Star Perfusionist

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 th...

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 p...

Cardiopulmonary bypass ( CPB ) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment.

Hemoconcentrators A hemoconcentrator is a fluid removal device used during cardio bypass surgery. The device is inserted into the extracorpeal circuit where it acts to control hemodilution, maintain hematocrit levels, and reduce the need for additional blood products during and after surgery. Recognized as a great asset in fluid management, hemoconcentrators lower instances of edema, organ dysfunction and protein concentration. Using the Hemocon HPH hemoconcentrator: Reduces the need for homologous blood and blood products by providing patients with their own concentrated whole blood. Maintains the desired hematocrit level for oxygen transport to tissues. Decreases the risk of post-operative bleeding through the retention of platelets and plasma coagulation proteins. Maintains oncotic pressure by retaining plasma proteins while quickly and gently removing excess plasma water. Minimizes the need for diuretic use, which may be contraindicated for some patients....

Extra Corporeal Circulation Cardiopulmonary bypass (CPB) Cardiopulmonary bypass (CPB) is a technique allows blood to bypass the heart and lungs, and takes over the function of the heart and lungs temporarily during surgery, to maintaining the circulation of blood and the oxygen content of the body.                    The Cardiopulmonary bypass machine also known as a heart–lung machine(HLM) or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists.                    The Cardiopulmonary bypass consists generally of, the CPB machine and circuit comprises of plastic tubing, cannulas, and oxygenator . The CPB is designed to maintain systemic blood flow, oxygenation, and temperature regulation during surgery. Venous blood is drained by gravity into the reservoir by cannula place...

OXYGENATION The historical development of oxygenators is summarized in Fig. 1.1.Many methods of oxygenating the blood have been investigated over the years. Early experiments involved actually injecting oxygen directly into the blood stream, whilst other equally inventive techniques of oxygenation were attempted and soon abandoned. These early experiments focused purely on artificial oxygenation, without concerning themselves with the need for carbon dioxide removal. It seemed that what was actually needed was in fact a lung, either natural or artificial. The lungs In 1956, Campbell reported successful cardiac surgical procedures in humans on bypass, by use of dog lungs (Campbell et al., 1956), and Mustard and co-workers reported the use of scrupulously washed monkey lungs for oxygenation in human cardiac surgery in 1954. These experiments, although seemingly moderately successful, were extremely complicated and soon abandoned (Mustard et al., 1954; Mustard and Thomson, 1957)...

Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment.

Cardiopulmonary bypass is commonly used in coronary bypass heart surgery because of the difficulty of operating on the beating heart. Operations requiring the opening of the chambers of the heart require the use of CPB to support the circulation during that period. The machine pumps the blood, and, using an oxygenator, allows red blood cells to pick up oxygen, as well as allowing carbon dioxide levels to decrease. This mimics the function of the heart and the lungs, respectively. CPB can be used for the induction of total body hypothermia, a state in which the body can be maintained for up to 45 minutes without perfusion (blood flow). If blood flow is stopped at normal body temperature, permanent brain damage normally occurs in three to four minutes – death may follow shortly afterward. Similarly, CPB can be used to rewarm individuals suffering from hypothermia. Extracorporeal membrane oxygenation (ECMO) is a form of CPB sometimes used as life-support for newborns with s...

The rationale for perioperative red blood cell (RBC) transfusion is based on the observations that anemia is an independent risk factor for morbidity and mortality after cardiac surgery and that red blood cell transfusion would benefit a subset of patients presenting tissue hypoperfusion . However, transfusions have been associated with high rates of morbidity and mortality in critically ill patients, and there is increasing evidence for independent relationships between RBC transfusion and infectious complications, cardiac and respiratory morbidity, prolonged length of stay (LOS) and mortality after cardiac surgery .                                     The Transfusion Requirements After Cardiac Surgery (TRACS) study was a prospective, randomized, controlled trial that recently demonstrated the ...

Cardiac physiology or heart function is the study of healthy, unimpaired function of the heart: involving blood flow; myocardium structure; the electrical conduction system of the heart; the cardiac cycle and cardiac output and how these interact and depend on one another.

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  Cardiopulmonary bypass ( CPB ) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment.

Four types of blood pumps are currently available for CPB: 1. roller pump 2. centrifugal pump 3. pulsatile and 4. nonocclusive roller pump

An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or great blood vessel. These organs can be the heart, lungs or liver, while the great vessels can be the aorta, pulmonary artery, pulmonary veins or vena cava. An oxygenator is typically utilized by a perfusionist in cardiac surgery in conjunction with the heart-lung machine. However, oxygenators can also be utilized in extracorporeal membrane oxygenation in neonatal intensive care units by perfusionist.