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Cardiopulmonary bypass
V A Ferraris1, R Klingman, A Bufo
1Albany Medical College, New York.
Insights
Researchers are exploring new cardiopulmonary bypass techniques, including percutaneous extracorporeal circulation for high-risk angioplasty and retrograde cardioplegia for myocardial protection. Efforts also focus on managing postoperative bleeding and inflammatory responses during extracorporeal circulation.
Area of Science:
- Cardiovascular Surgery
- Cardiopulmonary Bypass
- Extracorporeal Circulation
Background:
- Renewed interest in cardiopulmonary bypass (CPB) and extracorporeal circulation (ECC).
- Focus on percutaneous techniques for circulatory assistance during high-risk percutaneous transluminal coronary angioplasty (PTCA).
- Concerns regarding blood transfusion-related communicable diseases driving research into CPB-related hemorrhage.
Purpose of the Study:
- To review and monitor results of percutaneous extracorporeal circulation.
- To investigate advancements in cardioplegia delivery for myocardial protection during CPB.
- To research hemostatic adjuncts and factors influencing postoperative hemorrhage in CPB.
Main Methods:
- Establishment of a national registry for percutaneous extracorporeal circulation techniques.
- Investigation of retrograde cardioplegia delivery via the coronary sinus.
- Evaluation of hemostatic drugs (aprotinin, desmopressin acetate) and antiplatelet agents (aspirin) in CPB.
Main Results:
- Retrograde cardioplegia via the coronary sinus is effective for myocardial protection.
- Investigative techniques using warm cardioplegia show promise in minimizing injury.
- Research is ongoing into drugs to manage postoperative bleeding and inflammatory responses during CPB.
Conclusions:
- Percutaneous extracorporeal circulation and retrograde cardioplegia represent significant advancements in CPB.
- Minimizing CPB-associated complications, including hemorrhage and myocardial injury, remains a key research focus.
- Further investigation into hemostatic agents and inflammatory modulation is crucial for optimizing CPB outcomes.
Abstract:
There has been a recent renewed interest in certain aspects of cardiopulmonary bypass employing extracorporeal circulation. Several areas have received special attention. Among these is the institution of extracorporeal circulation using a percutaneous technique for circulatory assistance during high-risk percutaneous transluminal coronary angioplasty. A national registry has been established to review and monitor results using this percutaneous technique. Several recent developments in the delivery of cardioplegia during ischemic arrest have stimulated investigative efforts. In particular, the delivery of cardioplegia in a retrograde manner through the coronary sinus has proved an effective and useful adjunct to myocardial protection during cardiopulmonary bypass with extracorporeal circulation. A newer investigative technique employing only warm cardioplegia delivered primarily through the retrograde coronary sinus route seems to offer some promise in providing optimal myocardial protection while minimizing hemorrhagic complications and other cold-induced myocardial injury. Because of concerns regarding blood transfusion-related communicable disease (eg, acquired immune deficiency syndrome and non-A, non-B hepatitis), there has been increasing research effort into postoperative hemorrhage related to cardiopulmonary bypass with extracorporeal circulation. Specifically, various drugs that may serve as hemostatic adjuncts have been investigated extensively. These drugs include aprotinin and desmopressin acetate. Likewise, several studies have evaluated other drugs (mainly aspirin) that have a negative influence on postoperative hemostasis. Additionally, there has been continued research interest in the activation of the inflammatory system during cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)