cardiac perfusion learner

Off-pump coronary artery bypass grafting (OPCAB) is a standard procedure for patients who require CABG in Japan, with OPCAB performed in >60 % of patients who undergo CABG. This widespread use of OPCAB in Japan is supported by a number of studies that have been performed in the Japanese population. This chapter introduces those studies that have had a signifi cant impact on OPCAB-related practice and consists of four primary sections that summarize the technical aspects, patient management, intraoperative graft evaluation, and surgical outcomes related to OPCAB. Although the majority of these studies were conducted retrospectively in single institutions, they are well designed, relevant, and innovative. To establish evidence for guidelines to be used in Japanese clinical settings, larger multicenter, randomized prospective, and observational studies using nationwide databases should be conducted. https://drive.google.com/open?id=1v22y-8wy66JuDM4HX3YKZtthlNu8SD_O

In medicine, hemofiltration , also haemofiltration , is a renal replacement therapy which is used in the intensive care setting. It is usually used to treat acute kidney injury (AKI), but may be of benefit in multiple organ dysfunction syndrome or sepsis. During hemofiltration, a patient's blood is passed through a set of tubing (a filtration circuit ) via a machine to a semipermeable membrane (the filter ) where waste products and water (collectively called ultrafiltrate ) are removed by convection. Replacement fluid is added and the blood is returned to the patient

Myocardial protection was a key part of these developments that allowed safe cardiac surgery to be performed. The term myocardial protection encompasses more than just cardioplegia, and can be said to include things such as the perioperative management of patients with medical treatment (such as beta-blockers, etc.), or support devices (such as intraaortic balloon pumps), better anesthetic agents,and better hemodynamic management. All of these treatments contribute to making cardiac surgery safer, and to get a sick patient through a major operation. However, for the purposes of our discussion we will focus more on the development of cardioplegia. This is a very large field of research and has been reviewed in several books and review articles. In one chapter we will only be able to go over some of the important highlights, and give a general outline of the work that has brought us to where we are today. Cardioplegia The first use of "elective cardiac arrest" was b

Extracorporeal circulation and cardiopulmonary bypass are synonymous terms denoting a method by which the blood that usually returns directly to the heart is temporarily drained from the superior and inferior venae cavae. The blood is diverted into a reservoir, where it is oxygenated and subsequently returned to the patient’s arterial circulation. This process effectually excludes the heart from the general circulation and leaves it empty so that it can accommodate surgical intervention. Myocardial protection To provide a dry, motionless, operative area, a cross-clamp is placed across the ascending aorta above the coronary ostia and proximal to the aortic cannula, thus isolating the coronary circulation and preventing blood entering the chambers of the heart. Therefore, techniques of myocardial protection are used to preserve myocardial function and prevent cell death. Cardioplegic techniques for myocardial protection involve the delivery of cardioplegic solution t

We describe selective cerebral perfusion techniques for repair of the aortic arch in neonates. These techniques may help protect the brain from ischemic injury caused by a cessation of cerebral perfusion for aortic arch reconstruction in patients with hypoplastic left heart syndrome or interrupted aortic arch. Although hypothermic circulatory arrest has been  a widely used procedure for the surgical repair of arch anomalies in neonates and infants, it has been suggested that this procedure sometimes produces neurologic injury. Because the long-term outcomes of cerebral function such as intellectual function and development after hypothermic circulatory arrest still remain to be determined, it seems worthwhile to protect the brain from ischemic injury as much as possible in neonatal open heart operations. We herein present some selective cerebral perfusion techniques in which the cerebral blood flow can be better maintained during the reconstruction of the aortic arch in the No

The concept of assisted circulation began with the development  of cardiopulmonarybypass (CPB). As the techniques for extracorporeal circulationutilizing CPB were perfected during the 1950s, the era of open heart surgery began. When CPB was introduced into the clinical arena in 1953 open intracardiac repairs were performed for the first time. Ultimately, attempts were made to utilize CPB for temporary support or replacement of cardiac function. However, the oxygenator, an integral component in the CPB circuit has a large blood contacting surface area which results in a significant blood:biomaterial interaction. Activation of the systemic inflammatory response and the resultant capillary leak syndrome produce profound systemic side effects. Furthermore, attempts to utilize CPB for long-term cardiac support were limited by bleeding associated with the need for full systemic anticoagulation and damage to formed blood elements. As open heart surgery became more commonplace patie