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Extracorporeal devices
Published in Ronald L. Fournier, Basic Transport Phenomena in Biomedical Engineering, 2017
Heart surgery oftentimes requires that the heart be stopped or arrested (cardioplegia). Cardioplegia can be achieved by infusing a cold (4°C) cardioplegic solution into the coronary circulation. Once the heart is arrested, blood is no longer pumped throughout the body and the blood is no longer oxygenated by the lungs. Blood flow to the chambers of the heart is also stopped, providing a dry and bloodless field for surgery. Over 700,000 open heart surgeries are performed in the United States every year (Federspiel and Henchir, 2004). Special devices called heart-lung machines or extracorporeal blood pump-oxygenators (Richardson, 1987; Makarewicz et al., 1993; Galletti and Colton, 1995; Federspiel and Henchir, 2004) have been developed and used for over 50 years (Gibbon, 1954; Iwahashi et al., 2004) to replace the gas exchange function of the lungs and the pumping action of the heart during these open heart surgical procedures.
Sheer Unadulterated Professionalism
Published in James Reason, The Human Contribution, 2017
The ASO is carried out on babies (< 35 days) who are born with the great vessels of the heart connected to the wrong ventricle: the aorta is connected to the right ventricle and the pulmonary artery to the left ventricle. This procedure involves correcting these congenital defects by transposing the pulmonary artery and the aorta so as to permit the full circulation of oxygenated blood. Without such an intervention, the child would die. The operation involves putting the patient on to a heart–lung bypass machine and freezing the heart with a potassium-based solution (cardioplegia). The procedure may last for five or six hours and is highly demanding both technically and in human terms. For some 90–120 minutes of this time, the child’s heart is stopped while the surgeon transects the native aorta, excising the coronary arteries from it, and re-implanting them into a neo-aorta. A neo-pulmonary artery is also reconstructed using the tissue from the trunk of the native aorta and a piece of the pericardium.
The role of robotic technology in minimally invasive surgery for mitral valve disease
Published in Expert Review of Medical Devices, 2021
Johannes Bonatti, Bob Kiaii, Cem Alhan, Stepan Cerny, Gianluca Torregrossa, Gianluigi Bisleri, Caroline Komlo, T. Sloane Guy
Usually after going on pump the pericardium is opened anterior to the phrenic nerve with attention not to jeopardize the nerve. Pericardial stay sutures are placed and pulled through the thorax. If the transthoracic clamp is used a long cardioplegia cannula is inserted into the ascending aorta either through the minithoracotomy or in transthoracic fashion. The Chitwood or Cygnet clamp is placed under robotic 3D vision making sure that the left atrial appendage is not injured. Alternatively, the endoballoon is inflated, a maneuver which can be followed under direct inspection of the ascending aorta and under TEE vision. Recently, a method has been shown in which fluorescent dye is taken to inflate the balloon. The balloon can then be clearly identified using the fluorescence camera (Firefly™) [34]. Cardioplegia is infused antegradely, some surgeons use percutaneous retrograde infusion in addition.
The Visible Heart® project and methodologies: novel use for studying cardiac monophasic action potentials and evaluating their underlying mechanisms
Published in Expert Review of Medical Devices, 2018
Megan M. Schmidt, Paul A. Iaizzo
For the study of recovered/reanimated large mammalian hearts, either healthy animals eliciting specific cardiac pathologies, or those with prior implanted cardiac devices, were placed under general anesthesia. Next, a median sternotomy was performed and a cannula was inserted into the ascending aorta to administer a high potassium cardioplegia solution prior to excision. The major vessels were cannulated and the heart was perfused and warmed using a modified Krebs-Henseleit buffer. Once the ventricular myocardium reached normothermic temperature, defibrillation shocks (typically at 2 to 4J) were applied to elicit sinus rhythm. At this point the heart was considered to be functioning, using intrinsic conduction pathways with no pacing or electrical stimulation required. Electrical signals, including MAPs, from a multitude of locations were simultaneously recorded [24,57,60,61]. These procedures and protocols were reviewed and approved by the University of Minnesota Institutional Animal Care and Use Committee and ensure humane treatment of all animals as indicated by the ‘Guide for the Care and Use of Laboratory Animals’ (NIH).
Mitral valve surgery: current status and future prospects of the minimally invasive approach
Published in Expert Review of Medical Devices, 2021
Karel M. Van Praet, Jörg Kempfert, Stephan Jacobs, Christof Stamm, Serdar Akansel, Markus Kofler, Simon H. Sündermann, Timo Z. Nazari Shafti, Katharina Jakobs, Stefan Holzendorf, Axel Unbehaun, Volkmar Falk
TTC and EABO [4] are the two different techniques for occluding and protecting the heart. The TTC technique has been described in detail [20] (the aorta is occluded through a transthoracic direct clamp inserted through an additional port or directly through the working incision [4]). For the cardioplegia [4], a separate line into the ascending aorta is used. However, the EABO technique provides both aortic occlusion and cardioplegia [4], based on the use of an endo-luminal balloon catheter inserted through the femoral artery. Another use of EABO is the re-do procedures where external cross-clamping can be complicated by the presence of adhesions [20,58,59]. Although the EABO technique has been associated with higher risk of periprocedural aortic dissection in the past (the Bristol [60] group), currently both techniques are considered safe and have similar rates of stroke and survival [60]. The data comparing TTC with EABO are scarce and merely retrospective, highlighting the fact that there is no significant difference in the safety profiles of the two techniques [20,61–69]. Both techniques have a considerably lower stroke rate than fibrillatory arrest and there is no difference in retrograde aortic dissection, bleeding, or adequacy of myocardial protection [20,58,70–74]. Kowalesky et al [75]. suggested that (1) to predict and prevent complications with femoral cannulation and perfusion optimal preoperative patient evaluation is key; (2) differences in aortic cross-clamp and CPB timing between both techniques were not observed; (3) EABO was found to be associated with an increase in relative risk of limp ischemia and vascular complications; (4) complications occur more frequently when surgeons have an initial experience with EABO and lack an adequate learning curve, which is mandatory; (5) significant differences in the occurrence of acute kidney injury, cerebrovascular accidents, and mortality between TTC and EABO could not be found.