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Onan I.S.,Istanbul Mehmet Akif Ersoy Thoracic | Yivli P.,Istanbul Mehmet Akif Ersoy Thoracic | Erkan H.,Istanbul Mehmet Akif Ersoy Thoracic | Akcevin A.,American Hospital | And 2 more authors.
Artificial Organs | Year: 2012

Our objective is to compare our current findings with the findings of our former study in 2004 and to make new suggestions for the development of cardiovascular perfusion in Turkey according to the results of the survey in 2011. © 2012, the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. Source


Dhami R.,Penn State Hershey Pediatric Cardiovascular Research Center | Wang S.,Penn State Hershey Pediatric Cardiovascular Research Center | Kunselman A.R.,Ark Inc | Undar A.,Penn State Hershey Pediatric Cardiovascular Research Center | Undar A.,Penn Medicine
Artificial Organs | Year: 2014

Cardiopulmonary bypass (CPB) is used for a variety of procedures in pediatric patients. Flow settings of the CPB pump have dramatic effects on patient outcome, and gaseous microemboli delivery within the CPB circuit has been linked to neurological complications. To ensure the ongoing improvement of pediatric CPB, consistent evaluation and improvement of the equipment is necessary. In this study we analyze the Jostra HL-20 roller pump (Jostra USA, Austin, TX, USA) and a Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, Stolberg, Germany) which has not yet received Food and Drug Administration approval. An infant CPB model with heparinized human blood is used to quantify the gaseous microemboli delivery (via an Emboli Detection and Classification Quantifier), as well as the hemodynamic energy delivered under flow rates of 400, 800, and 1200mL/min. Results show that at most flow settings the DP3 delivers fewer microemboli than the Jostra roller pump at the pre-oxygenator site, with an exception at 1200mL/min under pulsatile mode. The total volume and the number of gaseous microemboli greater than 40μm in diameter were lower in the DP3 group. The HL-20 exhibits less stolen blood flow (except at 1200mL/min) and oxygenator pressure drops in both pulsatile and nonpulsatile mode. Additionally, under pulsatile flow the DP3 delivers greater surplus hemodynamic energy. Both pumps produce relatively few microemboli and deliver adequate hemodynamic energy to the pseudo-patient, with the DP3 performing slightly better under most flow settings. © 2013, the Authors. Artificial Organs © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation. Source


Wang S.,Penn State Hershey Pediatric Cardiovascular Research Center | Palanzo D.,Penn State Heart and Vascular Institute | Kunselman A.R.,Penn State Hershey Childrens Hospital | Undar A.,Penn State Hershey Pediatric Cardiovascular Research Center | Undar A.,Penn Medicine
Artificial Organs | Year: 2016

The objective of this study was to evaluate five small-bore arterial cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated arterial filter, an arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150cm), and an arterial cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400mL/min; 8Fr: 200-600mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore arterial cannula and small inner diameter arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7±1.0mmHg (Maquet 6Fr at 400mL/min), and 395.7±0.4mmHg (DLP 8Fr at 600mL/min) when using 1/8 in ID arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr arterial cannula had significantly lower pressure drop and energy loss. Maquet 6Fr arterial cannula had a greater pressure drop than the DLP 6Fr. A small-bore arterial cannula and arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate arterial cannula and arterial tubing should be considered to match the expected flow rate. Larger cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal arterial cannulae need to be developed. © 2016 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation. Source


Clark J.B.,Penn State Hershey Pediatric Cardiovascular Research Center | Pauliks L.B.,Penn State Hershey Pediatric Cardiovascular Research Center | Myers J.L.,Penn State Hershey Pediatric Cardiovascular Research Center | Undar A.,Penn State Hershey Pediatric Cardiovascular Research Center | Undar A.,Penn Medicine
Current Cardiology Reviews | Year: 2011

Approximately one in one hundred children is born with congenital heart disease. Most can be managed with corrective or palliative surgery but a small group will develop severe heart failure, leaving cardiac transplantation as the ultimate treatment option. Unfortunately, due to the inadequate number of available donor organs, only a small number of patients can benefit from this therapy, and mortality remains high for pediatric patients awaiting heart transplantation, especially compared to adults. The purpose of this review is to describe the potential role of mechanical circulatory support in this context and to review current experience. For patients with congenital heart disease, ventricular assist devices are most commonly used as a bridge to cardiac transplantation, an application which has been shown to have several important advantages over medical therapy alone or support with extracorporeal membrane oxygenation, including improved survival to transplant, less exposure to blood products with less immune sensitization, and improved organ function. While these devices may improve wait list mortality, the chronic shortage of donor organs for children is likely to remain a problem into the foreseeable future. Therefore, there is great interest in the development of mechanical ventricular assist devices as potential destination therapy for congenital heart disease patients with end-stage heart failure. This review first discusses the experience with the currently available ventricular assist devices in children with congenital heart disease, and then follows to discuss what devices are under development and may reach the bedside soon. © 2011 Bentham Science Publishers. Source


Wolfe R.,Penn State Hershey Pediatric Cardiovascular Research Center | Strother A.,Penn State Hershey Pediatric Cardiovascular Research Center | Wang S.,Penn State Hershey Pediatric Cardiovascular Research Center | Kunselman A.R.,Public Health and science | And 2 more authors.
Artificial Organs | Year: 2015

This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmission (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung membrane oxygenator (Xenios AG), an 18 Fr Medos femoral arterial cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous cannula (San Ramon, CA, USA), 3/8in ID×140cm arterial tubing, and 3/8in ID×160cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). The trials were conducted at flow rates 1-4L/min (1L/min increments) under nonpulsatile and pulsatile mode, with differential speed values 1000-4000rpm (1000rpm increments) at 36°. The pseudo patient's mean arterial pressure was kept at 100mmHg using a Hoffman clamp during all trials. Real-time flow and pressure data were collected using a custom-based data acquisition system. Mean pressures across the circuit increased with increasing flow rates, but increased insignificantly with increasing differential speed values. Mean pressure did not change significantly between pulsatile and nonpulsatile modes. Pulsatile flow created more THE than nonpulsatile flow at the preoxygenator site (P<0.01). Of the different components of the circuit, the arterial cannula created the greatest THE loss. THE loss across the circuit ranged from 24.8 to 71.3%. Still, under pulsatile mode, more THE was delivered to the pseudo patient at low flow rates. No SHE was created with nonpulsatile flow, but SHE was created with pulsatile flow, and increased with increasing differential speed values. At lower flow rates (1-2L/min), the arterial cannula contributed the most to SHE loss, but at higher flow rates the arterial tubing created the most SHE loss. The circuit pressure drop values across all flow rates were 33.1-246.5mmHg, and were slightly higher under pulsatile mode than nonpulsatile mode. The i-cor diagonal pump creates satisfactory pulsatile and nonpulsatile flows, and can easily change the pulsatile amplitude and energy transmission. The attributes of the XLung membrane oxygenator include low resistance, low energy loss, and low pressure drops at all flow rates and differential speed values. The arterial cannula created the highest pressure drop of all components of the circuit. Pulsatile flow improved the transmission of hemodynamic energy to the pseudo patient without significantly affecting the pressure drops across the circuit. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. Source

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