Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

Author:

Lombardi John1,Sedgwick Joseph2,Schenbeck Jennifer1,Lubbers Walter2,Ferguson Robert E1,Gardner Aimee1,McNamara Jerri L1,Eghtesady Pirooz3

Affiliation:

1. Division of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center and Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

2. Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA

3. Division of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center and Department of Surgery, University of Cincinnati, Cincinnati, OH, USA,

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.

Publisher

SAGE Publications

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology, Nuclear Medicine and imaging,General Medicine

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