Postoperative pulmonary complications are a leading cause of morbidity and mortality after cardiac surgery. There are no recommendations on mechanical ventilation associated with cardiopulmonary ...bypass (CPB) during surgery and anesthesiologists perform either no ventilation (noV) at all during CPB or maintain low tidal volume (LTV) ventilation. Indirect evidence points towards better pulmonary outcomes when LTV is performed but no large-scale prospective trial has yet been published in cardiac surgery.
The MECANO trial is a single-center, double-blind, randomized, controlled trial comparing two mechanical ventilation strategies, noV and LTV, during cardiac surgery with CPB. In total, 1500 patients are expected to be included, without any restrictions. They will be randomized between noV and LTV on a 1:1 ratio. The noV group will receive no ventilation during CPB. The LTV group will receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive end-expiratory pressure of 5 cmH2O. The primary endpoint will be a composite of all-cause mortality, early respiratory failure defined as a ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg at 1 hour after arrival in the ICU, heavy oxygenation support (defined as a patient requiring either non-invasive ventilation, mechanical ventilation or high-flow oxygen) at 2 days after arrival in the ICU or ventilator-acquired pneumonia defined by the Center of Disease Control. Lung recruitment maneuvers will be performed in the noV and LTV groups at the end of surgery and at arrival in ICU with an insufflation at +30 cmH20 for 5 seconds. Secondary endpoints are those composing the primary endpoint with the addition of pneumothorax, CPB duration, quantity of postoperative bleeding, red blood cell transfusions, revision surgery requirements, length of stay in the ICU and in the hospital and total hospitalization costs. Patients will be followed until hospital discharge.
The MECANO trial is the first of its kind to compare in a double-blind design, a no-ventilation to a low-tidal volume strategy for mechanical ventilation during cardiac surgery with CPB, with a primary composite outcome including death, respiratory failure and postoperative pneumonia.
ClinicalTrials.gov, NCT03098524 . Registered on 27 February 2017.
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The total artificial heart is the mechanical device which is used as a bridge to the heart transplant in patients with biventricular failure. Due to the mechanical nature of the device, patients ...receiving total artificial heart (TAH) require to be on anticoagulation therapy. Hemorrhage and coagulopathy are few of the known complications of TAH.
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Status on Heart Transplantation in China Hu, Xing-Jian; Dong, Nian-Guo; Liu, Jin-Ping ...
Chinese medical journal,
12/2015, Volume:
128, Issue:
23
Journal Article
Peer reviewed
Open access
INTRODUCTION
＂End-stage heart disease＂ commonly refers to an irreversible stage of cardiac decompensation caused by a variety of pathologies that cannot be treated using conventional drugs or ...traditional surgical treatments. The life expectancy of patients with end-stage heart disease ranges from 〈6 months to 1 year. Therapeutic strategies for end-stage heart disease patients are primarily based on three approaches： Internal medicine therapy, surgical therapy （heart transplantation）, and multiple organ protection therapy via the core method of mechanical circulation assistance. Among these approaches, heart transplantation has become recognized as the most efl＇ective treatment.
John Heysham Gibbon, Jr., M.D., was the first researcher to develop a heart-lung machine that could fully support an adult's cardiac and respiratory functions during surgical procedures to repair ...defects in the heart and lungs. Romaine-Davis here provides a thorough study of Gibbon and his accomplishment.
Good anatomical compatibility is an important aspect in the development of cardiovascular implants. This work analyzes the interaction of the pump unit of an electrically driven pulsatile Total ...Artificial Heart (TAH) and the mediastinum. For an adequate compliance, both overall dimensions and alignment of inlets and outlets must be matched.
Cross-sectional medical image data of 27 individuals, including male and female patients suffering from end stage heart failure, was segmented and reconstructed to three dimensional (3D) surface models. Dimensions and orientations of relevant structures were identified and analyzed. The TAH surface model was virtually placed in orthotopic position and aligned with atrioventricular valves and big vessels. Additionally seven conventional cadaver studies were performed to validate different pump chamber designs based on virtual findings. Thereby 3D-coordinates were captured and introduced to the virtual environment to allow quantitative comparison between different individuals.
Spatial parameters varied more in male patients with higher values if heart failure persists. Good correlation of the virtual analysis both to literature data and conventional cadaver studies could be shown. The full data of the 27 individuals as well as the summarized values found in literature are enclosed in the appendix. By superimposing the TAH-volume model to the anatomy, various misalignments were found and the TAH-design was adjusted.
Virtual fitting allows implant design adjustments in realistic anatomy which has not been influenced by thoracotomy. Higher numbers of relevant individuals can be reasonably investigated in the virtual environment and quantitatively correlated. Using this approach, conventional cadaver studies can be significantly reduced but not obviated, due to the unavailable haptic feedback and immobility of potentially compressed structures.
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Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB) is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related ...cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB.
The aim of this study is to improve the safe administration of volatile anesthesia during CPB.
Tertiary teaching hospital.
We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit.
We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase.
Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety.
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* Confidently devise a safe and successful 'plan for the pump run' for patients undergoing surgery for congenital heart disease. This practical guide for perfusionists and other members of the ...cardiac surgical team provides information on the devices, technology and techniques required for successful bypass of patients with congenital heart defects * A practical, spiral-bound, go-to reference designed to answer the most frequently-posed questions about bypass for CHD, the surgical treatment of which is often complicated * Focuses on the latest technology and techniques and provides clear, matter-of-fact guidance based on specific diagnoses * Written by a seasoned perfusionist who is co-chief and educator at one of the world's leading children's hospitals * Spiral binding allows the book to be laid flat for easy referral in the operating room * A notes section following each diagnosis enables readers to add institution and/or surgeon-specific information to tailor a bypass plan for each CHD lesion
The paper presents a newly researched acoustic system for blood volume measurements for the developed family of Polish ventricular assist devices. The pneumatic heart-supporting devices are still the ...preferred solution in some cases, and monitoring of their operation, especially the temporary blood volume, is yet to be solved.
The prototype of the POLVAD-EXT prosthesis developed by the Foundation of Cardiac Surgery Development, Zabrze, Poland, is equipped with the newly researched acoustic blood volume measurement system based on the principle of Helmholtz's acoustic resonance. The results of static volume measurements acquired using the acoustic sensor were verified by measuring the volume of the liquid filling the prosthesis. Dynamic measurements were conducted on the hybrid model of the human cardiovascular system at the Foundation, with the Transonic T410 (11PLX transducer - 5% uncertainty) ultrasound flow rate sensor, used as the reference.
The statistical analysis of a series of static tests have proved that the sensor solution provides blood volume measurement results with uncertainties (understood as a standard mean deviation) of less than 10%. Dynamic tests show a high correlation between the results of the acoustic system and those obtained by flow rate measurements using an ultrasound transit time type sensor.
The results show that noninvasive, online temporary blood volume measurements in the POLVAD-EXT prosthesis, making use of the newly developed acoustic system, provides accurate static and dynamic measurements results. Conducted research provides the preliminary view on the possibility of reducing the additional sensor chamber volume in future.
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