Dennis R. Williams

Hetastarch as a Prime for Cardiopulmonary Bypass

Hetastarch, a synthetic colloid osmotic plasma volume expander, was employed in a prime for cardiopulmonary bypass in 37 patients undergoing myocardial revascularization. Comparison of laboratory values to those of 42 patients undergoing myocardial revascularization using an albumin-containing prime showed lower postoperative platelet counts (p less than 0.02) with hetastarch. There were no differences in chest tube drainage, blood use, plasma hemoglobin, fibrinogen levels, of coagulation times. The hetastarch prime cost

Obstruction of the True Lumen during Retrograde Perfusion of Type I Aortic Dissections: A Simplified Solution

119.50 per patient, whereas the albumin-containing prime cost

Similarity of Clinical and Laboratory Results Obtained with Microporous Teflon Membrane Oxygenator and Bubble-Film Hybrid Oxygenator

321.35 per patient.

Preliminary clinical experience with isotonic hypothermic potassium-induced arrest.

Retrograde perfusion of the false lumen in cases of type I dissection of the thoracic aorta may not permit reperfusion of the coronary arteries when the aortic cross-clamp is removed. We have employed a Y connector between the coronary perfusion outlet of the oxygenator and cardioplegia delivery system. This allows reperfusion of the coronary arteries through the ascending aortic graft. As cardiopulmonary bypass is discontinued, the true aortic lumen is reexpanded and the false lumen collapsed by forward flow of blood from the heart. The successful use of this system is described.

Protection from ischemic cardiac arrest by coronary perfusion with cold Ringer's lactate solution.

For 80 elective clinical cardiopulmonary bypasses we alternately used either a commercial microporous Teflon membrane oxygenator or a commercial hybrid bubble-film oxygenator. Setup time was a little longer with the membrane unit (20 minutes), but priming volume (2,250 ml) was the same. No problems were encountered with the hybrid oxygenator. However, despite our monitoring of additional variables, including shim and inlet pressure and recirculation flow, gas exchange abnormalities were encountered in 5 patients on whom the membrane oxygenator was used; in 4 of these cases the abnormalities were encountered prior to our recognition of the potential for occasional internal shunting with this device. There were no hospital deaths. When the two groups, matched except for oxygenator selection, were compared, there were no significant differences clinically or hematologically. For cardiopulmonary bypass of 2 hours or less, both oxygenators studied are definite improvements over previous silicone membrane and high-gas-flow bubble oxygenators. However, lower cost and reduced complexity favor the hybrid oxygenator.