title: Perfusion-assisted beating heart support with a miniature extracorporeal circuit and leukocyte filtration: a 58-year-old patient with severe COPD.
abstract: Patients with severe chronic obstructive pulmonary disease (COPD) impose a significant risk for postoperative morbidity and mortality requiring cardiovascular surgical intervention and the use of extracorporeal circulation. Recently, we treated a 58-year-old male with acute coronary syndrome complicated with recurrent ventricular arrhythmia, hypoxemia secondary to severe COPD and resolving pneumonia, who required urgent coronary revascularization. A novel operative strategy was used that included beating heart bypass grafting with cardiac decompression and support with a miniature perfusion circuit, kinetic-assisted venous return, rapid autologous priming and leukocyte filtration. The combination of multiple modalities was chosen because the patient was in a pre-existing inflammatory condition and had severe COPD. We herein report our perioperative clinical experience with this patient and the use of multiple modalities for extracorporeal perfusion therapy in managing this challenging case. We believe that, based upon his clinical course of ventilation time (17.4 hours) and postoperative length of hospital stay (5 days), this high risk patient demonstrated a positive clinical outcome as a result of these techniques.
authors.affiliation: Baylor University Medical Center, Dallas, Texas, USA. ssutton240@aol.com
authors.forename: Steven W
authors.initials: SW
authors.lastname: Sutton
authors.forename: Michael A
authors.initials: MA
authors.lastname: Duncan
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Chase
authors.forename: Baron L
authors.initials: BL
authors.lastname: Hamman
authors.forename: Edson H
authors.initials: EH
authors.lastname: Cheung
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000401:mortality; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery*