title: Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump.
abstract: The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for 'off-pump' coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.
authors.affiliation: Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lombardi
authors.forename: Joseph
authors.initials: J
authors.lastname: Sedgwick
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schenbeck
authors.forename: Walter
authors.initials: W
authors.lastname: Lubbers
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ferguson
authors.forename: Aimee
authors.initials: A
authors.lastname: Gardner
authors.forename: Jerri L
authors.initials: JL
authors.lastname: McNamara
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
mesh_terms: D000818:Animals; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery; D007260:Infusion Pumps; D008904:Miniaturization; D012756:Sheep