American Journal of Cardiovascular Disease Research
ISSN (Print): ISSN Pending ISSN (Online): ISSN Pending Website: http://www.sciepub.com/journal/ajcdr Editor-in-chief: Dario Galante
Open Access
Journal Browser
Go
American Journal of Cardiovascular Disease Research. 2019, 6(1), 5-14
DOI: 10.12691/ajcdr-6-1-2
Open AccessOpinion Paper

Perfusion Quality Score (P.Q.S), in Material Selection before of Cardiopulmonary Bypass

Ignazio Condello1, and Giuseppe Speziale1

1Department of Cardiac Surgery, Anthea Hospital, Bari, Italy, GVM Care & Research

Pub. Date: September 05, 2019

Cite this paper:
Ignazio Condello and Giuseppe Speziale. Perfusion Quality Score (P.Q.S), in Material Selection before of Cardiopulmonary Bypass. American Journal of Cardiovascular Disease Research. 2019; 6(1):5-14. doi: 10.12691/ajcdr-6-1-2

Abstract

There is a large number of systems and technique patterns that deal with the extracorporeal circulation technique to reduce the biologic impact of the system. Nevertheless, there is no such thing as an evaluation quality score of the pathophysiology of the CPB cardiopulmonary bypass, as our world consists of a wide range of variants of the extracorporeal circulation, which are not provided with a quality yardstick.This work seeks to create a quality score, aiming at measuring the extra-corporeal circulation technique and its impact, linked to an inspection of the scientific literature in particular, to achieve goal directed perfusion.The studies concerning the optimisation of extracorporeal circulation techniques have been analysed to reduce the pathophysiological consequences of conventional systems. Also analysed were studies on patients with low- and high-risk candidates, candidates for cardiac surgery, who used special extracorporeal circulation techniques aimed at containing the pathophysiological response, cohort studies, prospective studies, retrospective studies and meta-analysis. This paper is meant to create a quality score of the components of the cardiopulmonary bypass, stimulating the qualitative selection of the materials of the techniques and methods.

Keywords:
cardiopulmonary bypass quality materials selection goal directed perfusion

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Baehner T, Boehm O, Probst C, et al. Cardiopulmonary bypass in cardiac surgery. Anaesthesist. 2012 Oct; 61(10): 846-56.
 
[2]  Condello I, Nasso G, Fiore F, et al. Fibonacci's golden ratio—an innovative approach to the design and management of extra-corporeal circulation. Surg Technol Int. 2019 Feb 27; 34.
 
[3]  Paparella D, Scrascia G, Rotunno C, Marraudino N, Guida P, De Palo M, Rubino G, Cappabianca G. A biocompatible cardiopulmonary bypass strategy to reduce hemostatic and inflammatory alterations: A randomized controlled trial. J Cardiothorac Vasc Anesth. 2012 Aug; 26(4): 557-62.
 
[4]  Potger KC, McMillan D, Ambrose M. Microbubble transmission during cardiotomy infusion of a hardshell venous reservoir with integrated cardiotomy versus a softshell venous reservoir with separated cardiotomy: An in vitro comparison. J Extra Corpor Technol. 2013 Jun; 45(2): 77-85.
 
[5]  Borrelli U, Al-Attar N, Detroux M, et al. Compact extracorporeal circulation: Reducing the surface of cardiopulmonary bypass to improve outcomes. Surg Technol Int. 2007; 16: 159-66.
 
[6]  Anastasiadis K, Murkin J, Antonitsis P, et al. Use of minimal invasive extracorporeal circulation in cardiac surgery: Principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS). Interact Cardiovasc Thorac Surg. 2016 May; 22(5): 647-62.
 
[7]  Bauer A, Hausmann H, Schaarschmidt J, et al. Shed-blood-separation and cell-saver: An integral Part of MiECC? Shed-blood-separation and its influence on the perioperative inflammatory response during coronary revascularization with minimal invasive extracorporeal circulation systems—a randomized controlled trial. Perfusion. 2018 Mar; 33(2): 136-147.
 
[8]  Anastasiadis K, Antonitsis P, Ranucci M, Murkin J. Minimally invasive extracorporeal circulation (MiECC): Towards a more physiologic perfusion. J Cardiothorac Vasc Anesth. 2016 Apr; 30(2): 280-1.
 
[9]  Basciani R, Kröninger F, Gygax E, et al. Cerebral microembolization during aortic valve replacement using minimally invasive or conventional extracorporeal circulation: A randomized trial. Artif Organs. 2016 Dec; 40(12): E280-E291.
 
[10]  Anastasiadis K, Antonitsis P, Kostarellou G, et al. Minimally invasive extracorporeal circulation improves quality of life after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2016 Dec; 50(6): 1196-1203.
 
[11]  El-Essawi A, Breitenbach I, Haupt B, Brouwer R, Baraki H, Harringer W. Impact of minimally invasive extracorporeal circuits on octogenarians undergoing coronary artery bypass grafting. Have we been looking in the wrong direction? Eur J Cardiothorac Surg. 2017 Dec 1; 52(6): 1175-1181.
 
[12]  Issitt RW, Mulholland JW, Oliver MD, et al. Aortic surgery using total miniaturized cardiopulmonary bypass. Ann Thorac Surg. 2008 Aug; 86(2): 627-31.
 
[13]  Stammers AH, Mongero LB, Tesdahl E, Stasko A, Weinstein S. The effectiveness of acute normolvolemic hemodilution and autologous prime on intraoperative blood management during cardiac surgery. Perfusion. 2017 Sep; 32(6): 454-465.
 
[14]  Passaroni AC, Felicio ML, Campos NLKL, Silva MAM, Yoshida WB. Hemolysis and inflammatory response to extracorporeal circulation during on-pump CABG: Comparison between roller and centrifugal pump systems. Braz J Cardiovasc Surg. 2018 Jan-Feb; 33(1): 64-71.
 
[15]  Demirtas H, Iriz E, Demirtas CY, et al. Investigating the effects of two different pump heads (Centrifugalvs. Roller Pump) on hematological and immunological mechanisms. Niger J Clin Pract. 2018 Jul; 21(7): 847-853.
 
[16]  Teligui L, Dalmayrac E, Mabilleau G, et al. An ex vivo evaluation of blood coagulation and thromboresistance of two extracorporeal circuit coatings with reduced and full heparin dose. Interact Cardiovasc Thorac Surg. 2014 Jun; 18(6): 763-9.
 
[17]  Marguerite S, Levy F, Quessard A, Dupeyron JP, Gros C, Steib A. Impact of a phosphorylcholine-coated cardiac bypass circuit on blood loss and platelet function: A prospective, randomized study. J Extra Corpor Technol. 2012 Mar; 44(1): 5-9.
 
[18]  Chores JB, Holt DW. Colloid oncotic pressure, monitoring its effects in cardiac surgery.J Extra Corpor Technol. 2017 Dec; 49(4): 249-256.
 
[19]  Magruder JT, Crawford TC, Harness HL, et al. A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg. 2017 Jan; 153(1): 118-125.
 
[20]  Beholz S, Zheng L, Kessler M, Rusche M, Konertz W. A new PRECiSe (priming reduced extracorporeal circulation setup) minimizes the need for blood transfusions: First clinical results in coronary artery bypass grafting. Heart Surg Forum. 2005; 8(3): E132-5.
 
[21]  Harsh Sateesh Seth, Prashant Mishra, Jayant V. Khandekar, et al. Relationship between high red cell distribution width and systemic inflammatory response syndrome after extracorporeal circulation. Braz J Cardiovasc Surg. 2017 Jul-Aug; 32(4): 288-294.
 
[22]  Gary Grist, RN, CCP, Carrie Whittaker, CCP, Kellie Merrigan, RRT, CCP, et al. The correlation of fluid balance changes during cardiopulmonary bypass to mortality in pediatric and congenital heart surgery patients. J Extra Corpor Technol. 2011 Dec; 43(4): 215-226.
 
[23]  Lou S, Ji B, Liu J, Yu K, Long C. Generation, detection and prevention of gaseous microemboli during cardiopulmonary bypass procedure. Int J Artif Organs. 2011 Nov; 34(11): 1039-51.
 
[24]  De Somer FM1, Vetrano MR, Van Beeck JP, Van Nooten GJ. Extracorporeal bubbles: A word of caution. Interact Cardiovasc Thorac Surg. 2010 Jun; 10(6): 995-1001.
 
[25]  Caltavuturo G, Reverberi R. A study of leucocyte removal by the Remowe LL cardiotomy reservoir. Blood Transfus. 2011 Jan; 9(1): 70-8.
 
[26]  Issitt R, Ball J, Bilkhoo I, Mani A, Walsh B, Voegeli D. Leukocyte filtration of the cardiotomy suction. Does it affect systemic leukocyte activation or pulmonary function? Perfusion. 2017 Oct; 32(7): 574-582.
 
[27]  Lagny MG, Gothot A, Hans GA, et al. Efficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte removal from shed mediastinal blood: A randomized controlled trial. Perfusion. 2016 Oct; 31(7): 544-51.
 
[28]  Molardi A, Di Chicco MV, Carino D, et al.The use of RemoweLL oxygenator-integrated device in the prevention of the complications related to aortic valve surgery in the elderly patient: Preliminary results. Eur J Prev Cardiol. 2018 Jun; 25(1_suppl): 59-65.
 
[29]  Hendrix RHJ, Ganushchak YM, Weerwind PW. Contemporary oxygenator design: Shear stress-related oxygen and carbon dioxide transfer. Artif Organs. 2018 Jun; 42(6): 611-619.
 
[30]  De Somer F. Does contemporary oxygenator design influence haemolysis? Perfusion. 2013 Jul; 28(4): 280-5.
 
[31]  Venema LH, Sharma AS, Simons AP, Bekers O, Weerwind PW. Contemporary oxygenator design relative to hemolysis. J Extra Corpor Technol. 2014 Sep; 46(3): 212-6.
 
[32]  Reagor JA1, Holt DW1. Removal of gross air embolization from cardiopulmonary bypass circuits with integrated arterial line filters: A comparison of circuit designs. J Extra Corpor Technol. 2016 Mar; 48(1): 19-22.
 
[33]  Gürsu Ö, Isbir S, Ak K, Gerin F, Arsan S. Comparison of new technology integrated and nonintegrated arterial filters used in cardiopulmonary bypass surgery: A randomized, prospective, and single blind study. Biomed Res Int. 2013; 2013: 529087.
 
[34]  Gürsu Ö, Isbir S, Ak K, Gerin F, Arsan S. Comparison of new technology integrated and nonintegrated arterial filters used in cardiopulmonary bypass surgery: A randomized, prospective, and single blind study. Biomed Res Int. 2013; 2013: 529087.
 
[35]  Durandy YD. Is there a rationale for short cardioplegia re-dosing intervals? World J Cardiol. 2015 Oct 26; 7(10): 658-64.
 
[36]  Issitt R, Ball J, Bilkhoo I, Mani A, Walsh B, Voegeli D. Leukocyte filtration of the cardiotomy suction. Does it affect systemic leukocyte activation or pulmonary function? Perfusion. 2017 Oct; 32(7): 574-582.
 
[37]  Naveed D, Khan RA, Malik A, Shah SZ, Ullah I, Hussain A. Role of modified ultrafiltration in adult cardiac surgery: A prospective randomized control trial. J Ayub Med Coll Abbottabad. 2016 Jan–Mar; 28(1): 22-5.
 
[38]  McRobb CM, Ing RJ, Lawson DS, Jaggers J, Twite M. Retrospective analysis of eliminating modified ultrafiltration after pediatric cardiopulmonary bypass. Perfusion. 2017 Mar; 32(2): 97-109.
 
[39]  De Somer F, Mulholland JW, Bryan MR, Aloisio T, Van Nooten GJ, Ranucci M. O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: Time for a goal-directed perfusion management? Crit Care. 2011 Aug 10; 15(4): R192.
 
[40]  Mandak J, Brzek V, Svitek V, et al. Peripheral tissue oxygenation during standard CPB and miniaturized CPB (direct oxymetric tissue perfusion monitoring study). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013 Mar; 157(1): 81-9.
 
[41]  Alsatli RA. Mini cardiopulmonary bypass: Anesthetic considerations. Anesth Essays Res. 2012 Jan-Jun; 6(1): 10-3.
 
[42]  Evora PR, Bottura C, Arcêncio L, Albuquerque AA, Évora PM, Rodrigues AJ. Key Points for Curbing Cardiopulmonary Bypass Inflammation.Acta Cir Bras. 2016; 31 Suppl 1: 45-52.
 
[43]  De Somer F. Optimization of the perfusion circuit and its possible impact on the inflammatory response. J Extra Corpor Technol. 2007 Dec; 39(4): 285-8.
 
[44]  Benedetto U, Luciani R, Goracci M, Capuano F, Refice S, Angeloni E, Roscitano A, Sinatra R. Miniaturized cardiopulmonary bypass and acute kidney injury in coronary artery bypass graft surgery. Ann Thorac Surg. 2009 Aug; 88(2): 529-35.
 
[45]  Moscarelli M, Condello I, Fattouch K, et al. Dopamine optimizes venous return during cardiopulmonary bypass and reduces the need for postoperative blood transfusion. ASAIO J. 2018 Dec 14.
 
[46]  Turnage C, DeLaney E, Kulat B, et al. A 201-2016 survey of American Board of Cardiovascular Perfusion Certified Clinical Perfusionists: Perfusion profile and clinical trends. J Extra Corpor Technol. 2017 Sep; 49(3): 137-149.
 
[47]  Carr BD, Johnson TJ, Gomez-Rexrode A, et al. Inflammatory effects of blood-air interface in a porcine cardiopulmonary bypass model. ASAIO J. 2018 Dec 18.
 
[48]  El-Sabbagh AM, Toomasian CJ, Toomasian JM, Ulysse G, Major T, Bartlett RH. Effect of air exposure and suction on blood cell activation and hemolysis in an in vitro cardiotomy suction model. ASAIO J. 2013 Sep-Oct; 59(5): 474-9.
 
[49]  Svenmarker S, Jansson E, Stenlund HJ, Engström KG. Red blood cell trauma during cardiopulmonary bypass: Narrow pore filterability versus free haemoglobin. Perfusion. 2000; 15: 33-40.
 
[50]  Johagen D, Appelblad M, Svenmarker S. Can the oxygenator screen filter reduce gaseous microemboli? J Extra Corpor Technol. 2014 Mar; 46(1): 60-6.
 
[51]  Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. A multidisciplinary perioperative strategy for attaining "more physiologic" cardiac surgery. Perfusion 2017 Sep; 32(6): 446-453.