SELCAB (self-lung cardiac bypass) procedures for pediatric patients

Cardiopulmonary bypass (CPB) for pediatric heart surgeries is not ideal. The currently available systems have a priming volume of 400-1,200 ml, requiring substantial hemodilution. CPB also subjects immature lung tissue to unphysiologic conditions. Exposure of the pediatric patient's blood to the large surface areas of foreign materials associated with an oxygenator results in humoral and cellular impacts on the pediatric patient's immature organs and should be avoided. For selected cases of pediatric heart surgeries, the SELCAB (self-lung cardiac bypass) procedure would be advantageous over CPB. This procedure is equivalent to a biventricular assist device (BVAD) implantation. To distinguish this procedure from long-term BVAD, a BVAD implantation of less than 2 weeks is referred to as SELCAB. Also, the SELCAB's inflow cannulations are either in atria or veins, whereas BVAD inflow cannulations are in ventricles. Advantages and disadvantages of SELCAB are discussed. The physiologic acceptance of SELCAB procedures in immature calves (pediatric model), with beating and nonbeating natural hearts for as long as 3 months, is described. The SELCAB and BVAD systems developed by these authors are also described in this article.