Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Samadinger, S.
P-MEC - Pediatric Minimal Extracorporeal Circulation:
First clinical experience using a newly established closed miniaturized bypass circuit as a new perfusion technique for pediatric cardiac surgery
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp. 90
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Knez Igor
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- Abstract:
- BACKGROUND: Closed miniaturized extracorporeal circulation (mini-ECC) systems proved to be beneficial in terms of the deleterious effects on the patient´s organism due to its reduced priming volume and lowered inflammatory response compared to conventional open cardiopulmonary bypass (CPB). Based on the convincing mini-ECC results current research deals with the miniaturization of the CPB setup for usage in pediatric cardiac surgery. To attenuate the CPB-associated systemic immune reaction and to cope with the extreme mismatch between the CPB priming volume and total blood volume of the children, a special adjustment of the CPB setup is required. Here we report on the first clinical experiences with the application of the newly established closed miniaturized bypass circuit as a new perfusion technique for pediatric cardiac surgery. METHODS: From August 2011 to September 2013, fourteen children with a body weight between 6.3 and 18.7 kilograms and a mean age of 2.9 ± 1.6 years underwent congenital cardiac surgery using the new pediatric-miniaturized extracorporeal circulation (P-MEC) system. The recently developed P-MEC® system is characterized by a closed circuitry with a low-prime oxygenator, an averaged priming volume of 250 ml and the possibility of emergency conversion to open bypass. To validate the quality of the perfusion flow rate and the degree of hemodilution, lactate and hematocrit values were measured pre-, intraand postoperatively. We were also interested in the demand of homologous blood transfusions, the alternative priming volumes for conventional bypass and the clinical outcome including surgical or embolic complications plus 6-months follow-up RESULTS: An emergency conversion to an open conventional bypass was not necessitated. Neither death nor any other postoperative complications including embolism, sepsis or reoperation due to excessive bleeding, occurred in any of the 14 patients. The average CPB duration was 72 minutes, with a mean aortic cross clamp time of 13 minutes. The hematocrit concentration averaged 36 % before bypass, 28 % respectively 26 % on bypass and 28 % after extracorporeal circulation. Only one child received 120 ml pRBCs after cessation of bypass, the other surgeries were performed without foreign blood transfusions. All patients presented an uneventful postoperative course and a satisfying long-time follow-up. CONCLUSIONS: Higher hematocrit concentrations and lower lactate levels on bypass, reduced transfusion requirements and good clinical outcome without the loss of safety standards are the favorable features of the novel P-MEC® system.