Versatile minimized system - a step towards safe perfusion

Abstract

A growing body of evidence indicates the superiority of minimized cardiopulmonary bypass (CPB) systems compared to conventional systems in terms of inflammatory reactions and transfusion requirements. Evident benefits of minimized CPB systems, however, do not come without consequences. Kinetic-assisted drainage, as used in these circuits, can result in severe fluctuations of venous line pressures and, consequently, fluctuation of the blood flow delivered to the patient. Furthermore, subatmospheric venous line pressures can cause gaseous microemboli. Another limitation is the absence of cardiotomy suction, which can lead to excessive blood loss via a cell saver. The most serious limitation of minimized circuits is that these circuits are very constrained in the case of complications or changing of the surgery plan. We developed a versatile minimized system (VMS) with a priming volume of about 600 ml. A compliance chamber in the venous line decreases peaks of pressure fluctuations. This chamber also acts as a bubble trap. Additionally, the open venous reservoir is connected parallel to the venous line and excluded from the circulation during an uncomplicated CPB. This reservoir can be included in the circulation via a roller pump and be used as a cardiotomy reservoir. The amount and rate of returned blood in the circulation is regulated by a movable level detector. Further, the circuit can easily be converted to an open system with vacuum-assisted venous drainage in the case of unexpected complications. The VMS combines the benefits of minimized circuits with the versatility and safety of a conventional CPB system. Perfusionists familiar with this system can secure an adequate and timely response at expected and unexpected intraoperative complications.