Cardiopulmonary Bypass: a Forgotten Area of Searching for New Knowledge in Brazil
            and the Importance of Translational Research

Neirotti, Rodolfo A.

doi:10.5935/1678-9741.20160073

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Brazil has a large number of medical devices manufactured and available only in this region which are approved by the National Health Surveillance Agency. These devices commonly do not have large clinical studies comparing clinical data or doing benchmarking of similar devices [ 19 - 21 ] . In this context, cultural issues associated with the widespread clinical use of devices without any scientific evidence could be responsible for suboptimal outcomes related to perfusion practice.…”

Section: Discussionmentioning

confidence: 99%

Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits

Canêo¹,

Matte²,

Guimaraes³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveHemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options.MethodsFour different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C.ResultsCircuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively.ConclusionA single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.

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Section: Discussionmentioning

confidence: 99%

Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits

Canêo¹,

Matte²,

Guimaraes³

et al. 2018

Braz J Cardiovasc Surg

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“…Brazil manufactures many medical devices approved by the Agência Nacional de Vigilância Sanitária (or Anvisa) available only in this region, without further clinical data or benchmarking with other significant research centers developing similar devices [ 30 ] . Usually, only Food and Drug Administration-approved products in widespread use in developed countries are research objects by the international scientific community.…”

Section: Pediatric Cardiac Surgery In the Brazilian Public Health Car...mentioning

confidence: 99%

A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way — Issues Around and Outside the Operating Room

Canêo¹,

Miana²,

Garros³

et al. 2022

Braz J Cardiovasc Surg

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In some developing countries, congenital heart disease still stands out among the leading causes of death in the first year of life. Therefore, there is a great need to develop programs designed to improve outcomes in the diagnosis and surgical treatment of congenital heart disease in these nations, where children have always been and still are severely underserved. The Brazilian Public Health Care System demands universal access to treatment as a constitutional right. Therefore, an underfunded Pediatric Cardiac Surgery program is unacceptable since it will cost lives and increase the infant mortality rate. Additionally, poor funding decreases providers’ interest, impedes technological advances and multidisciplinary engagement, and reduces access to comprehensive care. Unfortunately, in most developing countries, Pediatric Cardiac Surgery progress is still the result of isolated personal efforts, dedication, and individual resilience. This article aims to present the current state of Brazilian pediatric cardiac surgery and discuss the structural and human limitations in developing a quality care system for children with congenital heart disease. Considering such constraints, quality improvement programs via International collaboration with centers of excellence, based on proper data collection and outcomes analysis, have been introduced in the country. Such initiatives should bring a new dawn to Brazilian Pediatric Cardiac Surgery.

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“…Brazil has a large number of medical devices approved by the National Health Surveillance Agency, manufactured and available only in this region, without any further clinical data or benchmarking with other large clinical studies and similar devices .…”

mentioning

confidence: 99%

In Vitro Evaluation of Pediatric Hollow-Fiber Membrane Oxygenators on Hemodynamic Performance and Gaseous Microemboli Handling: An International Multicenter/Multidisciplinary Approach

et al. 2017

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The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr arterial cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P <0.01). GME count and volume at pre-/post oxygenator and pre-cannula sites in the Quadrox were lower than the Braile group at high flow rates (P < 0.05). In the additional experiment, an arterial filter captured a significant number of microemboli at all flow rates. The Braile Infant oxygenator has a matched hemodynamic characteristic with the Quadrox-i Pediatric oxygenator. The Quadrox-i has a better GME handling ability compared with the Braile Infant oxygenator. Regardless of type of oxygenator an additional arterial filter decreases the number of GME.

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Cardiopulmonary Bypass: a Forgotten Area of Searching for New Knowledge in Brazil and the Importance of Translational Research

Cited by 3 publications

References 4 publications

Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits

Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits

A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way — Issues Around and Outside the Operating Room

In Vitro Evaluation of Pediatric Hollow-Fiber Membrane Oxygenators on Hemodynamic Performance and Gaseous Microemboli Handling: An International Multicenter/Multidisciplinary Approach

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