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Perfusion for Congenital Heart Surgery: Notes on Cardiopulmonary Bypass for a Complex Patient Population

ISBN: 978-1-118-90079-6
208 pages
June 2015, Wiley-Blackwell
Perfusion for Congenital Heart Surgery: Notes on Cardiopulmonary Bypass for a Complex Patient Population (1118900790) cover image

Description

  • Confidently devise a safe and successful ‘plan for the pump run’ for patients undergoing surgery for congenital heart disease. This practical guide for perfusionists and other members of the cardiac surgical team provides information on the devices, technology and techniques required for successful bypass of patients with congenital heart defects
  • A practical, spiral-bound, go-to reference designed to answer the most frequently-posed questions about bypass for CHD, the surgical treatment of which is often complicated
  • Focuses on the latest technology and techniques and provides clear, matter-of-fact guidance based on specific diagnoses
  • Written by a seasoned perfusionist who is co-chief and educator at one of the world’s leading children’s hospitals
  • Spiral binding allows the book to be laid flat for easy referral in the operating room
  • A notes section following each diagnosis enables readers to add institution and/or surgeon-specific information to tailor a bypass plan for each CHD lesion
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Table of Contents

Foreword x

Preface xi

Acknowledgments xii

1 Equipment for bypass 1

Oxygenators 1

Arterial line filters 12

Tubing packs 13

Cardioplegia systems 16

The heart–lung machine 17

The heater-cooler system 19

Cannulae 20

2 Priming the bypass circuit 27

Prime constituents 27

Steps for priming 28

3 The bypass plan 33

Communication agreement for case 33

Anticoagulation management 35

Blood gas management 40

Carbon dioxide management 40

Oxygenation strategy 42

Hematocrit management 45

Blood pressure management 47

Temperature management 49

Flow rates regional perfusion and hypothermic circulatory arrest 52

Methods of ultrafiltration 55

Before bypass 55

On bypass 55

After bypass 56

SMUF specifications 59

Standard and augmented venous return 60

Standard venous return with gravity siphon drainage 60

Augmented venous return 60

The prebypass checklist 63

The surgical safety checklist for congenital heart surgery 65

4 Typical phases of cardiopulmonary bypass 72

Commencement of bypass 72

Standard support phase of bypass 74

Termination of bypass 76

Post bypass 78

5 Additional notes based on bypass tasks 79

Prebypass 79

Heart–lung machine (HLM) 79

Reoperations 79

Cannulation 79

Transfusion during cannulation 80

On bypass 80

Verification of adequate drainage when caval tapes are used 80

Blood gas management 80

Cardioplegia delivery 81

Planned circulatory arrest 81

Induced ventricular fibrillation 82

Administration of blood products 82

Atrial line placement 82

LV vent placement 83

Bed rotation during bypass 83

6 Bypass considerations based on diagnosis 85

Anomalous coronary arteries 86

Aortic regurgitation/insufficiency 89

Aortic stenosis 91

Aortopulmonary collaterals 93

Aortopulmonary window 95

Atrial septal defect 96

Cardiomyopathy requiring orthotopic heart transplantation 99

Coarctation of the aorta 100

Common atrioventricular canal defect 102

Cor triatriatum 104

Corrected transposition of the great arteries (L-TGA Levo-TGA or C-TGA) or congenitally corrected TGA 105

Critical aortic stenosis 107

Double chambered right ventricle 109

Double inlet left ventricle 110

Double outlet left ventricle 111

Double outlet right ventricle 112

Ebstein’s anomaly 113

Hypoplastic left heart syndrome 114

Stage 1 (Norwood) procedure 115

Hybrid stage 1 palliation 117

Stage 2 or bidirectional Glenn shunt 117

Fontan procedure (total cavopulmonary anastomosis) 119

Interrupted aortic arch 121

Left superior vena cava 123

Lung transplantation 124

Mitral regurgitation/insufficiency 125

Mitral stenosis 126

Patent ductus arteriosus 127

Pulmonary artery abnormalities 128

Pulmonary atresia 129

Pulmonary atresia with an intact ventricular septum 129

Pulmonary atresia with ventricular septal defect 130

Pulmonary regurgitation/insufficiency 132

Pulmonary stenosis 133

Pulmonary vein stenosis or pulmonary venous obstruction 134

Tetralogy of Fallot 136

Total anomalous pulmonary venous return and partial anomalous pulmonary venous return 138

d-Transposition of the great arteries 140

Tricuspid atresia 142

Tricuspid regurgitation/insufficiency 143

Truncus arteriosus 144

Ventricular septal defect 146

7 Notes on select issues during bypass 148

Blood pressure higher than expected 148

Blood pressure lower than expected 149

Bypass circuit pressure higher than expected 151

Bypass circuit pressure lower than expected 152

Central venous pressure elevated 153

Heat exchange issue (slow cooling or warming) 154

NIRS values lower than expected 155

PaCO2 higher than expected 157

PaCO2 lower than expected 159

PaO2 lower than expected 160

Reservoir volume acutely low 161

8 Notes on select emergency procedures during bypass 163

Arterial pump failure (roller head) 164

Failure to oxygenate 165

Massive air embolization 166

Acute aortic dissection at the initiation of bypass 168

Venous air lock 169

Inadvertent arterial decannulation 170

Inadvertent venous decannulation 171

9 Brief overview of named procedures and terms 172

Alfieri stitch 172

Batista procedure 172

Bentall procedure 172

Bidirectional Glenn shunt 172

Blalock–Hanlon procedure 172

Blalock–Taussig shunt (BTS) 173

Brock procedure 173

Central shunt 173

Cone procedure 173

Cox maze procedure 173

Damus–Kaye–Stansel anastomosis 173

Double switch procedure 173

Fontan procedure 174

Gott shunt 174

Hemi–Fontan procedure 174

Holmes heart 174

Jatene operation 174

Kawasaki disease 174

Kawashima procedure 175

(Diverticulum of) Kommerell 175

Konno procedure 175

LeCompte maneuver 175

LeCompte procedure 175

Manougian procedure 175

Marfan’s syndrome 175

Maze procedure 175

Mustard procedure 176

Nicks procedure 176

Nikaidoh procedure 176

Noonan syndrome 176

Norwood operation 176

Pannus 176

Pentalogy of Cantrell 176

Potts shunt 177

Rashkind procedure 177

Rastelli operation 177

Ross procedure 177

Sano shunt 177

Scimitar syndrome 177

Senning operation 177

Shone’s complex 178

Takeuchi procedure 178

Taussig–Bing anomaly 178

Trusler repair 178

Van Praagh classification 178

Warden procedure 178

Waterston shunt 178

Williams syndrome 178

Yasui procedure 179

10 Abbreviations for congenital heart surgery 180

11 Recommended reference books 186

12 Comprehensive experience-based equipment selection chart select medications administered during bypass 187

Index 190

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Author Information

Gregory S. Matte
Perfusion Clinical Coordinator (Co-Chief)
Boston Children’s Hospital
Boston, MA

In addition to coordinating perfusion at Boston Children’s, an internationally-recognized children’s hospital, Mr. Matte has extensive experience training clinicians and has written extensively in leading journals in the field.
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