Transfusion-free neonatal cardiopulmonary bypass using a TinyPump.
BACKGROUND
We devised a miniaturized circuit incorporating a TinyPump in the venous line to amplify the venous return. We compared this system to the conventional blood-primed circuit and investigated whether this circuit could maintain hematocrit levels without blood transfusion and reduce coagulation and inflammatory cascades.


METHODS
Thirteen 1-week-old piglets (3.7 ± 0.2 kg) were divided into group M (miniaturized circuits with TinyPump-assisted venous drainage without blood, n = 7) and group C (conventional circuits with blood priming, n = 6). Cardiopulmonary bypass (CPB) was performed at 150 to 180 mL·kg(-1)·min(-1) for 2 hours, including 60 minutes of cardioplegic cardiac arrest. Modified ultrafiltration (MUF) was subsequently performed. Data were acquired before CPB and after the end of MUF.


RESULTS
The priming volume including the hemofilter circuit of the main circuit required 152 mL in group M and 300 mL in group C. The mean hematocrit values in group M and group C were not significantly different during CPB (21.5% ± 2.0% versus 23.2% ± 1.3%) or after MUF (30.7% ± 2.1% versus 32.9% ± 4.0%). After MUF, group M had lower thrombin-antithrombin complex levels (16.7 ± 5.0 ng/mL versus 28.4 ± 8.4 ng/mL, p < 0.01) and interleukin-8 levels (2,867 ± 758 pg/mL versus 13,730 ± 5,220 pg/mL, p < 0.01) than group C. The pulmonary vascular resistance index was lower in group M after MUF (4,105 ± 862 dynes·cm(-5)·kg(-1) versus 6,304 ± 1,477 dynes·cm(-5)·kg(-1), p < 0.01). The lung water content was also better in group M (83.7% ± 0.5% versus 84.9% ± 0.5%, p < 0.01).


CONCLUSIONS
The minicircuit with TinyPump-assisted venous drainage successfully maintained acceptable hematocrit levels and the cardiopulmonary function in neonatal piglets. Employing this technique may attenuate blood requirements and inflammatory responses, thereby improving the clinical outcomes of neonatal open-heart surgery.
Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan. uga-strah@hotmail.co.jp
Shinya
S
Ugaki
Osami
O
Honjo
Mahito
M
Nakakura
Takuma
T
Douguchi
Akiko
A
Itagaki
Naoyuki
N
Yokoyama
Katsuhiro
K
Ohuchi
Setsuo
S
Takatani
Shunji
S
Sano
D000818:Animals; D000831:Animals, Newborn; D000990:Antithrombin III; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D004322:Drainage; D006400:Hematocrit; D006439:Hemodynamics; D016209:Interleukin-8 / Q000032:analysis; D010100:Oxygen / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D013552:Swine
D016209:Interleukin-8; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D010100:Oxygen