A cardioplegia circuit with versatility: the ‘ReVerse’ system. How to do it

Abstract

Various methods of cardioplegia administration have been used in cardiac surgery: crystalloid, blood and mixed crystalloid/blood. Each of these types of cardioplegia administration typically needs a different circuit. This may correspond to an increase in cost and the time needed to change the circuit if required. When various modifications are performed on the circuit, this also increases the risk of contamination. In order to simplify the management of differing cardioplegia circuits, we devised one circuit for all solutions in all situations by adding one modification. The ReVerse cardioplegia circuit system is a description of a two-pump cardioplegia circuit which is adaptable to either blood or crystalloid cardioplegia. The change from one mode to another requires a manoeuvre of two clamps, allowing the blood solution to travel through shunt tubing into the apposite pumphead. In our experience the versatility of this circuit is a fast, safe method to administrate all types of cardioplegia solution, saving the space taken up by storing multiple circuits.

Testosterone and imipramine have antidepressant effects in socially isolated male but not female rats

“…Biological, psychological, and sociological theories attempt to explain the preponderance of women suffering from anxiety and depressive disorders, however, the prevailing hypothesis implicates a critical role for gonadal hormones in both the onset and regulation of mood disorders (Colangelo et al, 2008). In particular, testosterone had antidepressant effects in humans and rodents.…”

A novel versatile concept of cardioplegia delivery in cardiac surgery: The ReverseTWO cardioplegia circuit system

“…The previous design named "ReVerse" CPL circuit has been previously described. 6 The main difference with the ReverseTWO circuit is that the novel system allows delivery of four than two types of CPL (precedent version called Reverse), thanks to an additional shunt and additional clamps.…”

“…However, in order to administer Del Nido CPL, that has an inversely proportional blood-to-CPL ratio with respect to Buckberg CPL, another modified circuit was necessary and the Reverse circuit could not be used. 6 The ReverseTWO system circuit (Figure 1) consists in: administration without changing the double pediatric pump setting. This system allows to choose the CPL solution also a few minutes before starting the intervention, so the surgeon can decide the best technique for myocardial protection.…”

“…However, in order to administer Del Nido CPL, that has an inversely proportional blood-to-CPL ratio with respect to Buckberg CPL, another modified circuit was necessary and the Reverse circuit could not be used. 6…”

“…With the following increase in mitral valve minimally invasive surgeries, 3,4 a shift towards a greater use of Bretschneider HTK (SALF, Italy) occurred 5 and the Reverse CPL circuit was developed. 6 ReVerse CPL circuit allowed the administration of two different types of CPL thanks to a single shunt between two pediatric roller pumps and to a single clamp in it.…”