Reoperation and the centrifugal pump?

Abstract

Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were divided into two groups of 25 each. In group 1 a centrifugal pump (Biomedicus) was used as arterial blood pump, while in group 2 a roller pump (Stöckert) was used. The two groups did not differ significantly and the number of variables during surgery was kept low (identical perfusion set, two surgeons, minimal cardiotomy suction). The parameters studied included the cellular elements of the blood and components indicating their functional integrity, such as PMN-elastase, plasma hemoglobin, beta-thromboglobulin, and thrombin-antithrombin III complex and D-dimer as representatives for activated coagulation and secondary fibrinolysis. Blood and urine samples were taken every 15 min during ECC, on arrival in the intensive care unit, and 1, 3, 6, 12, and 24 h thereafter. No difference between the groups was found in regard to bypass time, ECC flow and volume, fluid balance, and clinical outcome. Significant differences in favor of group 1 were found in plasma hemoglobin (P less than 0.05), beta-thromboglobulin (P less than 0.01), D-dimer (P less than 0.05), and platelet counts (P less than 0.5). These differences were clearly ECC-time-dependent and became statistically significant after 90 min bypass. We conclude that roller pumps still can be safely used for standard cardiac procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective Randomized Clinical Study of Arterial Pumps Used for Routine on Pump Coronary Bypass Grafting

“…During the past decades, several centrifugal continuous flow pumps have been invented. The reason for their increasing use for extracorporeal circulation is their assumed superiority to roller pumps, that is, flow pumps are thought to produce less blood damage (2,3,5). Nevertheless, many questions remain unanswered, and the clinical relevance needs to be discussed controversially (2,8–13).…”

“…Steines and coworkers (4) found similar results in their in vitro study, and Driessen (2) and Wahba (10) achieved comparable results in their in vivo series. Jakob and associates (5) compared a centrifugal pump (Biomedicus) with the roller pump in groups of 25 patients each, detecting differences in platelet count and D‐dimer in favor of the centrifugal pump. These differences obviously depended on the time of CPB circulation, reaching statistical significance after 90 min of CPB.…”

“…A number of studies have shown that centrifugal blood pumps, in comparison with roller pumps, decrease trauma to blood components. Nevertheless, the impact of these results needs to be controversially discussed with regard to the postoperative course including complications and survival time (2–9).…”

Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors

“…Interventions varied regarding components of CPB such as types of pumps [6][7][8][9][10][11][12][13][14][15][16][17][18], types of oxygenators [19][20][21][22], types of cannulas [23], and types of suctions [24]; circuit management, such as separated reservoir [25][26][27][28], coating [29][30][31][32][33][34][35][36][37], venous drainage [38][39][40]; techniques, such as pulsatility [3,[41][42][43][44], retransfusion [45,46], the use of cell saver [47][48][49], cardioplegia [50], priming [51], medications [4,[52]…”