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Clinical Use of Centrifugal Pumps and the Roller Pump in Open Heart Surgery: A Comparative Evaluation
Masaru Yoshikai1, Masakatsu Hamada1, Kyoumi Takarabe1
1Department of Cardiovascular Surgery, Koga Hospital, Kurume; and * Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan.
Insights
Centrifugal pumps showed fewer negative effects on blood and coagulation compared to roller pumps during heart surgery. Specifically, centrifugal pumps reduced thrombin generation, indicating a potential benefit for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Hematology
Background:
- Centrifugal pumps are preferred in open-heart surgery for minimizing blood damage.
- Reducing coagulation system activation is a key goal in cardiopulmonary bypass (CPB).
Purpose of the Study:
- To compare the effects of two centrifugal pumps and one roller pump on blood elements and the coagulation system.
- To evaluate the impact on complements and immunoglobulins during CPB.
Main Methods:
- Used Lifestream and BP-80 centrifugal pumps, and a Mera Co. roller pump in 29 CPB patients.
- Measured platelet counts, lactate dehydrogenase, antithrombin III, thrombin-antithrombin complex (TAT), complements (C3, C4, CH50), and immunoglobulins (IgG, IgA, IgM) pre- and post-CPB.
Main Results:
- No significant differences were observed in most parameters between the pump types.
- Thrombin-antithrombin complex (TAT) levels increased less with centrifugal pumps compared to the roller pump.
Conclusions:
- Centrifugal pumps may suppress thrombin synthesis more effectively than roller pumps.
- This suggests centrifugal pumps could offer advantages in managing coagulation during CPB.
Abstract:
Centrifugal pumps have been used widely as the main pump in open heart surgery to reduce damage to blood elements and to reduce the activation of the coagulation system. The purpose of this study was the evaluation and comparison of the effects of two types of centrifugal pumps and of one type of roller pump on blood elements, the coagulation system, complements, and immunoglobulins. Two types of centrifugal pumps (Lifestream; St. Jude Medical, Chelmsford, Massachusetts; and BP-80; Medtronic, BioMedicus, Inc., Eden Prairie, Minnesota, U.S.A.) and one roller pump (Mera Co.) were used separately as the main pump for cardio-pulmonary bypass (CPB) in 29 patients. Platelet counts, lactate dehydrogenase, antithrombin III, thrombin-antithrombin complex (TAT), complements (C3, C4, and CH50) and immunoglobulins G, A, and M values were measured before and after CPB and compared. Values, except those for TAT, showed no significant difference among the three groups. The TAT values increased less in each of the centrifugal pump groups than in the roller pump group. This finding suggests that thrombin synthesis might be suppressed by the use of a centrifugal pump.
