[Thermoregulation device with remote control for a heart-lung apparatus].
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A new, commercially available roller pump system able to deliver pulsatile and nonpulsatile flow has been studied in patients undergoing elective open-heart surgical procedures. The pulsatile pump (Stöckert Instrumente) may be used with standard extracorporeal circuit equipment and consistently produces a peripheral arterial pulse pressure of 25 to 30 mm. Hg at mean flow rates of 3.5 to 4.0 L. per minute. Twenty patients, arbitrarily allocated to pulsatile or nonpulsatile groups, have been studied. There were no significant differences between the groups in respect of age, weight, bypass time, pump flow, or mean arterial pressure during bypass. Comparative studies of the hematologic effects of pulsatile and nonpulsatile perfusion were carried out. There was no evidence of increased hemolysis with pulsatile flow, nor was there increased depletion of red blood cells (RBC's) or platelets in the pulsatile group. This pulsatile pump system may therefore be used to produce pulsatile perfusion during cardiopulmonary bypass without the fear of producing excessive blood cell trauma.
Previous studies have indicated that a significant reduction in plasma cortisol levels occurs during nonpulsatile cardiopulmonary bypass as a result of adrenocorticol hypofunction. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of plasma cortisol levels in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. The plasma cortisol response pattern in the nonpulsatile group was identical to the pattern previously described, with no significant rise in cortisol levels during the period of perfusion. In the pulsatile group, however, plasma cortisol levels rose significantly during perfusion, reaching a mean level at the end of perfusion which was highly significantly greater than that in the nonpulsatile group (p less than 0.001). Correction of the plasma cortisol values for the effect of hemodilution was performed and, again, corrected cortisol values indicated a highly significant increase in end-bypass levels in the pulsatile groups (p less than 0.001). These results clearly indicate that the reduction in cortisol secretion during nonpulsatile bypass may be prevented by the use of pulsatile perfusion.
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Single-use membraneous oxygenators "Teflo" (TMO) and bubble oxygenator "Variflow" (VF-1) issued by "Travenol" firm were used on 30 patients in open-heart operations with extracorporal circulation. A comparative assessment of working, technical and functional performances of these devices against the foam-membraneous oxygenator (FMO) of "AIK-5m" apparatus proved the reliability, safety, feasibility and high effectiveness of the single-use oxygenating systems, membraneous oxygenator in particular, which is the most promising one for the use in extracorporal circulation.
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Methods of extracorporeal circulation to permit intracardiac surgery still depend on the principles developed by John Gibbon in the early 1950s. This review traces Gibbon's early development, reviews the state of the art of instrumentation for extracorporeal circulation in the operating room today, and projects future changes in this instrumentation that will result in improvement in blood contact surfaces, automation and servo-regulation, and safety.
Aortic arch aneurysm has long been considered one of the most serious diseases in the circulatory system, and its resection is associated with great technical difficulties and hazardous consequences. Temporary shunts created with multiple graft anastomoses, deep hypothermia, progressive insertion of the graft, and cardiopulmonary bypass have been used to facilitate resection of the aneurysm at this vital segment of aorta. However, all of these techniques have certain disadvantages. To circumvent these disadvantages, we are proposing a simplified technique of external shunting combined with a permanent bypass graft. This method was used successfully in resection of a syphilitic aneurysm of the transverse aortic arch. The new technique is simple and easy to set up, and it greatly facilitates resection and graft replacement of the aneurysm. Because it does not require a pump oxygenator for bypass, it eliminates the postoperative blood coagulation problem. This technique is considered to be applicable in resection of aneurysms of the descending thoracic aorta as well.
The treatment of the cardiogenic shock complicating acute myocardial infarction has been drastically improved by the progress in temporary mechanical cardiovascular support. The improvement of the synchronous assist device, such as the intra aortic balloon, associated with the progress in the monitoring of the patients, in the surgical treatment of myocardial insufficiency and ventricular abnormalities such as ventricular septal defect and mitral insufficiency, has changed the seroius prognosis in patients. A review of some theretical, physiological and clinical problems are discussed in this paper.
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