Efficiency of Minimized Circuits of a Heart Roller Pump on Systemic Inflammatory Response Syndrome and Multiorgan Effects in a Rat Model.

BACKGROUND: The aim of this study is to compare the effects of tubing length on systemic inflammatory response syndrome and myocardial protection in a rat model of cardiopulmonary bypass (CPB) from a histological standpoint. METHODS: Twelve adult male Wistar Albino rats weighing >180 g were randomly selected and divided into 2 groups. In 1 group, the pump lines were kept 1 m shorter than standard. The right jugular vein and tail artery were cannulated using a 16-gauge catheter. Animals received 500 IU/kg intravenous heparin. Cardiac index and rectal temperature were set at 2.4 mL and 36°C, respectively. Total line volume was maintained at 8 mL. A roller pump was adjusted to supply a blood flow of 6 to 28 mL/min (mean 10 mL/min), similar to the typical cardiac output of rats. CPB duration was 15 minutes throughout the experiment. After sacrifice, tissue samples were collected from heart, liver, and kidney for histomorphologic examination. RESULTS: All histochemical and histomorphologic analyses, performed by 2 blinded researchers, revealed band loss in cardiomyocytes, mononuclear (MNL) cell infiltration, and impaired fibrillar organization in the standard-line group. Additionally in that group, sinusoidal dilatation in the liver, low-level congestion, focal necrosis, and periportal MNL infiltration were noted. In the shorter-line group, on the other hand, MNL cell infiltration, band loss in myofibrils, and cardiomyocyte degeneration were rarely observed. Higher liver congestion and lower MNL cell infiltration were observed in the shorter-line group. No significant differences were found in kidney samples. CONCLUSION: In a shorter-line roller pump test model, less multiorgan damage and fewer systemic inflammatory responses were observed. It may be applicable to keep CPB lines as close to the table as possible, especially in pediatric cardiac surgery cases.

Simulation of cerebrovascular circulation in the human cadaver for surgical neuroanatomy training.

OBJECTIVE: The current progress in diagnostic and screening methods and surgical equipment technologies facilitates the accessibility to numerous anatomic structures through various interventional approaches. Consequently, the exact knowledge of the anatomic locations of neurovascular structures and their interactions may ensure that the surgical intervention is planned in the most appropriate way and the structures are accessed with the least complication risk during the intervention. MATERIAL AND METHODS: A decapitated and formalin fixated whole-head of a male human cadaver kept for educational and research purposes in the Dokuz Eylul University Department of Anatomy was used in this study. Two separate reservoirs (for the arterial and the venous system) were connected to the Truno System 3 labeled perfusion pump. The reservoirs were filled with blue and red warm tap water. Colored tap water pumped on the right was emptied from the left. Continuous flow of the water in the closed-circuit arterial and venous systems was achieved. As the circulation was continuing, pterional craniotomy was performed and the dura mater was accessed and lifted under the Zeiss dissecting microscope. CONCLUSION: We believe that this model may contribute to neuroanatomy education and provide experience for the safe and ethical performance of surgical interventions during the intraoperative period.

Postcardiotomy extracorporeal life support.

The need for postcardiotomy mechanical support is uncommon and likely to decline. A mixture of options is necessary to meet the diverse indications for cardiac support in a comprehensive heart failure program. Between January 1997 and December 2000, 29 adult, neonate, and infant cardiac surgical patients were supported on an extracorporeal life support system. Indications for cardiac assist included post-cardiotomy low cardiac output syndrome, and hyperacute rejection after cardiac transplantation. Data for analysis were collected prospectively. Survival on the life support system was 20/29 (69%) and 12 patients (41%) survived to discharge. The mean time to starting extracorporeal life support was longer in survivors than non-survivors. The extracorporeal life support system provides effective cardiopulmonary and end-organ support.