Comparison of the standard roller pump and a pulsatile centrifugal pump for extracorporeal circulation during routine coronary artery bypass grafting

Abstract

The present prospective study compared the standard nonpulsatile twin roller pump with the Sarns centrifugal pump, in the pulsatile mode, as arterial pumps for extracorporeal circulation during coronary artery bypass grafting (CABG). The study was conducted in two consecutive groups of 25 patients receiving a standard anaesthetic and surgical protocol. The investigated parameters included haemodynamic profiles, oxygen exchange, blood gas and acid-base homeostasis, haematology, coagulation and complement consumption. With comparable settings for pump flow, gas flow and delivered oxygen concentrations, there was no difference between the groups in the main haemodynamic parameters during cardiopulmonary bypass (CPB). However, a tenfold lower dose of sodium nitroprusside was required to keep systemic vascular resistance within physiologic limits during CPB in the centrifugal group (C group) compared with the roller group (R group). During rewarming oxygen extraction was higher in the C group than in the R group. During the first eight hours after CPB no differences in haemodynamics, oxygenation parameters and pulmonary shunt between the groups were observed. During, as well as after, CPB there was no significant difference in blood gas and acid-base homeostasis between either group. Average postoperative blood loss via chest tubes, total transfusions of blood products, haemoglobin and coagulation did not differ between the two groups. However, the white blood cell count, corrected for changes in haematocrit, decreased during the early phase of CPB in the R group, but not in the C group. It was concluded that, since no major differences in clinical outcome were observed in the present study, the Sarns centrifugal pump is a safe alternative to the roller pump during routine cardiac surgery and should be further studied in a larger number of patients.

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References

Tinker JH , Roberts SL Management of cardiopulmonary bypass. In: JA Kaplan ed. Cardiac anesthesia. Second edition. Philadelphia: WB Saunders , 1987: 895-926.

Park SB , Liebler GA , Burkholder JA , Maher TD Mechanical support of the failing heart. Ann Thorac Surg 1986; 42: 627-31.

Chalmers Jrc , Graham TR Mechanical ventricular support in the management of postcardiotomy cardiogenic shock. Perfusion 1989; 4: 243-54.

High KM , Hensley FA , Campbell D. , Pierce WS , Kaplan JA

Case conference. J Cardiothorac

Anesthesia 1989; 3: 643-53.

Christmas EW , Kurusz M. Preventing massive gas embolism during cardiopulmonary bypass: a review of safety devices. J Extra-Corp Technol 1980;12: 115-19.

McGrath R. Invasive bedside hemodynamic monitoring. Prog Cardiovasc Dis 1986; 29: 129-44.

Wheeldon DR , Bethune DW , Gill RD Vortex pumping for routine cardiac surgery: a comparative study. Perfusion 1990; 5: 135-43.

Adams S. , Fleming J. , Gourlay T. , Taylor KM Clinical experience with the Sarns pulsatile pump during open-heart surgery . Perfusion 1986; 1: 53-57.

Wright G. Factors affecting the pulsatile hydraulic power output of the Stockert roller pump. Perfusion 1989;4: 187-95.

10.

James SD , Peters J. , Maresca L. , Kalush SL , Trigueros EA The roller pump does produce pulsatile flow. J Extra-Corp Technol 1987; 19: 376-83.

11.

Hammerschmidt DE , Stroncek DF , Bowers TK et al. Complement activation and neutropenia occurring during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1981; 81: 370-77.

12.

Knudsen F. , Pedersen JO , Juhl O. , Nielsen AH , Jersild C. Complement and leucocytes during cardiopulmonary bypass: effects on plasma C3d and C5a, leucocyte count, release of granulocyte elastase and granulocyte chemotaxis. J Cardiothorac Anesthesia 1989 ;2: 164-70.

13.

Westaby S. Organ dysfunction after cardiopulmonary bypass: a systemic inflammatory reaction mediated by the extracorporeal circuit. Intensive Care Med 1987; 13: 89-95.

14.

Semb AG , Vaage J. , Sörlie D. , Mjös OD Leucocytes and cardiopulmonary bypass: in vitro production of oxygen free radicals and trapping in reperfused myocardium. Perfusion 1990; 5: 169-80.

15.

Quiroga MM , Miyagishima R. , Haendschen LC et al. The effect of body temperature on leucocyte kinetics during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1985; 90: 91-96.

16.

Teoh KH , Christakis GT , Weisel RD et al. Blood conservation with membrane oxygenators and dipyridamole . Ann Thorac Surg 1987; 44: 40-47.

17.

Wright G. Blood cell trauma. In: Taylor KM ed. Cardiopulmonary bypass. Principles and management. London: Chapman and Hall Medical, 1987: 249-76.

18.

Cavarocchi NC , Pluth JR , Schaff HV et al. Complement activation during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1986; 91: 252-58.

19.

Tennenberg SD , Bailey WW , Cotta LA , Brodt JK , Solomkin Jss. The effect of complement-mediated neutrophil activation during cardiopulmonary bypass. Surgery 1986; 100: 134-42.

20.

Hoerr HR , Kraemer MF , Williams JL In vitro comparison of the blood handling by the constrained vortex and twin roller blood pumps. J Extra-Corp Technol 1987 ; 19: 316-21.