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PubMedDate not supplied

In vivo evaluation of a peripheral vascular access axial flow blood pump.

More than 80 acute and chronic calf in vivo studies were utilized to develop a 3 L/min axial flow blood pump designed for intraarterial ventricular assist. The 7 mm diameter transvalvular inlet cannula of the cable driven pump receives blood from the left ventricle. The pump then discharges blood into the descending aorta. In the calf, the pump was introduced into the renal aorta. Safety and effectiveness of the device were demonstrated in three control and 21 implanted animals. Blood chemistry results showed an average plasma free hemoglobin of 3 mg/dl for control and 6.7 mg/dl for implanted animals. Platelets were 1.04 X 10(6) and 0.65 X 10(6), respectively, for control and implanted animals. Fibrinogen, BUN, creatinine, and bilirubin were essentially the same for both groups of animals. The hardware was typically free of deposits, and histopathologic examination revealed minimal injury to intracardiac structures, aortic valve leaflets, and aortic intima. The data indicates that the device may provide full support for a failing left ventricle with minimal trauma or risk.

Animals↗
PubMed1996

[Survival of a patient with postinfarction ventricular septal defect following venoarterial bypass with centrifugal pump and reoperation for residual shunt].

A 61-year-old man was hospitalized because of circulatory collapse due to postinfarction ventricular septal defect. As his hemodynamic condition deteriorated despite intraaortic counterpulsation, he underwent patch closure of VSP and patch reconstruction of the anterior left ventricular wall concomitant with coronary artery bypass grafting to the circumflex lesion immediately after admission. Femorofemoral circulatory assist with centrifugal pump was necessitated to wean from cardiopulmonary bypass because of severe left ventricular dysfunction. Circulatory assist was controlled to maintain mixed venous oxygen saturation of more than 70% under mild hypothermia. On the second postoperative day (POD), increased oxygen saturation from right atrium to pulmonary artery developed (Qp/Qs = 2.1). Further surgery was performed on an emergency basis for additional patch closure of VSP. Then he was successfully weaned from cardiopulmonary bypass successfully. The patient was extubated on the 14th POD and was ambulatory when he discharged on the 56th POD. Immediate surgical intervention should be performed for the patient with postinfarction ventricular septal defect when the hemodynamic state deteriorates under intraaortic counterpulsation.

Assisted Circulation↗
PubMed1978

[Transportation of patients with myocardial infarct complicated by cardiogenic shock and the use of countershock via an intra-aortic balloon].

The article deals with the first experience in the use of auxiliary circulation by contrapulsation with an intraaortic balloon during the transportation of patients with myocardial infarction complicated by cardiogenic shock from an unspecialized hospital to a cardiosurgical hospital. Transportation on the background of contrapulsation does not affect the efficacy of auxiliary circulation and does not lead to a recurrence. A conclusion is drawn on the experiency of using contrapulsation during transportation of patients with myocardial infarction complicated by cardiogenic shock to specialized cardiosurgical hospitals for continuation of auxiliary circulation and emergency revascularization of the myocardium.

Assisted Circulation↗
PubMed1983

Mechanical techniques of circulation support: a percutaneous intra-aortic balloon device.

As medical indications for intra-aortic balloon (IAB) pumping expand, many physicians without surgical expertise are faced with the decision to institute circulatory support. Accordingly, to facilitate rapid establishment of cardiac assist and to obviate the need for operative insertion and removal, a 40-cc single-chambered device was designed for percutaneous insertion by the Seldinger technique. Hemodynamic augmentation produced by the percutaneous balloon is similar to that obtained with conventional IAB. It appears that complications related to IAB insertion may be decreased by the percutaneous method.

Assisted Circulation↗
PubMed1992

A survey of static and dynamic work postures of operating room staff.

Work in health care units is associated with considerable physical strain and many musculoskeletal complaints. Most investigations have concentrated on the work of general hospital nurses; little is known about the physical stress load on other health care workers. We therefore carried out an ergonomic study amongst operating room staff in order to (i) determine the work (posture) stress load on this particular group of health care workers and the effect of static posture on this stress, (ii) identify activities involving poor work postures, and (iii) determine differences between specialties in regard to work posture stress load. The work postures and related work activities of four different groups of staff in operating rooms (surgeons, assistant anaesthesists, instrumentation nurses and circulating nurses) were recorded and evaluated using the specified Ovako Working posture Analysing System (OWAS). Observation during the course of 18 daily surgical programmes (total number of observations: 3714) in the specialties general surgery and ear-nose-throat (ENT) surgery revealed that the work-load according to OWAS for circulating nurses and assistant anaesthesists was not harmful. Some work postures seen among instrumentation nurses and surgeons, however, need improvement. The work posture stress load in these groups is mainly due to the high prevalence of static work postures during the activities "surgery" (surgeons) and "assisting surgery" (instrumentation nurses). Significant differences in ergonomic stress load were observed between general surgeons and ENT surgeons. This survey in operating theatres relates work postures to basic activities and can be used as a starting point from which to improve work conditions in order to reduce or eliminate physical complaints among operating room staff.

Ergometry↗
PubMed1988

Preclinical evaluation of the abdominal aortic counterpulsation device.

A valveless, single-orifice abdominal aortic counterpulsation device (AACD) was implanted retroperitoneally on the abdominal aorta and was pumped continuously, providing aortic diastolic augmentation for 45 +/- 4.9 days in four calves (group A). The hematocrit, lactate dehydrogenase (LDH), bilirubin, blood urea nitrogen, and creatinine were obtained before implantation and weekly thereafter. Biocompatibility data were compared to those obtained from 11 calves (group B) that received a total artificial heart (TAH) and were electively terminated 50.0 +/- 19.5 days after implantation. The hematocrit values in the first week were 20.9 +/- 11.5% and 39.8 +/- 11.5% below control values for group A and group B, respectively (p less than 0.02); in the sixth week they were 5.1 +/- 14.6% above control values (group A) and 22.6 +/- 9.0% below control values (group B) (p less than 0.05). LDH did not change in group A, while in group B it was constantly about 100% above control values. Autopsy revealed one to three infarcts 1 to 3 mm in diameter in 63% of the kidneys in group A, while in all of group B kidneys there were multiple infarcts of more than 10 mm. After the induction of left ventricular (LV) failure, the AACD decreased the LV end-diastolic pressure (EDP) by 21.2% (p less than 0.005) and the aortic (AO) EDP by 18% (p less than 0.005). It increased the endocardial viability ratio by 300% (p less than 0.0005), and the cardiac index by 66.9% (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Mechanical circulatory support therapy as a bridge to transplant or recovery (new advances).

PURPOSE OF REVIEW: Large pulsatile left ventricular assist devices have been used as bridge-to-transplant therapy for the past 20 years. Over the past 2 years, a number of smaller rotary pumps have been introduced into clinical trials in the United States, Europe, and Australia. These devices offer the potential for smaller operations, greater resistance to infection, and new opportunities for bridge-to-recovery therapy. RECENT FINDINGS: Ongoing trials with axial flow devices support greater durability and less device-related infection than the HeartMate XVE (Thoratec Corporation, Pleasanton, California, USA). A greater tendency for pump thrombus and a higher anticoagulation requirement, however, are disadvantages compared with the HeartMate device. SUMMARY: Large pulsatile left ventricular assist devices have been the mainstay of mechanical support. The combination of durability and smaller pump size has become a focus of mechanical circulatory support in the current era. Ongoing clinical trials in the United States with three rotary pumps in both bridge-to-transplant and destination trials will likely result in a major increase in options for circulatory support. At least five other small, durable devices have recently entered non-US trials and are poised for clinical studies in the US. The National Institutes of Health-sponsored Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) will facilitate the introduction of new technology and study patient and device outcomes.

Assisted Circulation↗
PubMed1985

Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function.

Approximately 20% of patients who receive left ventricular assist devices (LVADs) for refractory cardiac failure after open heart surgery have had complications of right ventricular failure. To evaluate this problem in the diseased heart we simulated an LVAD in the operating room by bypassing and unloading the left ventricle with the heart-lung machine before routine open heart surgery. Right ventricular function was assessed in 12 patients with preoperative left ventricular ejection fractions of less than 0.55 (poor left ventricular function) (mean +/- SEM 0.40 +/- 0.03) and 10 patients with ejection fractions greater than 0.55 (normal left ventricular function) (0.63 +/- 0.02). Measurements before and during left ventricular bypass in the normal left ventricular function group revealed no change in cardiac output (from 5.7 +/- 0.6 to 5.8 +/- 0.4 liters/min), with a decrease in right ventricular end-diastolic pressure (from 8 +/- 2 to 6 +/- 1 mm Hg). However, in the poor left ventricular function group, cardiac output was increased significantly during left ventricular bypass from 4.5 +/- 0.2 to 5.3 +/- 0.4 liters/min and right ventricular end-diastolic pressure was decreased significantly from 13 +/- 2 to 8 +/- 2 mm Hg. During bypass there were significant reductions in mean pulmonary arterial pressure from 17 +/- 3 to 10 +/- 2 mm Hg in the normal left ventricular function group and from 27 +/- 3 to 12 +/- 2 mm Hg in the poor left ventricular function group. These measurements reflect passive changes in pulmonary pressures due to reductions in left ventricular filling pressure during left ventricular bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Isolated left ventricular assist as bridge to cardiac transplantation.

The electrically driven Novacor implantable left ventricular assist device has been implanted in six patients (four men and two women) since Sept. 7, 1984. In four of the six patients (67%) the device was a successful bridge to cardiac transplantation. One patient died of multiple organ failure and Candida sepsis after 16 days of support with the device. One patient died in the operating room of uncontrollable hemorrhage and biventricular failure caused by severe cardiac rejection. Three patients are alive with cardiac transplants 38, 17, and 10 months after transplantation. One patient died after cardiac transplantation of presumed sepsis. The Novacor left ventricular assist device performed in all cases without mechanical or electrical failure. Excluding the intraoperative death, assist duration ranged from 2 to 16 days. The cardiac index (synonymous with device output) ranged from 2.4 to 3.4 L/min/m2. No embolic events (cerebrovascular or systemic) occurred during assistance with the device. Minimal red cell hemolysis was documented during the period of support. The Novacor left ventricular assist device is a safe and effective bridge to cardiac transplantation in patients with refractory cardiogenic shock.

Adult↗
PubMed1994

Role of percutaneous cardiopulmonary bypass and other support devices in interventional cardiology.

Percutaneous cardiopulmonary bypass support has a role to play in the management of the high-risk coronary angioplasty patient. This article discusses the basic principles of cardiopulmonary bypass, technique, indications, and complications of this new addition to interventional cardiology. In addition, the role of other support devices during high-risk coronary interventions is also discussed.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Non-pulsatile circulatory support in 90 cases.

Survival after cardiac arrest is reportably less than 10%; after cardiogenic shock it is less than 50%; and in failure to wean post-cardiotomy (even with centrifugal pumps in several large series) it is only 11-21%. The authors' experience with non-pulsatile circulatory support in 90 consecutive cases from 1986-91 has shown improved survival. The emergent cardiopulmonary bypass system (CPS) was used in 67 of the 90 patients, with 65 patients resuscitated, 34 (51%) weaned, and 19 (28%) transferred to other cardiovascular support therapies. Of the patients weaned or transferred, 34 (51%) survived > 24 hr, and 21 (31%) survived > 30 days. In the current series, 108 major cardiovascular procedures were done during or after CPS implementation. An in-house trained nursing team working with surgeons and perfusionists contributed to early implementation of the CPS and the subsequent improved survival. The BioMedicus centrifugal pump (VAD) was used predominantly for post-cardiotomy failure to wean in 16 patients and as a bridge to transplant in 7 patients. Fourteen patients (61%) were weaned or transplanted. Of these 14 patients, 11 (48%) survived > 30 days. Non-pulsatile circulatory support devices are relatively inexpensive and available to most hospitals. With careful patient selection and early implementation, one can expect survival of 37% of patients who would otherwise not survive.

Assisted Circulation↗