 even at low temperature and pH. Its shelf life is long and it dose not require cross-matching. In the field of cardiac surgery, the use of HBOCs can reduce the amount of transfusion postoperatively, and can be used in cardiopulmonary bypass priming and myocardial protection.
Cardiopulmonary bypass(CPB) is associated with thrombocytopenia and platelet dysfunction. The primary cause of acquired platelet defect is thought to be activation and release of alpha granules during CPB. Before CPB, platelet-rich plasma (PRP) was prepared by obtaining the required amount of patient’s whole blood by autologous plateletpheresis. PRP could be reinfused after operation in order to protect the function and quantities of the platelets. On the other hand, PRP could be made into autologous platelet gel (APG). APG contains supraphysiologic amounts of growth factors, and has adequate tensile strength and adhesive ability. Therefore, it can be used for hemostasis in operation, sealing wound and enhancing incision or dehiscent sternal wounds healing.
Abstract: There is a 1% - 4% incidence of cardiac disease in pregnancy, and rheumatic heart disease is the most common diagnosis. On the condition that medical treatment is inefficacious, an open heart surgery should be performed. Because of the changes in physiological functions, there is a major difference between pregnant patients and the general population in perioperative management of valve replacement. Now , the pregnancy is not an absolute contraindication for cardiopulmonary bypass, though the incidence of mortality and birth defects remains high. It is helpful in decreasing complications and increasing survival rate by improving themethods of cardiopulmonary bypass, postoperative monitoring, anticoagulation etc. In this article, the progress in t reatments of perioperative period of cardiac valve replacement during pregnancy is reviewed.
Patients with heparin-induced thrombocytopenia have a poor prognosis and high mortality, thus surgical risk under extracorporeal circulation increased. Early diagnosis, safe and effective alternative anticoagulation strategy are crucial for these patients to receive extracorporeal circulation surgery. This review focuses on the pathophysiology, laboratory examination, diagnosis and alternative anticoagulation strategy of extracorporeal circulation for patients with heparin-induced thrombocytopenia.
Perioperative monitoring of blood coagulation is critical to better understand causes of hemorrhage, to guide hemostatic therapies, and to predict the risk of bleeding. Point-of-care (POC) coagulation monitoring devices assessing the viscoelastic properties of whole blood may overcome several limitations of routine coagulation tests in the perioperative setting. The advantage of these techniques is that they have the potential to measure the clotting process, starting with fibrin formation and continue through to clot retraction and fibrinolysis at the bedside, with minimal delays. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red blood cells, and thereby providing useful additional information on platelet function. Viscoelastic POC coagulation devices are increasingly being used in clinical practice, especially in the management of patients undergoing cardiac and liver surgery, assessment of hypo-and hypercoagulable states, guiding pro- and anticoagulant therapies, monitoring of antiplatelet therapy and procoagulant therapy. To ensure optimal accuracy and performance, standardized procedures for blood sampling and handling, strict quality controls and trained personnel are required.
Objective To investigate the trends of cardiopulmonary bypass （CPB） professional development and personnel constitution in the past five years in China， and provide prediction and advice for the trend of Chinese CPB personnel constitution in the future. Methods We conducted 2 questionnaire investigations of Chinese hospitals in which cardiovascular surgeries were performed in the year 2005 and 2010， regarding the number of on-pump and off-pump cardiovascular operations and cases of extracorporeal membrane oxygenation （ECMO）. Data of CPB personnel constitution in the year 2005 and 2010 were analyzed. Results The total number of cardiovascular operation， on-pump cardiovascular operation and ECMO cases was 104 631， 86 155， and 68 respectively in 2005. The total number of cardiovascular operation， on-pump cardiovascular operation and ECMO cases was 170 547， 136 753， and 206 respectively in 2010. There were 708 CPB professionals in 2005， including 40.2% （285/708）full time perfusionists and 23.2% （164/708）perfusionists with senior professional titles. There were 2 111 CPB professionals in 2010， including 37.6% （793/2 111） full time perfusionists and 25.5% （539/2 111） perfusionists with senior professional titles. Conclusion There has been a rapid CPB professional development in the past five years in China. The proportion of full time perfusionists， perfusionists with senior professional titles and higher educational degree will further increase in the future.
Abstract: Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass (CPB) of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation (ECMO) in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2.2±0.8L and 0.6±0.3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9±1.8L and 2.4±1.3L respectively.The electrolytes and bloodgas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after peration.Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left thehospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient (68mg/L), and normal in 2 patients (lt;40mg/L). Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Objective To analyze the current situation of civil cardiopulmonary bypass, then to give suggestion and prediction for the future of civil cardiopulmonary bypass (CPB). Methods Civil hospitals carrying out cardiac operations were inquired with questionnaires annually concerning the scope of cardiac operations being carried out, the ratio of onpump operations and offpump operations, the situation of extracorporeal membrane oxygenation(ECMO), the composition of CPB technicians, and oxygenators being utilized, et al. Results 76 319 cases of cardiac operations were performed in 2003, while 136 015 cases of cardiac operations were performed in 2007 (among them 113 465 cases were CPB, account for 83.42% of cardiac operations). 41 hospitals carried out 153 cases of extracorporeal membrane oxygenation(ECMO) in 2007. The rate of membrane oxygenator(import) utilization was 46.16%, and the rate of membrane oxygenator(made in China) utilization was 23.9% in 2007. There were 1 497 persons engaged in of CPB in 2007, and among them 55% were doctors. All the perfusionisters had not been trained normally so far. Conclusion Cardiac surgery and CPB technique make rapid progress in china, so persons engaged in CPB need to be trained normally and systematically. In recent years, more and more membrane oxygenators are utilized, and there is a trend that bubble oxygenators would be abandoned finally.