ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Comparative Study
Comparison of coronary artery blood flow and hemodynamic energy in a pulsatile pump versus a combined nonpulsatile pump and an intra-aortic balloon pump.
We compared the coronary artery blood flow and hemodynamic energy between pulsatile extracorporeal life support (ECLS) and a centrifugal pump (CP)/intra-aortic balloon pump (IABP) combination in cardiac arrest. A total cardiopulmonary bypass circuit was constructed for six Yorkshire swine weighing 30 to 40 kg. The outflow cannula of the CP or a pulsatile ECLS (T-PLS) was inserted into the ascending aorta, and the inflow cannula of the CP or T-PLS was placed into the right atrium. ⋯ The percent change of the mean arterial pressure to EEP was effective in both groups (23.3 +/- 6.1 in CP plus IABP vs. 19.8 +/- 6.2% in T-PLS, p = NS). The SHE was high enough in the CP/IABP and the T-PLS (20,219.8 +/- 5824.7 vs. 13,160.2 +/- 4028.2 erg/cm3, respectively, p = NS). The difference in the coronary artery flow was not statistically significant at 30 minutes after bypass was initiated (28.2 +/- 9.79 ml/min in CP plus IABP vs. 27.7 +/- 9.35 ml/min in T-PLS, p = NS).
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We reviewed the performance of a new polymethylpentene oxygenator (DIDECMO, Dideco, Mirandola, Italy) in terms of clinical safety and efficiency in priming, oxygenation, and oxygenator resistance in neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. Between March 2005 and January 2006, 14 patients required ECMO in the San Vincenzo Hospital. Of these, 8 (median age, 9 days; range, 3 days to 15 months) received normothermic ECMO for postcardiotomy heart failure after surgery for congenital heart disease. ⋯ Neither oxygenator-related major nor minor adverse events occurred during support. In our initial experience, the new polymethylpentene DIDECMO oxygenator provided adequate gas exchange and offered technical advantages in terms of low priming volume and acceptable hemodynamic resistance despite pulsatile flow regimen. Also, we used this device for more than 8 days without any technical problems.
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Mechanical support of the failing myocardium has become standard therapy for adults who fail medical management. Historically, there have been fewer options for children with heart failure. ⋯ For example, there has been increasing experience using the DeBakey VAD Child and the Berlin Heart VAD to provide circulatory support for children during this period. A number of innovative devices under development supported by the Pediatric Circulatory Support Program of the National Heart, Lung, and Blood Institute hold great promise for expanded options for pediatric mechanical circulatory support in the future.
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The purpose of this investigation was to present the first European clinical experience with the new MEDOS DELTASTREAM DP1 used in pulsatile extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) options in the pediatric population. Between January 2002 and April 2006, 11 patients required ECMO and 5 patients received a left VAD (LVAD) in the San Vincenzo Hospital. Indications were postcardiotomy heart failure in 15 patients and fulminant myocarditis in one patient. ⋯ Our results suggest that the MEDOS DELTASTREAM DP1 pulsatile pump system can be used as an ECMO or a VAD support. The opportunity to utilize pulsatile flow in postcardiotomy cardiogenic shock significantly improved the outcomes by producing more physiologic hemodynamics and superior end organ function. Easy implantation and simple management of this device represents the major advantage.
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Children with postcardiotomy heart failure who are unresponsive to maximal medical management have limited options for survival. Short-term mechanical circulatory support, such as with extracorporeal membrane oxygenation and ventricular assist devices, has assumed an expanding role in the care of these patients by providing a bridge to recovery. This report describes the use of left ventricular assist devices with centrifugal pumps in five pediatric cases (weight <15 kg) with postcardiotomy heart failure.