Shinsuke Choh

Clinical evaluation of the Gyro Pump C1E3 as a cardiopulmonary bypass pump.

The Gyro Pump C1E3 is a new centrifugal pump with numerous features, including a ceramic pivot bearing system, secondary vanes, and an eccentric inlet port. To evaluate its biocompatibility, antithrombogenicity, and produced hemolysis, we used the Gyro Pump during cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG) cases to compare it with the BioMedicus pump. From September 1998 to February 1999, 30 consecutive patients underwent CABG under conventional CPB. Fifteen patients were supported by the Gyro Pump C1E3 (Group G), and the remaining 15 patients, by a BioMedicus BP-80 pump (Group B). In both groups, flow rate was equivalent. Blood samples were taken as follows: preoperative, 60 minutes after the end of the procedure, and at postoperative days (POD) 0, 1, and 2. We evaluated the plasma free hemoglobin (free Hb) as an indication of hemolysis; beta-thromboglobulin (beta-TG) and platelet factor four (PF-4) as an indication of platelet deterioration; C3, C4, CH50 for complement activation; coagulation parameters, fibrinolytic factor, thrombomodulin, nitric oxide (NO), and endothelin as an indication of endothelial deterioration. This was the first clinical sized Gyro Pump CIE3. De-airing from the pump was easily accomplished via the eccentric oblique inlet port. The system, including its console, was easily and simply controlled. Perioperative laboratory data were not markedly changed in either group with demonstrated equivalence for biocompatibility and hemolysis. After pumping, no thrombus formation or pivot wear were observed inside the pump. This atraumatic, small centrifugal pump appears well suited not only for CPB but also for circulatory support.

Abdominal Aortic Aneurysm Accompanied by Aortic Dissection

大動脈解離が及んだ腹部大動脈瘤3例を経験した.3例中2例を腸管壊死により失ったが,このうち1例は解離が腹部大動脈瘤に進展したために破裂した症例で,人工血管の中枢側吻合にさいして開窓術を行わなかったことによる上腸間膜動脈の血流障害が原因と考えられた.もう1例の死亡例は開窓術を行ったのちに人工血管置換術を行ったが,剖検の結果,グラフトの吻合には問題なかったものの,内腸骨動脈の閉塞が原因で下行結腸からS状結腸が壊死に陥り死亡したと判明した.生存例では開窓術ののち,人工血管置換術を施行し経過は良好であった.手術時期は大動脈解離を発症した急性期では血管壁が脆弱であることから,破裂例およびmalperfusionによる虚血症状が認められる症例を除き,発症から1ヵ月の期間をおくことが望ましいと思われる.また慢性期では開窓術の安全性は高く,これを行うべきであり,また急性期であっても可能なかぎり行うべきである.

Retrospective analysis of the clinical trends and current indications for perioperative intraaortic balloon pumping in high-risk coronary artery bypass surgery

We clinically evaluated the current indications for perioperative intraaortic balloon pumping (IABP) in high-risk patients undergoing coronary artery bypass grafting (CABG). Over the past 22 years, 196 CABG patients received perioperative IABP at our institution. We divided the 22 years into periods I–IV (earliest to latest) and investigated the annual changes in the indications for and mortality from IABP. In periods I and II, IABP was mainly employed for postoperative low-output syndrome (LOS) or perioperative myocardial infarction (PMI). The hospital mortality rate was 13.2%–18.5%. In period III, the mortality rate was markedly reduced by the use of preoperative scheduled IABP. In period IV, however, scheduled IABP was used less often for high-risk CABG, and IABP was mainly employed in patients having emergency CABG for acute coronary syndrome (ACS). The hospital mortality rate was reduced to 3.7%. In the last 2 years, 19 (65.5%) of 29 patients who received preoperative IABP had emergency CABG for ACS, while 27 high-risk CABG patients with poor left ventricular (LV) function or left main trunk (LMT) disease were treated successfully without scheduled IABP. There were no significant differences between the IABP and non-IABP patients in age, sex, number of bypasses, and aortic cross-clamp time. Because of improvements in anesthesia, operative techniques, perioperative management, and cardioplegic solutions, preoperative support with IABP is less often needed for high-risk CABG, except in patients undergoing emergency surgery for ACS.