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Clinical use of centrifugal pumps and the roller pump in open heart surgery: a comparative evaluation
M Yoshikai1, M Hamada, K Takarabe
1Department of Cardiovascular Surgery, Koga Hospital, Kurume, Japan.
Insights
Centrifugal pumps showed fewer negative impacts on blood elements and coagulation compared to roller pumps during cardiopulmonary bypass. Specifically, centrifugal pumps resulted in lower thrombin-antithrombin complex levels, suggesting reduced thrombin generation.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Hematology
Background:
- Centrifugal pumps are preferred in open heart surgery for minimizing blood damage and coagulation activation.
- Previous research indicates potential benefits of centrifugal pumps over roller pumps.
Purpose of the Study:
- To compare the effects of two centrifugal pump types and one roller pump on blood elements and the coagulation system during cardiopulmonary bypass.
- To evaluate impacts on complements and immunoglobulins.
Main Methods:
- Cardiopulmonary bypass was performed in 29 patients using either a Lifestream or BP-80 centrifugal pump, or a Mera Co. roller pump.
- Measurements included platelet counts, lactate dehydrogenase, antithrombin III, thrombin-antithrombin complex (TAT), complements (C3, C4, CH50), and immunoglobulins (IgG, IgA, IgM) pre- and post-bypass.
Main Results:
- No significant differences were observed among the pump types for most parameters measured.
- Thrombin-antithrombin complex (TAT) values increased significantly less in patients using centrifugal pumps compared to those using the roller pump.
Conclusions:
- Centrifugal pumps may suppress thrombin synthesis more effectively than roller pumps during cardiopulmonary bypass.
- This suggests centrifugal pumps could offer improved hemocompatibility in cardiac surgery.
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 cardiopulmonary 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.