RESUMEN
OBJECTIVES: Morbidity associated with coronary artery bypass grafts and embolization during aortic cannulation is strongly related to patient characteristics/comorbidities, arterial cannulation site used and the shape of arterial cannulae tips. The desired features of an arterial cannula should be to mitigate the morbid effects of these cannulas and to focus on achieving higher blood flows with lower cannula pressures (CPs). MATERIALS AND METHODS: To evaluate the in vivo performance of two aortic dispersion flow cannulas: the Optiflow (Sorin Group, Italy) and EZ Glide (Edwards Lifesciences). They were evaluated for CPs, pump-flow rates (FRs), and plasma-free hemoglobin (Hb) over a 12-month period. Data were collected in a prospective, randomized (1:1), nonblinded, monocentric study with a cohort of 30 patients (optiflow group N = 15; EZ Glide group N = 15). RESULTS: The optiflow cannula was found to have decreasing CPs as the pump FRs were increased (112.3 ± 10.9 vs 131.1 ± 11.4 mm Hg; P < .001). Results indicated no significant differences between groups for increases in plasma free Hb (P = .41) and total microembolic signals counts during the period of cardiac surgery (P = .63). CONCLUSIONS: Both optiflow and EZ Glide dispersion flow arterial cannulas performed well, but the optiflow cannula demonstrated an ability to increase pump FRs with lower arterial line and CPs than the EZ Glide cannula. This implies an ability to improve peripheral perfusion while reducing cannula shear stress and the risk of endothelial damage, thereby having the potential to reduce the risk of atherosclerotic plaque dislodgement.
Asunto(s)
Arterias , Cateterismo/métodos , Anciano , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Complicaciones Posoperatorias/terapia , Adulto , Análisis de los Gases de la Sangre , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Toma de Decisiones Clínicas , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Desconexión del VentiladorRESUMEN
The objectives of this study were to evaluate the efficacy of percutaneous cardiopulmonary support (CPS) for circulatory assistance during electrophysiological endocavitary procedures for ventricular tachycardia (VT) in high-risk patients. From January to June 1999, eight patients with VT not haemodynamically tolerated, underwent an electrophysiological mapping and ablation while supported with percutaneous CPS in the cardiac surgery service of the University of Milan. The CPS system allowed for the maintenance of an arterial pressure of 60-70 mmHg during the tachycardia episodes. CPS was used for 10-20 min periods to restore haemodynamic stability. With the haemodynamic support of CPS, it was possible to target and induce 21 VTs, with a mean cycle of 325 ms. The mean support time was 140 min (120-160 min). Stabilization of the arterial pressure at a mean value of 65 mmHg (55-85 mHg) was achieved over a mean period of 26 seconds. Oxygen saturation remained over 90% throughout the support for all patients, with no blood gas or electrolyte abnormalities. No CPB-related complications were observed. In conclusion, percutaneous CPS guarantees effective haemodynamic support during mapping and ablation of VTs not haemodynamically tolerated, with no complications related to the extracorporeal circulation or the cannulation.