Kenji Shiroma

Clinical Performance of Microporous Polypropylene Hollow-Fiber Oxygenator

A newly developed polypropylene hollow-fiber oxygenator was used from June 1979, to July, 1980, in 100 patients undergoing open-heart operation. Adequate oxygenation and carbon dioxide elimination were observed throughout perfusion in spite of a relatively low ratio of oxygen flow to blood flow. Plasma hemoglobin level was maintained low after long hours of perfusion. There were no complications related to the oxygenator during or after the operation. Because of its highly efficient performance as well as small size and easy handling, this oxygenator is being used routinely during open-heart procedures in our hospital.

Postoperative deep body temperature rhythm.

The postoperative deep body temperature rhythms of fifteen patients who received aorto-coronary bypass surgery (group I), and of seven patients who received non-cardiac major surgery (group II), were studied. Postoperative patients, especially those who received aortocoronary bypass surgery, showed greatly disturbed deep body temperature rhythm. There existed infradian and ultradian rhythm in both groups, and there existed two patients in group I who did not show sinusoidal rhythm. The patients of group I also showed a longer period of rhythm than did those of group II. The mesor and amplitude of the patients in group I showed a greater individual variation than did those in group II. The acrophase of both groups deviated widely. The patients who underwent cardiac surgery needed a longer time for temperature rhythm recovery than did those who underwent general surgery.

Removal of trypsin complexed alpha-2 macroglobulin by plasma fractionation.

Ischemia-reperfusion injury in open heart surgery can cause atherosclerotic changes in both bypass grafts and native coronary arteries by increasing endothelial permeability and allowing excessive influx of LDL into the subendothelium. The authors used LDL apheresis during cardiopulmonary bypass (CPB) to actively remove serum LDL before reperfusion, minimizing LDL influx. They evaluated the efficacy and safety of this new procedure in eight hypercholesterolemic patients. The control group consisted of 41 patients. Mean LDL cholesterol (LDL-C) level on admission was 180 +/- 41 (SD) in the LA group and 139 +/- 32 mg/dl in the control group (p = 0.02). After 105 +/- 27 min of apheresis, the LDL-C level in the LA group decreased to 62 +/- 25 mg/dl (reduction rate: 59 +/- 18%). In contrast, in the control group, the LDL-C level was reduced to 117 +/- 41 mg/dl (reduction rate: 16 +/- 9.5% [P = 0.0001]) after CPB. No significant difference was observed in intraoperative blood loss, postoperative blood loss, platelet count, prothrombin time, activated partial thromboplastin time, incidence of wound complications, or early patency rate of bypass graft between groups. Low density lipoprotein apheresis during CPB is a safe and effective method for lowering serum LDL level sufficiently before reperfusion, and can adequately reduce LDL influx into the vessel wall.Ischemia-reperfusion injury in open heart surgery can cause atherosclerotic changes in both bypass grafts and native coronary arteries by increasing endothelial permeability and allowing excessive influx of LDL into the subendothelium. The authors used LDL apheresis during cardiopulmonary bypass (CPB) to actively remove serum LDL before reperfusion, minimizing LDL influx. They evaluated the efficacy and safety of this new procedure in eight hypercholesterolemic patients. The control group consisted of 41 patients. Mean LDL cholesterol (LDL-C) level on admission was 180 +/- 41 (SD) in the LA group and 139 +/- 32 mg/dl in the control group (p = 0.02). After 105 +/- 27 min of apheresis, the LDL-C level in the LA group decreased to 62 +/- 25 mg/dl (reduction rate: 59 +/- 18%). In contrast, in the control group, the LDL-C level was reduced to 117 +/- 41 mg/dl (reduction rate: 16 +/- 9.5% [P = 0.0001]) after CPB. No significant difference was observed in intraoperative blood loss, postoperative blood loss, platelet count, prothrombin time, activated partial thromboplastin time, incidence of wound complications, or early patency rate of bypass graft between groups. Low density lipoprotein apheresis during CPB is a safe and effective method for lowering serum LDL level sufficiently before reperfusion, and can adequately reduce LDL influx into the vessel wall.