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PubMed2000

Strategy of circulatory support with percutaneous cardiopulmonary support.

We evaluated the efficacy and problems of circulatory support with percutaneous cardiopulmonary support (PCPS) for severe cardiogenic shock and discussed our strategy of mechanical circulatory assist for severe cardiopulmonary failure. We also described the effects of an alternative way of PCPS as venoarterial (VA) bypass from the right atrium (RA) to the ascending aorta (Ao), which was used recently in 3 patients. Over the past 9 years, 30 patients (20 men and 10 women; mean age: 61 years) received perioperative PCPS at our institution. Indications of PCPS were cardiopulmonary bypass weaning in 13 patients, postoperative low output syndrome (LOS) in 14 patients, and preoperative cardiogenic shock in 3 patients. Approaches of the PCPS system were the femoral artery to the femoral vein (F-F) in 21 patients, the RA to the femoral artery (RA-FA) in 5 patients, the RA to the Ao (RA-Ao) in 3 patients, and the right and left atrium to the Ao in 1 patient. Seventeen (56.7%) patients were weaned from mechanical circulatory support (Group 1) and the remaining 13 patients were not (Group 2). In Group 1, PCPS running time was 33.1 +/- 13.6 h, which was significantly shorter than that of Group 2 (70.6 +/- 44.4 h). Left ventricular ejection fraction was improved from 34.8 +/- 12.0% at the pump to 42.5 +/- 4.6% after 24 h support in Group 1, which was significantly better than that of Group 2 (21.6 +/- 3.5%). In particular, it was 48.6 +/- 5.7% in the patients with RA-Ao, which was further improved. Two of 3 patients with RA-Ao were discharged. Thrombectomy was carried out for ischemic complication of the lower extremity in 5 patients with F-F and 1 patient with RA-FA. One patient with F-F needed amputation of the leg due to necrosis. Thirteen patients (43.3%) were discharged. Hospital mortality indicated 17 patients (56.7%). Fifteen patients died with multiple organ failure. In conclusion, our alternate strategy of assisted circulation for severe cardiac failure is as follows. In patients with postcardiotomy cardiogenic shock or LOS, PCPS should be applied first under intraaortic balloon pumping (IABP) assist for a maximum of 2 or 3 days. In older aged patients particularly, the RA-Ao approach of PCPS is superior to control flow rate easily, with less of the left ventricular afterload and ischemic complications of the lower extremity. If native cardiac function does not recover and longer support is necessary, several types of ventricular assist devices should be introduced, according to end-organ function and the expected support period.

Adolescent↗
PubMed1999

Major organ function under mechanical support: comparative studies of pulsatile and nonpulsatile circulation.

We examined a major organ function during 3 h biventricular assisted circulation after acute myocardial infarction model in the pig. In left ventricular circulation, the outflow cannula was placed in the ascending aorta and an inflow cannula through the mitral valve in the left ventricle. A pump (pulsatile group, Zeon Medical, Inc., Tokyo, Japan and nonpulsatile group, Nikkiso HPM-15, Nikkiso, Inc., Tokyo, Japan) was connected to each cannula. In right ventricular circulation, the outflow cannula was placed in the pulmonary artery and an inflow cannula in the right ventricle. The right ventricular circulation was supported by a nonpulsatile pump (Nikkiso HPM-15). The items measured were the regional blood flows of the cortex and medulla in the kidney, white matter and gray mater in brain, and liver; renal arterial flow; carotid arterial flow; portal vein flow; common hepatic arterial flow; arterial ketone body ratio (AKBR); and lactate/pyrubic acid (L/P). In the pulsatile group, the renal cortical blood flow increased, and the medulla blood flow decreased. On the other hand, in the nonpulsatile group, both regional blood flows decreased. That means that in the pulsatile assisted group intrarenal redistribution improved rather than in the nonpulsatile assisted group. In addition the liver regional blood flow, AKBR, and L/P showed significant differences between the pulsatile and nonpulsatile groups. On the other hand, the white matter and gray matter regional blood flows and carotid arterial flow did not show significant differences between the groups. The results of our study indicated that pulsatile circulation produced superior circulation in the kidney and liver, and microcirculation on the cell level was superior as well in early treatment of acute heart failure.

Animals↗
PubMed1989

[Multiple organ failure following open heart surgery in adults].

The cases multiple organ failure (MOF) which occurred post-operatively following open heart surgery in adults were studied on a pre and post-operative hemodynamics. Post-operative low cardiac output syndrome (LOS) was thought to result in decreased renal and hepatic perfusion with subsequent ischemic damage to these organs. Therefore, to management MOF, we have to prevent post-operative LOS, for example, administration of cathecholamine and vasodilator, and early clinical application of IABP and ventricular assist device (VAD). In a post-operative hemodynamics, the cases of severe right ventricular failure tend to have more protracted MOF. It was though that MOF could be minimized with shortened cardiopulmonary bypass duration, and early application of assisted circulation.

Adult↗
PubMed2000

[Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin].

Administration of protamine intravenously to neutralize the anticoagulant effects of heparin may be associated with hypotension. These adverse cardiovascular responses to protamine fall into three distinct types: transient hypotension related to rapid drug administration; anaphylactic responses: and catastrophic pulmonary vasoconstriction. We recently observed three patients who had catastrophic pulmonary vasoconstriction, which were treated with the assist circulation and intraaortic balloon pumping. The two patients were survived except one who was dead due to the cerebral ischemic damage which was introduced by delayed establishment of circulatory assist device. We conclude that meticulous longstanding observation of the hemodynamic condition is important after administration of protamine under the unremoved cannulations.

Aged↗
PubMed1991

Extracorporeal mechanical pulsatile pump and its significance for myocardial function recovery and circulatory support.

The authors performed 12 acute (on dogs) and 12 chronic (on calves) assisted circulation experiments with the use of the total extracorporeal mechanical pump (TEMP) artificial ventricles. The functional morphological research of the myocardium suggests that in addition to the possibility of the biological heart function full replacement, the artificial ventricle also helps recover damages in both the myocardial infarction and distal zones. The critical time period up to the onset of artificial circulation is not more than 2 h, and after that myocardial changes are irreversible.

Animals↗
PubMed1991

Perspectives for pneumatic and hydraulic circulatory assist devices and their application for heart transplantation.

Intraventricular blood-forcing-principle-based pneumo- and hydraulic assistance circulation device test results are proposed. The system consists of a uninipple valveless dome pump, a pneumo- or hydraulic drive, and an artificial pericardium. Stand tests of these systems and medical-biologic experiments on dogs and 17 calves were performed. The duration of these experiments was up to several days. In this report, the features of surgical techniques, perfusion parameters, control principles, hemodynamic variations, complications, and other problems concerning realization of the proposed method are discussed.

Animals↗
PubMed1991

A new technique for bridging to heart transplantation: feasibility of monoventricularization of bilateral ventricles with LVAD.

Because the prognosis of ventricular septal perforation (VSP) and mitral regurgitation (MR) after acute myocardial infarction (MI) is remarkably poor, heart transplantation would be necessary for many of those patients. A new bridging technique was examined in canine models. The bilateral ventricles communicating through VSP were monoventricularized with mitral valve closure and maintained the pulmonary circulation, which had low vascular resistance. The systemic circulation was maintained by a left ventricular assist device (LVAD) placed between the left atrium and the aorta. VSP and MR were made in eight mongrel dogs (pulmonary to systemic flow ratio = 2.24 +/- 0.90). They were then monoventricularized and equipped with LVADs. The hemodynamic state was evaluated (a) in intact hearts, (b) after VSP and MR were made, and (c) after monoventricularization and assisted circulation by LVAD. Cardiac output was (a) 90.60 +/- 23.16, (b) 42.23 +/- 15.76, and (c) 73.43 +/- 15.14 ml/min/kg (a vs. c: not significant; a vs. b and b vs. c: p less than 0.001); mean aortic pressure was (a) 96.75 +/- 24.69, (b) 30.25 +/- 11.08, and (c) 66.50 +/- 18.40 mm Hg (a vs. b: p less than 0.01, a vs. c and b vs. c: p less than 0.05); central venous pressure was (a) 4.76 +/- 1.68, (b) 8.94 +/- 2.17, and (c) 10.68 +/- 2.43 mm Hg (a vs. c: p less than 0.01, a vs. b: p less than 0.05, and b vs. c: not significant). Mean pulmonary arterial pressure and mean left atrial pressure did not show any significant difference among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1978

Hemodynamic effects of the concomitant use of intra-aortic balloon pumping and venoarterial bypass without oxygenation in cardiogenic shock.

The concomitant use of INTRA-AORTIC BALLOON PUMPING (IABP) and venoarterial bypass (VAB) without oxygenation (VABsO) was performed in 10 experiments using 6 dogs in cardiogenic shock. VABsO was accomplished with the cricuit from the right atrium to the femoral artery and bypass flow rates were set at approximately one third of the baseline cardiac output. Displacement volume of the IABP balloon was 10 or 20 ml. Evaluation of hemodynamic effects of the concomitant use was carried out, as compared with the single use of IABP or VABsO. The following findings were obtained: (1) In the concomitant use, left ventricular afterload decreased, while mean aortic root pressure increased. Increase in total perfusion flow, decrease in mean left atrial pressure and decrease in left ventricular stroke work were shown more effective than each of the single uses. (2) These results suggest that the concomitant use of IABP and VABsO can be used as a second step assisted circulation when IABP is shown uneffective in the case of severe cardiogenic shock.

Animals↗
PubMed1990

[Partial heterotopic and total orthotopic transplantation of the liver in dogs].

From 1983 to 1988 on the Department for Experimental Surgery 20 preservations of the liver has been done, with ice cold Euro- Collins and Ringer solutions, either with in situ or with on banch technique after fast expantation. On five dogs standard 55% left hepatectomy has been done and the right side preserved in situ. Partial heterotopic liver transplantation to the right iliac fossa was performed on five dogs. Total vascular exclusion of the liver and extracorporal inierior vena cava and jugular vein by pass with assisted circulation was performed on one dog, without assistance on four dogs. Total orthotopic liver transplantation was performed on two dogs. The surgical team practiced the technique of liver transplantation in experiment and liver resection with in situ technique and on banch technique.

Animals↗
PubMed1995

[A successful circulatory assist in acute left heart failure after a rapid two-stage arterial switch operation].

A 6-month-old female with transposition of the great arteries with intact ventricular septum successfully survived with the aid of a circulatory assist device for acute left heart failure after rapid two stage-arterial switch operation (ASO). The interval between pulmonary artery banding and ASO was 9 days. Left heart failure appeared immediately after ASO, so we started the circulatory assist with a centrifugal pump. The left ventricular function gradually recovered. After 43 hours assisted circulation, she was successfully weaned from the pump. Subsequent recovery was uneventful and the patient was discharged from the hospital on the 40th postoperative day. In case of acute left heart failure after ASO due to sudden changes in the left ventricular afterload, adaptation of the left ventricle can be expected by a relatively short period of circulatory assist with centrifugal pump.

Acute Disease↗
PubMed1990

[Electric stimulation of skeletal muscles as the optimal method of left-ventricular bypass].

Experiments were performed on 15 mongrel dogs to evaluate the influence of electrostimulated contractions of the hind limb and abdominal skeletal muscles on the efficacy of assisted circulation (AC). The influence of massage of the abdomen on AC efficacy was studied in 10 experiments. In electrostimulation of the hind limb muscles the drainage along the femoral vein, measured by the direct method, increased threefold: from 58 +/- 9 to 162 +/- 7 ml/min under conditions of an intact heart and from 5.8 +/- 0.8 to 15 +/- 1.2 ml/min in cardiac insufficiency. The efficacy of AC by the method of left-ventricular bypass by means of the Module artificial heart ventricle (AHV) increased through the flow of blood to the heart, which was manifested by greater AHV performance with rise of systolic and diastolic pressure to 7-8 mm Hg. In cardiovascular insufficiency the influence of electrostimulation on AC efficacy was weaker, the systolic and diastolic pressure increased only by 2-4 mm Hg, in massage of the abdomen both indices increased by 8-10 mm Hg.

Abdominal Muscles↗
PubMed1976

[Advances in the treatment of cardiogenic shock (author's transl)].

Advances in the conservative treatment of cardiogenic shock have been achieved by a combination of the use of drugs (dopamine, furosemide, prednisolone), artificial ventilation and parenteral nutrition (to avoid a negative energy situation). Basic requisites for such therapy are the continuous monitoring of haemodynamic parameters (pulmonary wedge pressure, cardiac index) and of laboratory results (blood gas analysis, pO2, pCO2, osmolarity, blood glucose level). Assisted circulation (IABP) should be started immediately if it becomes apparent that little or no effect has been achieved by medical treatment. Protection is provided by the IABP for further investigation of the patient by selective coronary angiography and surgical intervention whenever possible.

Assisted Circulation↗
PubMed1998

Successful treatment of anomalous origin of the left coronary artery from the pulmonary artery in a 5-week-old male infant.

A 5-week-old male infant who was referred to our hospital because of tachypnea and poor feeding. An electrocardiogram showed a deep Q wave in lead aVL, negative T waves in leads I, II, III, aVF and V6 and a positive T wave in VL. Echocardiography revealed severely impaired left ventricular function. Aortography confirmed with a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Takeuchi's procedure was performed and the patient maintained postoperatively on assisted circulation for 7 hours even though sternal closure delayed until 7 days post operatively. His left ventricular function showed and marked improvement gradually.

Assisted Circulation↗
PubMedDate not supplied

[Cardiosynchronized means of treatment and diagnosis].

Diverse ways of a cardiophased action on the cardio-vascular system for therapeutic and diagnostic purposes are assessed. Requirements for the basic subunits of the assisted circulation apparatus to be met, the possibilities open for developing automatic cardiosynchronization systems, and also features peculiar to the synchronization mode in effecting coronarography and conditions necessary for implementation of the method for elective introduction of liquid agents into the supravalvular space of the aorta are discussed.

Assisted Circulation↗
PubMed2002

[Long time use of percutaneous cardiopulmonary support after cardiovascular operation; clinical problems from our experience].

Result and problems were studied in 12 patients who received percutaneous cardiopulmonary support (PCPS) after cardiac or aortic surgery. Causative diseases included acute myocardial infarction in 7 cases, rupture of the left ventricular septum after infarction, acute mitral valve regurgitation after infarction, rupture of the left ventricular free wall, a stuck valve, and an aortic aneurysm in the thoracicoabdominal region in each 1 case. The time of postoperative PCPS ranged from 2 to 361 hours, and the mean supply flow volume was 1.78 +/- 0.45 l/min/m2. Seven patients could be taken off the treatment or discharged from the hospital (58.3%). The comparison between surviving and non-surviving cases showed a significantly longer assisted circulation time in the latter. An increase of bleeding after surgery was found in all 8 patients who received PCPS for a long period postoperatively. This was assumed to be due to the thrombocytic activation by heparin.

Aged↗
PubMed2001

[Pulsatile rotary pumps with low hemolysis].

As is well known, a pulsatile flow is important in assisted-circulation but it is difficult to produce a pulsatile flow with rotary pump, because excessive hemolysis will be generated. The authors have found that the turbulent shear is the main factor for red cell damage and therefore the key point of pulsatile rotary pumps is to reduce the turbulence by producing a pulsatile flow. In the authors' pulsatile axial pump, the pulsatile flow is obtained by axial reciprocation of constant rotating impeller; the rotation and reciprocation of the impeller are driven separately by a DC motor and a pneumatic device. Though a physiological pulsatile flow could be achieved and turbulence would not increase remarkably because the impeller rotates constantly, a second driver except a DC motor is nevertheless necessary, thus the system will become complicated. In the authors' pulsatile radial pump, a pulsatile flow is achieved by changing the rotating speed of the impeller periodically. Turbulence is minimized by a special design of twisted vanes which enable the blood flow to change its direction rather than its dimension during periodic change of rotating speed. Hemolysis tests demonstrated that the index of hemolysis(IH) of the author's pulsatile radial pump is 0.020, with is slightly more than that of the author's nonpulsatile radial pump(IH = 0.015). Animal experiments indicated that the pulsatile radial pump can assist the circulation of calves for several months without harm to blood elements and organ functions of the recipients.

Animals↗
PubMedDate not supplied

Computer analysis of external counterpulsation by use of a nonlinear mathematical model of the cardiovascular system.

A pressure system externally applied to the limbs of a patient has been proven effective in assisting circulation in animal and clinical studies. In this study a nonlinear mathematical model of the cardiovascular system is utilized to determine the effectiveness of high-frequency components in the external pressure waveform. The development of the model, the method of analysis, and the results acquired with the model are presented in this report, demonstrating its suitability for the study of external counterpulsation.

Animals↗
PubMed1994

[A case report of Tetralogy of Fallot in the adult with severe congestive heart failure].

We operated on a 47-year-old male for Tetralogy of Fallot with severe right heart dysfunction (RVEF 25%, RVEDP 15 mmHg, massive TR) and right heart failure (ascites and edema). The operation was completed successfully. However, persistent severe arrhythmia occurred in the CCU and assisted circulation was used for 6 days until the patient's condition stabilized. Arrhythmia diminished and hemodynamic status improved gradually. The patient improved sufficiently to be able to eat and read books. Unfortunately, he died of sudden ventricular arrhythmia on 69 POD. It was suspected that the right ventricle in this case had deteriorated beyond the threshold for surviving the radical operation for Tetralogy of Fallot.

Arrhythmias, Cardiac↗