Cardiopulmonary Bypass.ppt

Cardiopulmonary Bypass Cardiac surgery Coronary revascularisation (On and off pump) Valvular heart disease Surgery for heart failure Transplantation and assist devices Congenital and GUCH surgery Minimally invasive techniques Re-do surgery Miscellaneous (trauma, tumours, aneurysms, septal defects, pericardiectomy, embolectomy, dissections) Adult Cardiac Surgery The Heart-Lung machine Venous cannulae Venous reservoir Oxygenator/Heat exchanger Pump Arterial line filter Arterial cannula Cardiotomy suction Cardioplegia delivery system Venous Reservoir Siphons blood by gravity Provide storage of excess volume Allows escape of any air bubbles returning with the venous blood Oxygenator Provides oxygen to the blood Removes carbon dioxide Several types Bubble oxygenator Membrane oxygenator Microporous hollow-fiber oxygenators Heat Exchanger Also called the heater / cooler Controls perfusate temperature Warm and cold Cardiopulmonary Bypass Heparinization Total bypass Partial bypass Flowrates 2-2.5 l/min. per square meter Flowrates depend on body size Flowrates depend on cannula sizes Hypothermia Shed Blood Is aspirated with a suctioning apparatus, filtered and return to the oxygenator A cell saving device may also be utilized during and after bypass Blood Pressure Decreases sharply with onset of bypass (vasodilatation) Mean arterial pressure needs to the above 50-60 mm Hg. After 30 minutes perfusion pressure usually increases (vasoconstriction) Oxygen and Carbon Dioxide Tensions Concentrations are periodically measured in both arterial and venous lines Arterial oxygen tension should be above 100 mm Hg Arterial carbon dioxide tensions should be 30-35 mm Hg A drop in venous oxygen saturation suggests underperfusion Acid-Base Regulatory Strategy pH-stat strategy Aim ; constant pH, Total CO2 ; increased Intracellular state ; acidosis Alpha-stat strategy Aim; constant OH/H, Total CO2 ; constant , Intracellular state ; neutral Myocardial Protection Cold hyperkalem