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Miniaturization in cardiopulmonary bypass
Ludwig K von Segesser1, Piergiorgio Tozzi, Iker Mallbiabrrena
1Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland. ludwig.von-segesser@chuv.hospvd.ch
Insights
Cardiopulmonary bypass (CPB) technology has advanced, but haemodilution remains an issue. Miniaturizing CPB equipment is the next crucial step to improve patient outcomes in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Perfusion Technology
Background:
- Cardiopulmonary bypass (CPB) is essential for complex cardiac surgeries.
- Despite 50 years of progress, current CPB systems have significant limitations.
- Major haemodilution affects gas transport, coagulation, and oncotic pressure.
Purpose of the Study:
- To highlight the need for miniaturized CPB equipment.
- To review advancements in low-prime perfusion devices.
- To identify key components for CPB system optimization.
Main Methods:
- Review of commercially available low-prime perfusion devices.
- Discussion of promising prototypes for CPB systems.
- Systematic approach to optimizing CPB components (pumps, oxygenators, filters, etc.).
Main Results:
- Commercial low-prime devices like CORx are available.
- Innovative prototypes such as smart suction systems and smart cannulas show promise.
- Miniaturization of CPB equipment is identified as the primary next step.
Conclusions:
- Further miniaturization of CPB equipment is essential to mitigate haemodilution.
- Optimizing all CPB components is necessary for improved clinical practice.
- Advancements in perfusion technology aim to enhance patient safety and surgical outcomes.
Abstract:
Cardiopulmonary bypass (CPB) remains the key technology for more complex cardiac operations. The perfusion equipment used nowadays has seen tremendous progress since its introduction into clinical practice 50 years ago. However, overall, CPB is still far from perfect. Major haemodilution is not only a problem for red cell-dependent gas transport, but also for the platelet and humeral factor-dependent coagulation, the protein-dependent intravascular oncotic pressure and so forth. Reduction of the priming volume through further miniaturization of CPB equipment is, therefore, the most obvious next step. A systematic approach needs to optimize all CPB components, including pumps, oxygenator/heat exchanger structures, filters, reservoirs, cardiotomy suction, tubings and cannulas. This report provides an update of already commercially available low prime perfusion devices (e.g., the CORx integrated pump-oxygenator) as well as promising prototypes like the smart suction system and the smartcanula.
