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B Leskosek

Publications and source records attributed to B Leskosek.

At least 37 records · Page 2Linked to original sources

Continuous thermodilution measurement of cardiac output: in-vitro and in-vivo evaluation.

The current study was designed to evaluate a method for continuous measurement of cardiac output. The system consists of a modified pulmonary artery catheter that uses the thermodilution principle for determination of cardiac output. The evaluation was performed in vitro and in vivo. In-vitro evaluation was performed using a simple flow bench model (flow 2-9 L/min). Both continuous and bolus thermodilution methods were compared. Both methods showed good correlation with the pump flow calibrated using a volumetric tank and timer (correlation coefficient (r) for bolus thermodilution = 0.92, r for continuous thermodilution = 0.90). In-vivo evaluation was performed in six bovine experiments. Data from a total of 87 pairs of bolus versus continuous measurements were obtained. The cardiac output ranged from 1.9 to 8.9 L/min. The absolute measurement bias was not significant (mean: -0.07 L/min; 95% confidence limits: -0.87 and 0.73 L/min). The squared correlation coefficient from linear regression was 0.92. The results from this study suggest that the new continuous thermodilution measurement system for cardiac output provides accurate data in vitro and in vivo. Continuous monitoring of cardiac output adds a new dimension for evaluation of the patient's hemodynamic profile. Furthermore, significant volume load due to bolus thermodilution measurements can be avoided.

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Heparin surface coated hard shell venous reservoirs: experimental evaluation ex vivo.

The present study was designed for ex vivo evaluation of a heparin coated hard shell venous reservoir in comparison to uncoated control reservoirs. An open chest bovine right heart bypass model (n = 9, bodyweight 72 +/- 6 kg) with passive blood drainage from the right atrium into the venous reservoir and active retransfusion into the pulmonary artery (roller pump) was selected for this purpose. Clear priming was used for the open perfusion circuit. No heparin was given before or during the evaluation period which was scheduled for 6 hours. Reservoir blood flow was at the beginning 3.5 +/- 0.6 l/min for coated versus 3.4 +/- 0.3 l/min for uncoated (NS). After 6 hours, blood flow was 3.3 +/- 0.1 l/min for coated versus 2.7 +/- 0.4 l/min for uncoated (p < 0.05). Hematocrit moved from a baseline level of 30 +/- 2% for coated versus 28 +/- 3% for uncoated (NS) to 28 +/- 3% for coated versus 27 +/- 5% for uncoated (NS) after 6 hours. Prebypass platelet levels of 100% in both groups moved to 84 +/- 3% for coated versus 78 +/- 23% for uncoated (NS) after 6 hours. Activated coagulation time (ACT) before bypass was 148 +/- 12 s for coated and 153 +/- 6 s for uncoated (NS). After 6 hours, ACT was 160 +/- 9 s for coated versus 152 +/- 5 s for uncoated (NS). Thrombin time before bypass was 15 +/- 2 s for coated versus 16 +/- 2 s for uncoated (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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[Hemodynamic properties of the hemopump].

The hemopump HP 31 is an improved version of a catheter-mounted, transvalvular, left ventricular assist device, which can be placed into the left ventricle through the ascending aorta. The purpose of this study was to examine the influence of hematocrit and afterload on the pump flow. The hemopump was tested using a flow bench model filled with heparinized bovine blood. The measurements were performed at four various hematocrit values: 16%, 24%, 32%, and 40%. The pump flow was measured at each hematocrit value under increasing afterload pressures (40-120 mm Hg), by all pump speed levels (n = 7). The average pump flow at highest pump speed and lowest afterload was 5.1 +/- 0.3 l/min (mean +/- standard deviation). The influence of afterload on the pump flow was statistically significant (p < 0.001). The highest afterload pressure of 120 mm Hg caused a reduction in pump flow of 24 +/- 5%. The alterations of hematocrit values caused no statistically significant influence on the pump flow (p = 0.72). The results of our study enabled the construction of the nomogram for the in vivo determination of the pump flow. The in vivo performances of the hemopump can be improved through the afterload reduction, especially in the weaning phase of treatment. The oxygen delivery can be improved through the increase in hematocrit values without significant impairment of the pump flow.

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Evaluation of phospholipidic surface coatings ex-vivo.

To evaluate the thromboresistant properties of phospholipidic surface coatings mimicking the lipid surface of blood cells, we studied four different types of phospholipids bound onto PVC tubings in comparison to uncoated as well as heparin bonded controls. The samples analyzed included diacetylenic phospholipid coated as a monomeric treatment (A), diacetylenic phospholipid polymerised prior to being coated (B), and two types of polymeric phospholipids made using methacrylate containing monomers (C and D). A bovine (bodyweight 67 +/- 3 kg) left heart bypass model (pump flow 3.2 +/- 0.1 l/min) was selected and the surfaces were exposed to the blood stream up to 360 min without systemic heparinization. Thereafter another set of samples was exposed to stagnant blood over 20 min. Besides hemodynamic, hematologic and biochemical analyses, the macroscopic appearance of 119 blood exposed surface samples was graded semiquantitatively on a scale of 0 to 10: no macroscopic deposits = grade 0, 1 spot (1 mm diameter) = grade 1, 2 spots = grade 2, 5 or more spots = grade 5, up to 10% of the surface covered with clots = grade 6, 100% covered = grade 10 (P < 0.05 = *): mean grade of deposits was 0.0 +/- 0.0 for segments perfused and 0.0 +/- 0.0 for segments exposed to stagnant blood with surfaces exposing to the blood either heparin, phospholipid A, or phospholipid B (NS). Phospholipids C and D were graded 0.0 +/- 0.0 if perfused and 0.7 +/- 1.2 if exposed to stagnant blood.(ABSTRACT TRUNCATED AT 250 WORDS)

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[Hemodynamic effects of the implantation of an intracaval oxygenator].

Treatment of severe respiratory failure by extracorporeal membrane oxygenation (ECMO) is complex. However, there is now an intravascular gas exchanger (IVOX) available that provides extrapulmonary gas transfer without requiring an extracorporeal blood path. The present study was performed to determine the hemodynamic effects resulting from the intracaval placement of the intravascular device. A bovine model (n = 6; body-weight = 72 +/- 5 kg) was selected for temporary lung support with the intravascular device. The latter was placed in the caval axis under fluoroscopic control after full instrumentation of the animal for hemodynamic measurements including a pulmonary artery catheter for determination of cardiac output by thermodilution and continuous readout of mixed venous oxygen saturation. All measurements were taken after a stabilization period of 15 min. The heart rate moved from 65 +/- 8 before to 72 +/- 10 after implantation and 68 +/- 9 after onset of intravascular gas exchange (NS). Right atrial pressure was 13 +/- 3 mm Hg before, 12 +/- 3 mm Hg after implantation and 10 +/- 3 mm Hg after onset (NS) whereas femoral venous pressure moved from 14 +/- 3 mm Hg to 17 +/- 4 mm Hg (p < 0.05) and remained at 17 +/- 4 mm Hg after onset. Cardiac output was 5.3 +/- 0.7 l/min before, 5.4 +/- 0.7 l/min after implantation and 5.3 +/- 1.1 l/min after onset (NS) while mixed venous oxygen saturation dropped from 60 +/- 7% to 54 +/- 11% and moved to 57 +/- 11 after onset of the device (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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Coronary artery resistance and oxygen uptake during reperfusion: is there any difference between warm and cold cardioplegia?

To evaluate the effects of warm continuous versus cold intermittent blood cardioplegia on coronary blood flow patterns after prolonged cardioplegic arrest, nine pigs underwent cardiopulmonary bypass with 210 minutes of aortic cross-clamping. Antegrade blood cardioplegia was administered either cold intermittent (n = 4) or warm continuous (n = 5). During the first 30 minutes of reperfusion, there was decreased coronary blood flow with higher coronary vascular resistance in the cold group (mean +/- standard error; warm vs. cold: 30 min: flow: left anterior descending artery (LAD): 66 +/- 6 vs 36 +/- 4 ml/min, right coronary artery (RCA): 88 +/- 2 vs 61 +/- 4, p < 0.05, resistance: LAD: 33 +/- 3 vs 69 +/- 5 dyn.s.cm-5 x 10(3), RCA: 41 +/- 3 vs 58 +/- 8, p < 0.05). After one hour of reperfusion there were no differences between groups. Arterio-venous oxygen difference was higher in the cold group after 15 min (3.1 +/- 0.5 vs 4.8 +/- 0.3 ml O2/100 ml, p < 0.05) and 30 min (4.2 +/- 0.5 vs 6.2 +/- 0.7, p < 0.05) with equal values after 1 hour. During reperfusion there is reduced myocardial blood flow after cold intermittent blood cardioplegia. This may reflect superior myocardial protection with warm continuous cardioplegia.

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Regional diastolic dysfunction in postischaemic myocardium in calf: effect of nisoldipine.

OBJECTIVE: The aim was to assess the effect of nisoldipine on left ventricular systolic and diastolic function during prolonged myocardial ischaemia. METHODS: The left circumflex coronary artery was ligated for 2 h and reperfused for 4 h in 12 calves. The animals were randomised to a control group (n = 6) or to treatment with 1.25 mg.h-1 intravenous nisoldipine (n = 6) during 2 h of ischaemia. Circulatory support by a ventricular assist device was performed throughout the experiment except for the time of haemodynamic measurements. Regional wall thickening of a normal and an ischaemic left ventricular region was determined using pairs of ultrasonic crystals. Left ventricular pressure was measured by micromanometry. Left ventricular wall thickness and regional wall stiffness at a common preload of 10 mm Hg were calculated using an elastic model with shifting asymptote. RESULTS: Ten animals survived after 6 h. No difference was observed in systolic function between controls and nisoldipine treated animals. Systolic thickening of the ischaemic wall remained depressed 4 h after reperfusion and showed some recovery after dopamine infusion. Ischaemic wall stiffness at a common preload was lower after nisoldipine during ischaemia and reperfusion than in controls. Control wall stiffness remained unchanged during the whole experiment with and without nisoldipine. Diastolic thinning of the ischaemic wall was prevented by nisoldipine during ischaemia and after reperfusion. CONCLUSIONS: Prolonged myocardial ischaemia is associated with increased myocardial stiffness of the ischaemic wall. Mechanical unloading can help to bridge the acute phase but cannot prevent postischaemic diastolic dysfunction of the ischaemic wall. Nisoldipine has a beneficial effect on regional diastolic function during ischaemia and reperfusion by decreasing regional wall stiffness and preventing diastolic thinning of the ischaemic wall.

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[Are the advantages of percutaneous catheterization technique gained by increased blood trauma?].

UNLABELLED: The development of thin-walled cannulas which can be introduced by percutaneous technique into femoral artery and vein has revived interest in emergency cardiopulmonary support (CPS). To assess possible blood damaging effect due to the small-bore cannulas, 8 in vitro perfusions were performed with two parallel pump circuits: one circuit with a 17 F arterial and a 21 F venous cannula, one circuit without cannulas (control). The circuits were filled with 61 of bovine blood and run for 6 hours at a temperature of 37 degrees C and a flow of 4 l/min. Serial blood samples were taken before and during the experiment. There was a significantly higher level of free plasma haemoglobin (pl Hb) and a decreased number of leukocytes (Lc) after 6 hours of perfusion in the group with percutaneous cannulas as compared with control (pl Hb: 63.2 +/- 0.3 vs. 26.3 +/- 4.1 mumol/l, p < 0.05, Lc: 2.4 +/- 0.6 vs. 4.6 +/- 0.8 x 10(9)/l, p < 0.05, mean +/- se). CONCLUSION: percutaneous cannulas are associated with an increased blood trauma. If extended cardiopulmonary support is considered (more than several hours), percutaneous cannulas should be replaced by large-bore cannulas.

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[Hemodynamic effects of implantation of an intracaval gas exchanger].

Treatment of severe respiratory failure by extracorporeal membrane oxygenation (ECMO) is complex. However, there is now an intravascular gas exchanger (IVOX) available that provides extrapulmonary gas transfer without requiring an extracorporeal blood path. The present study was performed to determine the hemodynamic effects resulting from the intracaval placement of the intravascular device. A bovine model (n = 6; bodyweight = 72 +/- 5 kg) was selected for temporary lung support with the intravascular device. The latter was placed in the caval axis under fluoroscopic control after full instrumentation of the animal for hemodynamic measurements including a pulmonary artery catheter for determination of cardiac output by thermodilution and continuous read out of mixed venous oxygen saturation. All measurements were taken after a stabilization period of 15 min. The heart rate moved from 65 +/- 8 before to 72 +/- 10 after implantation and 68 +/- 9 after onset of intravascular gas exchange (NS). Right atrial pressure was 13 +/- 3 mm Hg before, 12 +/- 3 mm Hg after implantation and 10 +/- 3 mm Hg after onset (NS) whereas femoral venous pressure moved from 14 +/- 3 mm Hg to 17 +/- 4 mm Hg (p < 0.05) and remained at 17 +/- 4 mm Hg after onset. Cardiac output was 5.3 +/- 0.7 l/min before, 5.4 +/- 0.7 l/min after implantation and 5.3 +/- 1.1 l/min after onset (NS) and mixed venous oxygen saturation dropped from 60 +/- 7% to 54 +/- 11% and moved to 57 +/- 11 after onset of the device (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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Temporary lung support using an intravascular gas exchanger.

Severe respiratory failure may be difficult to overcome by conventional mechanical ventilation. As an alternative to the very demanding lung support using various modalities of extracorporeal circulation (ECMO, ECLA, etc.) we evaluated an intravascular gas exchanger (IVOX) in a "reversible" bovine model. Several degrees of hypoventilation were studied with and without intravascular gas exchange in 5 endotracheal intubated, anaesthetized, and volume-controlled ventilated animals (body weight 73 +/- 4 kg). After systematical heparinization (300 IU/kg body weight) the animals were instrumented with EKG electrodes, thermodilution pulmonary artery catheter with continuous measurement of O2-saturation, central venous and femoral arterial catheter, etc. The intravascular gas exchanger made from siliconized microporous polypropylene hollow fibres was placed in the caval veins under radiofluoroscopic control. The following scenarios were studied without and with intravascular gas exchange (gas inlet 100% O2): Normoventilation (with 14-20 strokes/min) at F10(2) 0.50 and at F10(2) 0.21; Hypoventilation (ventilator frequency reduced to 50% and tidal volume reduced to 50% of normoventilation) at F10(2) 0.50 and at F10(2) 0.21. Hemodynamics, mixed venous O2-saturation, arterial and venous blood gases, and gas-exchanger exhaust were analyzed after stabilization over 15 minutes (mean +/- standard deviation). Blood gas analyses showed significant improvement with intravascular gas exchange during hypoventilation at F10(2) 0.21: pH moved from 7.10 +/- 0.17 to 7.19 +/- 0.15*, PaCO2 moved from 9.9 +/- 4.2 kPa to 8.7 +/- 2.8*, PaO2 moved from 6.5 +/- 1.2 kPa to 7.3 +/- 0.8* and mixed venous O2-saturation moved from 33.9 +/- 16.0% to 48.1 +/- 4.6* (* = p less than 0.05 for without versus with intravascular gas exchange).(ABSTRACT TRUNCATED AT 250 WORDS)

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Preservation of myocardial function by mechanical circulatory support during prolonged ischaemia.

The effect of mechanical circulatory support on left ventricular (LV) function was evaluated during prolonged myocardial ischaemia. Regional wall thickening of a normal and an ischaemic LV region were determined in eight calves (mean body weight 76 kg) using pairs of ultrasonic crystals. LV end-diastolic (mmHg) and peak systolic (mmHg) pressure as well as maximum dP/dt (mmHg s-1) were calculated from LV high-fidelity pressure tracings. The left circumflex coronary artery was ligated proximally for 6 h and reperfused for 18 h. Circulatory support by the assist device was performed from the beginning of ischaemia to the end of the experiment. After a mean time of 4 h all animals showed ventricular fibrillation, which was converted successfully in six animals after a mean time interval of 5 h. Five animals survived after 24 h. The non-surviving animals had larger infarcts, greater creatine kinase release and a larger drop in cardiac output during ischaemia. Haemodynamic measurements were carried out after turning off the assist device. Inotropic stimulation with 0.68 mg.min-1 dopamine i.v. was performed at the end of the study. LV regional function showed systolic bulging during myocardial ischaemia. After 18 h of reperfusion, the ischaemic wall recovered and showed normal systolic wall thickening in the presence of an increased LV preload. LV relaxation was prolonged after reperfusion, suggesting diastolic dysfunction. It is concluded that mechanical circulatory support is effective in protecting myocardial function during prolonged ischaemia in approximately two-thirds of the animals, despite severe ischaemic ventricular dysfunction and intermittent ventricular fibrillation.

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Performance characteristics of hemofilters with heparin surface coating: an experimental study.

Heparin surface coated hemofilters and tubing sets were evaluated in comparison to identical but uncoated controls in 8 bovine experiments (74+/-6 kg). No heparin was given (neither systemically nor in the priming fluid). The hemofilters were primed with one liter of Ringer's lactate in both groups and the maximal filter performance (arterial line pressure 300 mmHg; transmembrane pressure (TMP) 500 mmHg) was measured over 6 hours or until filter occlusion. All coated and one control filter remained functional during the scheduled 6 hours. The mean filter patency was 360+/-0 minutes for coated versus 210+/-99 minutes for uncoated (p less than 0.01). Mean blood flow at 1 hour and 6 hours was 675+/-114 and 580+/-96 ml/min for coated versus 432+/-183 and 25+/-43 for uncoated (NS; p less than 0.01). Mean filter output during the 6th hour and total filter output over 6 hours was 4225+/-998 ml and 21779+/-4273 for coated versus 400+/-692 and 7717+/-9757 for uncoated (p less than 0.01; p<0.01). Mean lactatedehydrogenase (LDH) levels before and 30 minutes after hemofiltration were 1855+/-411 IU and 2007+/-635 for coated versus 2160+/-411 and 1945+/-500 for uncoated (NS; NS). The heparin coated hemofilters demonstrated improved thromboresistance resulting in superior filter performance. There was no evidence of increased blood trauma.

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Improved biocompatibility of heparin surface-coated ventricular assist devices.

Heparin surface coated ventricular assist devices (VADs) and cannulas were evaluated in comparison to uncoated VADs in 10 bovine experiments (body weight 77 +/- 6 kg). All systems were primed with cristalloid solution. No systemic heparin was given. Left ventricular assist was started with a blood flow of 4.2 +/- 0.4 l/min and maintained over 6 hours. Besides hemodynamic monitoring, blood samples were taken at regular intervals for blood gas, hematological, biochemical and coagulation studies. All animals in the study group (coated) were assisted for the scheduled 6 hours without device failure. In the control group, however, total occlusion occurred in 1 VAD after 1 hour of left ventricular assist whereas the other 4 VADs remained functional throughout the protocol. Mixed venous oxygens saturation was preassist 56 +/- 12% for coated versus 63 +/- 11% for uncoated and the final value at 60 minutes after weaning was 58 +/- 16% versus 59 +/- 5% (NS). Mean hematocrit dropped from a baseline value of 33 +/- 4% for coated versus 29 +/- 8% for uncoated to 29 +/- 7% versus 30 +/- 5% (NS) after 6 hours of assist. There was no significant difference between the baseline values (5.7 +/- 3.0 mumol/l for coated versus 4.6 +/- 3.1 mumol/l for uncoated) and the 6-hour values (3.8 +/- 3.7 mumol/l versus 7.6 +/- 6.4 mumol/l) for mean plasma hemoglobine. The normalized platelet levels dropped after 10 minutes of assist to 91 +/- 21% for coated versus 94 +/- 49% for uncoated (NS) and 89 +/- 29% versus 65 +/- 44 at 6 hours (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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Experimental evaluation of heparin-coated cardiopulmonary bypass equipment with low systemic heparinization and high-dose aprotinin.

Cardiopulmonary bypass (n = 8 calves) with heparin-coated perfusion equipment, low-dose systemic heparinization (activated clotting time: ACT greater than 180 s) and high-dose aprotinin administration was evaluated in comparison to standard perfusion equipment with full-dose systemic heparinization (ACT greater than 480). All animals were perfused for 6 hours and similar values were observed for blood gases and mixed venous oxygen saturation in both groups. The heparin doses given in the study group before and during the 6 hours of perfusion totalized 14660 +/- 2553 IU as compared to 60833 +/- 5137 IU for the control group. No protamin was given in the study group whereas an equivalent of 27000 +/- 5805 IU was necessary to reverse heparin in the control group. There was no difference for prebypass hematocrit versus postbypass hematocrit in the two groups. Prebypass plasma hemoglobine was 8.4 +/- 2.1 mumol/L in the study group versus 10.0 +/- 3.8 mumol/L in the control group. After mixing with the priming volume, plasma hemoglobine was 8.6 +/- 2.5 mumol/L in the study group versus 6.7 +/- 1.6 mumol/L in the control group. The highest value was observed in the study group after 2 hours of perfusion (8.2 +/- 2.1 mumol/L) versus 5 hours of perfusion in the control group (7.4 +/- 3.6 mumol/L). Prebypass LDH levels of 1610 +/- 150 IU in the study group versus 1740 +/- 210 IU in the control group moved to 1870 +/- 200 IU in the study group at 24 hours after perfusion versus 2650 +/- 400 IU in the control group at 24 hours and decreased thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

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[Mechanical circulatory assist using a miniaturized Archimedes screw].

An axial flow blood pump (Archimedes screw) for intraarterial left ventricular assist was evaluated in comparison to standard roller pump left heart bypass (LHBP) in 13 bovine experiments (bodyweight 74 +/- 15 kg). Full systemic heparinization (ACT greater than 500 s) was used for LHBP in comparison to limited systemic heparinization (ACT greater than 180 s) for axial. A standard battery of blood samples was taken before and at regular intervals throughout perfusion: (table; see text) Transarterial access and relatively limited blood trauma appear to be the main advantages of the evaluated axial flow blood pump. However, the impossibility to assess the pump flow may be a major problem for the management of the failing left ventricle.

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Superior hemodynamics in left heart bypass without systemic heparinization.

Open-chest left heart bypass was performed in 10 canine experiments (30 +/- 9 kg) by a servo controlled roller pump for 6 h at a pump flow of 50 ml/min per kg bodyweight. The surfaces of the tubing sets were either standard (with systemic heparinization) or with end-point attached heparin (no systemic heparin). Besides continuous monitoring of hemodynamics, a standard battery of blood samples was taken before bypass, after 10 min and every hour thereafter. There is no evidence of increased fibrin production in the group with end-point attached heparin surfaces perfused without systemic heparinization. Superior hemodynamics in left heart bypass performed without systemic heparinization appear to be due to improved hemostasis, reduced blood loss and therefore reduced transfusion requirements. Left heart bypass with heparin-coated equipment has been successfully used for resection of a thoracoabdominal aneurysm in six patients.

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Performance characteristics of centrifugal pumps with heparin surface coating.

Heparin surface coating is one approach to improve the biocompatibility of existing blood pumps used for mechanical circulatory support. Experimental evaluation of centrifugal pumps with heparin surface coating was performed during open chest left heart bypass (3.7 L/min over 6 hours) in two series of bovine experiments. Eight calves (74 +/- 4 kg) were perfused either by heparin surface coated equipment without systemic heparinization or uncoated equipment with systemic heparinization (300 I. U,/kg bodyweight; ACT greater than 400 s). A standard battery of analyses was performed before and at regular intervals after onset of perfusion. At the end of perfusion all pump-heads were gently rinsed. There were no macroscopic clots for both groups whereas macroscopic clots were observed in uncoated tubings introduced for control in the group perfused without systemic heparinization. The hemodynamics were significantly better in the group perfused without systemic heparinization and maintained functional coagulation system. Clinical application of heparin surface coated equipment during resection of thoraco-abdominal aortic aneurysms is showing promising results in 12 patients.

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