Artificial organs
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Cardiopulmonary bypass (CPB) is used for a variety of procedures in pediatric patients. Flow settings of the CPB pump have dramatic effects on patient outcome, and gaseous microemboli delivery within the CPB circuit has been linked to neurological complications. To ensure the ongoing improvement of pediatric CPB, consistent evaluation and improvement of the equipment is necessary. ⋯ The HL-20 exhibits less stolen blood flow (except at 1200 mL/min) and oxygenator pressure drops in both pulsatile and nonpulsatile mode. Additionally, under pulsatile flow the DP3 delivers greater surplus hemodynamic energy. Both pumps produce relatively few microemboli and deliver adequate hemodynamic energy to the pseudo-patient, with the DP3 performing slightly better under most flow settings.
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Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). ⋯ The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.
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Pediatric patients supported on ventricular assist devices (VADs) require systemic anticoagulation and are at risk for intracranial hemorrhage (ICH). Little is known about the incidence or outcomes of pediatric patients with ICH while supported on a VAD. A retrospective chart review of all patients receiving VAD support was completed. ⋯ ICH is a devastating complication of VAD support. Prior ischemic infarcts and interruptions to anticoagulation may put a patient at risk for ICH. Prompt neurosurgical evaluation/intervention can result in positive outcomes.
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Cardiopulmonary bypass (CPB) is known to cause a systemic inflammatory response. Inflammation includes several cascade activations: complement, cytokine, and coagulation. The early phase is triggered by blood contact with the synthetic bypass circuit and the late phase by ischemia-reperfusion and endotoxemia. ⋯ Minimization of systemic inflammation is a major concern and several strategies aiming to inhibit the inflammatory response are described. None of them is satisfactory, but the "control" of the inflammatory response extent is likely to require a multimodal approach. This review aims to describe the strategies proposed to reduce CPB-related systemic inflammation.
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Extracorporeal life support (ECLS) is used after congenital heart surgery for several indications, including failure to separate from cardiopulmonary bypass, postoperative low cardiac output syndrome, and extracorporeal cardiopulmonary resuscitation. Here, we assessed the outcomes of ECLS in children after cardiac surgery at our institution. Medical records of all children who required postoperative ECLS at our institution were reviewed. ⋯ ECLS is beneficial to children with low cardiac output after cardiac surgery. Rates of survival-to-hospital discharge were higher in BVH patients than UVH patients. Additional interventions to reduce ventricular volume load may be effective for discontinuing ECLS in patients with UVH.