Heart Lung Machine

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Michael E. Debakey - One of the best experts on this subject based on the ideXlab platform.

  • John Gibbon and the Heart-Lung Machine: a personal encounter and his import for cardiovascular surgery.
    The Annals of thoracic surgery, 2003
    Co-Authors: Michael E. Debakey
    Abstract:

    I am privileged to have been invited to participate in this Golden Anniversary of the development and first successful clinical use of the Heart-Lung Machine, and I am especially touched to be able to honor Dr Gibbon’s memory. He was not only a friend but also an inspiration to me. I had the pleasure of meeting Dr Gibbon for the first time in the 1930s at a medical meeting, and he later invited me to his laboratory to discuss the experimental work he was then doing on the Heart-Lung Machine using cats. He noted that one of the mechanical problems he encountered was the pump; he was dissatisfied with the one he was using. He had devised a pump himself and had used the Dale Schuster pump for perfusion, but these were simply not adequate for his purposes. When I was a medical student at Tulane University School of Medicine, I had the privilege of working as a technician in a research laboratory. The faculty member under whom I was working was interested in a pump that he could use to study the pulse wave, and he asked me to find such a pump. As a medical student, I had no knowledge of pumps, but I felt a responsibility to fulfill my assignment. I went to the medical library in search of existing knowledge about pumps, but I felt I needed more information. Then I remembered that one of my freshman classmates in the Tulane College of Arts and Sciences decided to study engineering. We had become good friends during college, and when he went into engineering and I went to medical school, we continued to see each other at lunch or dinner about once every week or two. Shortly after my assignment to find a pump, I met him and mentioned my frustration. He pointed out that I had gone to the wrong library and directed me to the one in the engineering school, where, he said, I would find a great deal about pumps. I immediately went to that library and found that people had been working on pumps for more than 2,000 years, dating back to Archimedes, who developed a pump for irrigation purposes (similar in principle to an axial flow pump, to which I will refer later). As a consequence of my library experience, I developed the roller pump. When I became a resident at the Charity Hospital in New Orleans, we used direct blood transfusions (there were no blood banks at the time), and I used this pump quite successfully for that purpose [1]. And so when I met Dr Gibbon, I suggested that he might try this pump. I then sent him a model of my roller pump, which he subsequently incorporated into his Heart-Lung Machine. In some of his articles, he graciously referred to obtaining the roller pump from me [2]. And that is how it became an integral component of the Heart-Lung Machine. I would like to comment on some other aspects of Dr Gibbon’s contribution because it had a much more profound effect than the mere construction of a mechanical pump for temporary replacement of the function of the Heart and Lungs. Once he showed successfully that it could be used for that purpose, that success had a profound impact on the medical community, particularly on researchers who were interested in the cardiovascular field. In a way, he blasted open the door that had been locked for centuries against any medical therapeutic intrusion into the cardiovascular field, and he thus helped greatly to stimulate the developments in the past half century that have provided us the satisfying experience we have today in dealing with cardiovascular problems. Not that we have completed that process by any measure. After all, we still do not know the real cause of arteriosclerosis, although we do know a great deal more about how to deal with it and with other forms of cardiovascular disease because of the door he opened. That, I think, is the most important aspect of his contribution. The mechanical part was, of course, also important, but he stimulated the imagination of other researchers, and his contribution certainly had a great impact on me. In this connection, it is of interest that Dr Gibbon, in his Presidential Address before the Society for Vascular Surgery in 1965, recognized some aspects of this impact by choosing with admirable insightfulness to discuss the artificial intracorporeal Heart [3], a device that has since received increasingly intensive investigation. I have selected a series of illustrations to show Dr Gibbon’s impact from my standpoint, because it also illustrates the impact on many others. Figure 1 is an autographed photograph he kindly gave me. This quotation from one of his early articles projects a vision that led to the event of half a century ago that we are celebrating today—one of the truly great sagas of medical research in Presented at the symposium, “Gibbon & His Heart-Lung Machine: 50 Years & Beyond,” Philadelphia, PA, May 2, 2003.

Takeyoshi Dohi - One of the best experts on this subject based on the ideXlab platform.

Jaime F. Vazquez-jimenez - One of the best experts on this subject based on the ideXlab platform.

  • A newly developed miniaturized Heart-Lung Machine--expression of inflammation in a small animal model
    Artificial organs, 2010
    Co-Authors: Heike Schnoering, Jutta Arens, Thomas Schmitz-rode, Ulrich Steinseifer, Joerg S. Sachweh, Estella Terrada, Maximilian Walter Runge, Jaime F. Vazquez-jimenez
    Abstract:

    Cardiopulmonary bypass may cause severe inflammatory reactions and multiorgan failure, especially in premature and low-weight infants. This is due in part to the large area of contact with extrinsic surfaces and the essential addition of foreign blood. Thus, we developed a new miniaturized Heart-Lung Machine (MiniHLM) with a total static priming volume of 102 mL (including arterial and venous lines) and tested it in a small animal model. Seven Chinchilla Bastard rabbits were perfused with the MiniHLM (dynamic priming volume 127 mL). Seven animals serving as a control were perfused using Dideco Kids and a Stockert roller pump (modified dynamic priming volume 149 mL). The rabbits were anesthetized and sternotomized, followed by cannulation of the aorta and the right atrium. The aorta was clamped for 1 h. Blood for examination of inflammation (TNF-α, IL-1β, IL-6, IL-8, and IL-10) and blood gas analysis were taken before skin incision, 5 min before opening of the aorta, 15 min after opening of the aorta, and 4 h after the initiation of cardiopulmonary bypass. The parameters of inflammation were expressed by means of the comparative CT method (ΔΔCT method). After gradual reduction of perfusion with the HLM, the Heart was decannulated, and the sternum was closed. All rabbits were successfully weaned from cardiopulmonary bypass. Blood gas analysis was unremarkable in all cases. Foreign blood was not administered. Although statistical significance was not achieved, there was a reduced expression of inflammatory markers in the MiniHLM group. The newly developed MiniHLM prototype was tested successfully in a small animal model in terms of technical function and expression of inflammation. Upcoming tests with the industrially manufactured MiniHLM may reveal the advantages of the MiniHLM in comparison with the conventional HLM.

  • The Aachen miniaturized Heart-Lung Machine--first results in a small animal model.
    Artificial organs, 2009
    Co-Authors: Heike Schnoering, Jutta Arens, Thomas Schmitz-rode, Ulrich Steinseifer, Joerg S. Sachweh, Melanie Veerman, Rene Tolba, Jaime F. Vazquez-jimenez
    Abstract:

    Congenital Heart surgery most often incorporates extracorporeal circulation. Due to foreign surface contact and the administration of foreign blood in many children, inflammatory response and hemolysis are important matters of debate. This is particularly an issue in premature and low birth-weight newborns. Taking these considerations into account, the Aachen miniaturized Heart-Lung Machine (MiniHLM) with a total static priming volume of 102 mL (including tubing) was developed and tested in a small animal model. Fourteen female Chinchilla Bastard rabbits were operated on using two different kinds of circuits. In eight animals, a conventional HLM with Dideco Kids oxygenator and Stockert roller pump (Sorin group, Milan, Italy) was used, and the Aachen MiniHLM was employed in six animals. Outcome parameters were hemolysis and blood gas analysis including lactate. The rabbits were anesthetized, and a standard median sternotomy was performed. The ascending aorta and the right atrium were cannulated. After initiating cardiopulmonary bypass, the aorta was cross-clamped, and cardiac arrest was induced by blood cardioplegia. Blood samples for hemolysis and blood gas analysis were drawn before, during, and after cardiopulmonary bypass. After 1 h aortic clamp time, all animals were weaned from cardiopulmonary bypass. Blood gas analysis revealed adequate oxygenation and perfusion during cardiopulmonary bypass, irrespective of the employed perfusion system. The use of the Aachen MiniHLM resulted in a statistically significant reduced decrease in fibrinogen during cardiopulmonary bypass. A trend revealing a reduced increase in free hemoglobin during bypass in the MiniHLM group could also be observed. This newly developed Aachen MiniHLM with low priming volume, reduced hemolysis, and excellent gas transfer (O(2) and CO(2)) may reduce circuit-induced complications during Heart surgery in neonates.

  • The Aachen MiniHLM - A Miniaturized Heart Lung Machine for Neonates with Congenital Heart Defect
    IFMBE Proceedings, 2009
    Co-Authors: Jutta Arens, Heike Schnöring, Michael Pfennig, Ilona Mager, Jaime F. Vazquez-jimenez, Thomas Schmitz-rode, Ulrich Steinseifer
    Abstract:

    Predominantly standard adult Heart Lung Ma chines (HLMs) are used for pediatric cardiac surgery, only with individually downsized components. Downsizing is limited, e.g. by the required gas exchange surface, etc. In order to diminish complications we developed a new miniaturized Heart Lung Machine (Aachen MiniHLM) for neonates, with significantly reduced priming volume and blood contact surface by integration of all major system components in one single de vice. In particular, the MiniHLM is a Heart-Lung-Machine with the rotary blood pump centrically integrated into the oxygenator and the cardiotomy reservoir with integrated heat exchanger is directly connected. Thus, tubing is only necessary between patient and MiniHLM.

  • Development of a miniaturized Heart-Lung Machine for neonates with congenital Heart defect.
    ASAIO journal (American Society for Artificial Internal Organs : 1992), 2008
    Co-Authors: Jutta Arens, Heike Schnöring, Jaime F. Vazquez-jimenez, Thomas Schmitz-rode, Fabian Reisch, Ulrich Steinseifer
    Abstract:

    Predominantly, standard adult Heart Lung Machines are used for pediatric cardiac surgery, only with individually downsized components. Downsizing is limited, e.g., by the required gas exchange surface. To diminish complications, we developed a new miniaturized Heart Lung Machine (MiniHLM) for neonates, with significantly reduced priming volume and blood contact surface by integration of all major system components in one single device. In particular, a rotary blood pump is centrically integrated into the oxygenator and the cardiotomy reservoir with integrated heat exchanger is directly connected. Thus, tubing is only necessary between patient and MiniHLM. A total priming volume of 102 ml could be achieved for the entire extracorporeal circuit (including arterial/venous line), in contrast to the currently smallest device on the market with 213 ml. In first animal experiments with female New Zealand rabbits, the MiniHLM guaranteed both a sufficient gas exchange and an adequate blood flow; 12 rabbits could successfully be weaned off after 1 hour of aortic clamp time. The first in vitro and in vivo tests confirm the concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce complications during Heart surgery in neonates.

Hideo Fujimoto - One of the best experts on this subject based on the ideXlab platform.

  • A medical training system for the operation of Heart-Lung Machine
    International Journal of Computational Science and Engineering, 2019
    Co-Authors: Ren Kanehira, Hideo Hori, Kazinori Kawaguchi, Hideo Fujimoto
    Abstract:

    It has been a strong tendency to use information communication technology (ICT) to construct various education/training systems to help students or other learners to master necessary skills more ea...

  • a medical training system for the operation of Heart Lung Machine
    Fuzzy Systems and Knowledge Discovery, 2015
    Co-Authors: Ren Kanehira, Hideo Hori, Kazinori Kawaguchi, Hideo Fujimoto
    Abstract:

    It has been a strong tendency to use Information Communication Technology (ICT) to construct various education/training systems to help students or other learners master necessary skills more easily, among which such systems with operational practice are particularly welcome in addition to the conventional E-learning ones mainly for obtaining textbook-like knowledge only. In this study, we proposed a medical training system for the operation of Heart-Lung Machine. Two training contents, i.e., for the basic operations and trouble shooting, respectively, are considered in the system, with more attention paid to how to deal with trouble shooting.

Tetsuya Horiuchi - One of the best experts on this subject based on the ideXlab platform.

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