ORIGINAL
Cardiopulmonary bypass (CPB) remains the key technology for more complex cardiac operations. Despite tremendous progress since its introduction into clinical practice, CPB is still far from perfect and hence continuous efforts to study and improve hemocompatibilityof both conduct and components of CPB are crucial. The problem is cardiac surgery in conjunction with cardiopulmonary bypass in its current form restricts the patient to exit the hospital in 5-7 days. We know that conventional standard bypass triggers the release of inflammatory mediator which elongates patient’s length of stay. The Pinnacle System tricks red blood cells, platelets, proteins and inflammatory mediators that they have never left the body. The Pinnacle System is a true physiologic bypass system which drastically attenuates the systemic inflammatory response (SIRS).
REVISED
In considering the many aspects pertaining to the overall problem of combining cardiac surgery and existing cardiopulmonary bypass methodology, we suggest that if the Systemic Inflammatory Response Syndrome (SIRS) can be reduced, there is sufficient evidence that the patient can expect a quicker recovery; thereby leading to an overall better outcome.
Cardiopulmonary bypass (CPB) still remains the key technology for more complex cardiac operations. Despite tremendous progress since its introduction into clinical practice, CPB is still far from perfect and hence continuous efforts are still essential in order to facilitate ongoing improvement within this field of study. Improving hemo-compatibility of both conduct, and components of CPB are crucial to improved patient care. The problem can be perhaps further defined by acknowledging that cardiac surgery in conjunction with cardiopulmonary bypass in its current form and practice, restricts the patient’s ability to recover sufficiently enough so as to exit the hospital in less than the current expected 5-7 day time period. We also know that conventional standard bypass triggers the release of inflammatory mediator which elongates patient’s length of stay.
We submit that the ‘Pinnacle System’ tricks red blood cells, platelets, proteins and inflammatory mediators that they have never left the body, therefore it is our suggestion that this novel patented surgical device is a true physiologic bypass system which drastically attenuates the systemic inflammatory response (SIRS).
ORIGINAL
- Does the study address something that is not known or has not been studied before—How is this study new or different from other studies? The study is based on the development of a novel patented surgical device invented by the author.
- If your research questions are studied, how could your findings impact your field of interest—“So What?”
Cardiopulmonary bypass has been done is a similar manner for 57 years. The development of this method and device allows for significant advancement and better patient outcomes.
What possible practical implications do you predict the results of your research will have? For instance, what will be the impact of these results on your sample, your site location, or your workplace—“Who Cares?” Surface coating, decreased priming volume, decreased blood transit time in the circuit and eliminating blood-air interface are some of the important features essential to a circuit aiming to improve hemocompatibility. Reduction of the priming volume through further condensation of the equipment is, therefore, the most obvious step. Decreasing the physical length of the circuit and reducing contact activation and generation of inflammatory mediators by minimizing blood transit time through foreign surfaces and safely eliminating air-blood interface are the next steps.
REVISED
- Does the study address something that is not known or has not been studied before—How is this study new or different from other studies? We will base this study on the development of a novel patented surgical device which has been invented by the author.
- If your research questions are studied, how could your findings impact your field of interest—“So What?”
Cardiopulmonary bypass has been enacted and practiced incorporating similar procedures for 57 years. We submit that the development of this surgical method and device allows for significant advancement in enabling better patient outcomes.
Can you predict what possible practical implications the results of your research will have? For example, what will be the impact of these results on your sample, your site location, or your workplace—“Who Cares?”
We believe that there will be a decrease in ‘surface coating’, ‘priming volume’, ‘blood transit time’ in the circuit, furthermore both this decrease and the elimination of blood-air interface will prove to be some of the important features essential to a circuit focusing on improving hemo-compatibility. Logically, reduction of the priming volume through further condensation of the equipment is, therefore, the most obvious step. Leading from this, we anticipate that the next steps will be validated by decreasing the physical length of the circuit, and reducing contact activation and generation of inflammatory mediators; all these steps can be achieved by minimizing blood transit time through foreign surfaces and safely eliminating air-blood interface.
ORIGINAL
Accordingly, I designed this study to include a novel coated circuit with all the previously mentioned crucial features and compare it with a coated conventional circuit which lacked the decreased prime and decreased blood transit time features. The typical extracorporeal circuit uses a venous reservoir, membrane oxygenator and arterial line filter. These components together aid in removal of trapped air in the venous line and minimize the transmission of gaseous microemboli to the patient. Elimination of the blood-air interface has been accomplished by several closed operations that do not use a hard shell reservoir. Such closed configurations do not provide the flexibility of an open configuration; however, since only closed heart procedures such as coronary bypass are possible. Yet other similar circuits have reduced circuit length and prime volume to limit transit time of blood through foreign surfaces but have retained an open configuration that exposes the blood to an air interface in the hard shell reservoir. This negates some of the advantages of coating the circuit and reducing the length. It is in this context that the newly introduced dual-function, condensed and coated circuit seems to make the most progress in reducing systemic inflammatory response syndrome (SIRS) and improving patient hospital stay parameters. Other issues that limit safe operation, such as trapped air removal from a purely closed circuit have reduced the acceptance of closed circuits in the field. Several manufacturers have introduced closed, minimized circuits with component configurations that differ from conventional systems, including a centrifugal pump without a venous reservoir. These configuration changes may change the ability of the circuit to handle air and, therefore, their ability to minimize gaseous microemboli. Recently, I introduced the MAST (minimized area surface treated) system, which comprises 30 inches of arterial and venous tubing mounted on swivel poles, allowing the pumps to be brought closer to the patient and resulting in a smaller priming volume and reduced hemodilution.(McCusker,2001)
REVISED
Accordingly, I am designing this study to include a novel coated circuit with all the previously mentioned crucial features and compare it with a coated conventional circuit which lacks the decreased prime and decreased blood transit time features. The typical extracorporeal circuit uses a venous reservoir, membrane oxygenator and arterial line filter. Together, these components will aid in removing trapped air in the venous line and minimizing the transmission of gaseous microemboli to the patient. Elimination of the blood-air interface has been accomplished by several closed operations that do not use a hard shell reservoir. Such closed configurations do not provide the flexibility of an open configuration, since only closed heart procedures such as coronary bypass are possible. Yet other similar circuits can reduce circuit length and prime volume so as to limit transit time of blood through foreign surfaces, but retains an open configuration that exposes the blood to an air interface in the hard shell reservoir. This negates some of the advantages of coating the circuit and reducing the length. It is in this context that the newly introduced dual-function, condensed and coated circuit seems to enable the most progress in reducing systemic inflammatory response syndrome (SIRS). This results in the improvement of patient hospital stay parameters; thereby reducing costs and unnecessary stress to the patient.
Other issues that limit safe operation, such as depicted by trapped air removal from a purely closed circuit have reduced the acceptance of closed circuits in the field. Several manufacturers have introduced closed, minimized circuits with component configurations that differ from conventional systems, including a centrifugal pump without a venous reservoir. These configuration changes may change the ability of the circuit to handle air and, therefore, their ability to minimize gaseous microemboli. Recently, I introduced the MAST (minimized area surface treated) system, which comprises 30 inches of arterial and venous tubing mounted on swivel poles, allowing the pumps to be brought closer to the patient and resulting in a smaller priming volume and reduced hemodilution.(McCusker,2001)
KEVIN – I feel limited in my ability to improve this next part, however perhaps the style and spacing should be kept the same as above.
References
Vijay V, DeBois W, Helm R, Sisto D. MAST system: a new condensed
cardiopulmonary bypass circuit for adult cardiac surgery. Perfusion 2001; 16: 447-52.
McCusker K, Vijay V. Perioperative Blood Conservation Strategies in Pediatric
Patients Undergoing Open-Heart Surgery: Impact of Non-Autologous Blood Transfusion and
Surface-Coated Extracorporeal Circuits. Perfusion. 2011; 26: 199-205.
Rizzi G, Scrivani A, Fini M, Giardino R. Biomedical coatings to improve the tissue-
biomaterial interface. Int J Artif Organs 2004; 27: 649-57.
von Segesser LK, Tozzi P, Mallbiabrrena I, Jegger D, Horisberger J, Corno A.
Miniaturization in cardiopulmonary bypass. Perfusion 2003; 18: 219-24.
Groom RC. A systematic approach to the understanding and redesigning of
cardiopulmonary bypass. SeminCardiothoracVascAnesth 2005; 9: 159-61.
Norman MJ, Sistino JJ, Acsell JR. The effectiveness of low prime cardiopulmonary
bypass circuits at removing gaseous emboli. J Extra CorporTechnol 2004; 36: 336-42.
Fransen EJ, Ganushchak YM, Vijay V, de Jong DS, Buurman WA, Maessen JG.
Evaluation of a new condensed extracorporeal circuit for cardiac surgery: a
prospective randomized clinical pilot study. Perfusion 2005; 20: 91-9.
Gunaydin S, Farsak B, Kocakulak M, Sari T, Yorgancioglu C, Zorlutuna Y. Clinical
performance and hemocompatibility of poly (2-methoxyethylacrylate) coated
extracorporeal circuits. Ann Thoracic Surg 2002; 74: 819-24.
Gunaydin S. Emerging technologies in biocompatible surface modifying additives: Quest
for physiologic cardiopulmonary bypass. Curr Med Chem Cardiovascular Hematology
Agents 2004; 2: 295-302.
Tanaka M, Motomura T, Kawada M et al. Blood compatible aspects of poly (2-
methoxyethylacrylate) relationship between protein adsorption and platelet adhesion
on PMEA surface. Biomaterials 2000; 21: 1471-81.
Moen O, Fosse E, Dregelid E, et al. Centrifugal pump and heparin coating improves
cardiopulmonary bypass biocompatibility. Ann ThoracSurg 1996; 62: 1134-40.
Nishida H, Aomi S, Tomizawa Y, et al. Comparative study of biocompatibility between
open circuit and closed circuit in cardiopulmonary bypass. Artif Organs 1999; 23:
547-51.
Gorman RC, Ziats N, Rao AK, et al. Surface bound heparin fails to reduce thrombin
formation during clinical cardiopulmonary bypass. J ThoracCardiovascSurg 1996;
111:1-11.
Perthel M, Kseibi S, Sagebiel F, Alken A, Laas J. Comparison of conventional
extracorporeal circulation and minimal extracorporeal circulation with respect to
microbubbles and microemboli signals. Perfusion 2005; 20: 329-33.
Nollert G, Schwabenland I, Maktav D, et al. Miniaturized cardiopulmonary bypass in
coronary artery bypass surgery: marginal impact on inflammation and coagulation but
loss of safety margins. Ann ThoracSurg 2005; 80: 2332.
Gunaydin S, McCusker K, Vijay V, et al. Clinical significance of strategic leukofiltration
in different risk cohorts undergoing cardiac surgery. Filtration 2005; 1: 95-106.
Gunaydin S. Clinical significance of coated extracorporeal circuits: A review of novel
technologies. Perfusion 2004
2.4 ORIGINAL
Provide a detailed explanation for at least one of the following questions.
In what ways does the research generate a new theory?
In what ways does the research refine or add to an existing theory?
In what ways does the research test to confirm or refute theory?
In what ways does the research expand theory by telling us something new about application or processes? In what ways does the research expand theory by telling us something new about application or processes? This new setup offers certain unique circuit configuration characteristics, such as the ability to run an open or closed configuration (bypassing the reservoir),which permits sequestration of significant blood volume within the circuit (in the reservoir) that is not exposed to the inflammatory mediators. This setup, by virtue of its ability to sequester a large portion of the blood volume (up to 2.5 liters), allows complete control over the circulating hematocrit, which has hitherto not been possible to this extent.(Kutschka,2005)
A total condensed circuit for cardiopulmonary bypass and cardioplegia are provided, as well as methods of using the same. The total circuit includes a cardiopulmonary bypass portion including tubing and components which together have a substantially short path length and priming volume preferably under 800 ml. Thus, the opportunity for an inflammatory response caused by blood contacting plasticizers is minimized. The bypass circuit includes a shunt which bypasses a blood reservoir of the total circuit. The cardioplegia circuit infuses cardioplegia fluid into blood pulled from an oxygenator of the bypass circuit. According to the method, either or both of heart-lung bypass and cardioplegia can be performed with only minimal or no isotonic priming solution circulated into the patient.(McCusker,1999) In addition, use of the shunt and reservoir together eliminate the possibility of air entering the circulation system upon kinking of the circuit. A method of priming a cardiopulmonary bypass circuit for use with a patient, comprising: a) providing a cardiopulmonary bypass circuit; b) priming said bypass circuit with an isotonic solution; c) coupling said bypass circuit to a patient; and d) replacing substantially all of the isotonic solution with blood from the patient without circulating the isotonic solution through the patient, wherein said replacing requires less than 800 ml of blood. A method of performing a cardiopulmonary bypass on a patient, comprising: a) providing a bypass circuit including, i) a reservoir culpable to the patient, ii) a perfusion pump in fluid communication with said reservoir, iii) a blood oxygenator in fluid communication with said pump, iv) an arterial filter in fluid communication with said oxygenator, v) a first length of tubing placing said reservoir in venous-side fluid communication with the patient, vi) a second length of tubing placing said arterial filter and in arterial-side fluid communication with the patient, and vii) a shunt which can be activated to place the first length of tubing and the pump in fluid communication and completely bypass the reservoir; b) priming said bypass circuit with the blood of the patient; c) storing an amount of blood in the reservoir; and d) circulating the patient's blood through the circuit, wherein said circulating includes activating said shunt and bypassing said reservoir to pull blood into said pump directly from the patient rather than from the stored blood in the reservoir.
In conventional open-heart surgery, the patient's breast bone is sawed open, the chest is spread apart with a retractor, and the heart is accessed through the large opening created in the patient's chest. The patient is placed on cardiopulmonary bypass and the patient's heart is then arrested using catheters and cannula which are inserted directly into the large arteries and veins attached to the heart through the large opening in the chest. Referring to prior art, the prior art bypass perfusion circuit includes an arterial cannula typically passed through the wall of the ascending aorta. (Fransen,2005) A venous cannula is passed through the right atrium for withdrawing blood from the patient. The venous cannula is coupled to an approximately eight foot length of 1/2 inch diameter polyvinyl chloride (PVC) tubing 20 (volume of 304 ml). All prior art systems have mandated the use of at least 1/2 inch diameter tubing at this location in order to ensure proper blood flow. Tubing leads to a blood reservoir adapted to store a blood volume of 300 to 600 ml. A one foot length of 3/8 inch diameter tubing (volume of 21 ml) couples the reservoir to a centrifugal pump which has a volume of 80 ml. The centrifugal pump is connected to a heart/lung console which powers the pump. A one foot length of 3/8 inch diameter tubing (volume of 21 ml) transfers blood from the pump to an oxygenator (volume 280 ml). Another one foot length of 3/8 inch diameter tubing (volume of 21 ml) transfers blood from the oxygenator to a forty micron arterial filter (volume of 50 ml). The arterial filter is adapted to capture gaseous and fatty embolisms. From the filter, an eight foot length of 3/8 inch diameter tubing (volume 168 ml) completes the circuit back to the arterial cannula. The reservoir, oxygenator, and arterial filter are an integrated unit. Nevertheless, tubing’s are required to connect the various sections thereof. Blood is pulled from the patient through the venous cannula, circulated through the tubing, reservoir, pump, oxygenator and filter, which are together referred to as the perfusion circuit, and back to the patient through the arterial cannula. The entire bypass circuit is mounted on a pole fixed to the console which powers the centrifugal pump, and is thus constrained to the location of the console.(McCusker,2001)
Prior to use, the two lengths of eight foot tubing of the circuit are coupled together at a pre-bypass filter having an 80 ml volume. One length of the tubing is then decoupled from about the pre-bypass filter and the circuit is primed with an isotonic solution, e.g., saline, to remove air and any other impurities from within the components and tubing. The priming volume is relatively high, calculated from the above stated individual volumes of the tubing and components to be approximately 1325 to 1625 ml (not including the cannula). Note that the 1/2 inch diameter tubing has a volume of 38 ml/foot, and 3/8 inch diameter tubing has a volume of 21 ml/foot. After the perfusion circuit is primed with saline, the pre-bypass filter is removed and respective ends of the circuit are coupled to the arterial and venous cannula.(McCusker, 1989)
Referring to prior art, a cardioplegia circuit is then coupled to the heart. The cardioplegia circuit generally includes a roller pump which pulls blood from the oxygenator and feeds the blood into the heart. To the circuit, cardioplegia fluid is added. The cardioplegia fluid is generally potassium suspended in a one liter isotonic solution. A length of flexible tubing extends from the roller pump to a bubble trap and a catheter extending from the bubble trap into the heart. The components and tubing of the cardioplegia circuit must also be primed with approximately 300 to 400 ml of an isotonic solution to remove air and foreign matter prior to use. After priming, the roller pump is operated to induce cardioplegia.(Nollert,2005) Once the perfusion circuit pump is operated, cardioplegia is induced and the patient's blood is oxygenated outside the body and circulated back to the patient. When the perfusion pump is operated, the priming saline is also circulated through the patient's body.
This standard procedure is undesirable for several reasons. First, the relatively large priming volume, and particularly the length of tubing, of the system requires that the patient's blood come into contact with a large non-vascular surface area for a relatively long period of time. When blood contacts plasticizer components such as the tubing, there tends to be an inflammatory response by the body. This is so even when the tubing and other components are coated with modern anti-inflammatory coatings. This response can compromise the recovery of the patient. Second, there are instances in prior art perfusion circuits where a section of the tubing or cannula kinks, inhibiting blood flow through the perfusion circuit. In such a situation, the pump may draw in air through the reservoir, which is open to the atmosphere, and circulate the air into the patient's vascular system. This is extremely dangerous to the patient and may even be deadly. Third, the large amount of isotonic fluid required for priming the perfusion bypass and cardioplegia circuits is circulated into the patient's body in addition to units of blood that may have been administered to the patient prior to the procedure. This extraordinary volume of fluid in the human body taxes the patient, as the kidneys are forced to process a substantial amount of additional fluid. (von Seggeser, 2003)
2.4 REVISED
Provide a detailed explanation for at least one of the following questions.
In what ways does the research generate a new theory?
In what ways does the research refine or add to an existing theory?
In what ways does the research test to confirm or refute theory?
In what ways does the research expand theory by suggesting something new about application or processes?
This new ‘setup’ offers certain unique circuit configuration characteristics, such as the ability to run an open or closed configuration (bypassing the reservoir), which permits the sequestration of significant blood volume within the circuit (in the reservoir) that is not exposed to the inflammatory mediators. This setup, by virtue of its ability to sequester a large portion of the blood volume (up to 2.5 liters), allows complete control over the circulating hematocrit, which has hitherto not been possible to this extent (Kutschka,2005).
A total condensed circuit for cardiopulmonary bypass and cardioplegia are provided, as well as methods of using the same. The total circuit includes a cardiopulmonary bypass portion including tubing and components, which together have a substantially short path length and priming volume, which should preferably be under 800 ml. Thus, the opportunity for an inflammatory response caused by blood contacting plasticizers is minimized. The bypass circuit includes a shunt which bypasses a blood reservoir of the total circuit. The cardioplegia circuit infuses cardioplegia fluid into blood pulled from an oxygenator of the bypass circuit. According to the method, either or both of heart-lung bypass and cardioplegia can be performed with only minimal or no isotonic priming solution circulated into the patient.(McCusker,1999) In addition, use of the shunt and reservoir together eliminate the possibility of air entering the circulation system upon kinking of the circuit. A method of priming a cardiopulmonary bypass circuit for use with a patient, comprising: a) providing a cardiopulmonary bypass circuit; b) priming said bypass circuit with an isotonic solution; c) coupling said bypass circuit to a patient; and d) replacing substantially all of the isotonic solution with blood from the patient without circulating the isotonic solution through the patient, wherein said replacing requires less than 800 ml of blood. A method of performing a cardiopulmonary bypass on a patient, comprising: a) providing a bypass circuit including, i) a reservoir culpable to the patient, ii) a perfusion pump in fluid communication with said reservoir, iii) a blood oxygenator in fluid communication with said pump, iv) an arterial filter in fluid communication with said oxygenator, v) a first length of tubing placing said reservoir in venous-side fluid communication with the patient, vi) a second length of tubing placing said arterial filter and in arterial-side fluid communication with the patient, and vii) a shunt which can be activated to place the first length of tubing and the pump in fluid communication and completely bypass the reservoir; b) priming said bypass circuit with the blood of the patient; c) storing an amount of blood in the reservoir; and d) circulating the patient's blood through the circuit, wherein said circulating includes activating said shunt and bypassing said reservoir to pull blood into said pump directly from the patient rather than from the stored blood in the reservoir.
In conventional open-heart surgery, the patient's breast bone is sawn open, the chest is spread apart with a retractor, and the heart is accessed through the large opening created in the patient's chest. The patient is placed on cardiopulmonary bypass and the patient's heart is then arrested using catheters and cannula which are inserted directly into the large arteries and veins attached to the heart through the large opening in the chest. Referring to prior art, the prior art bypass perfusion circuit includes an arterial cannula typically passed through the wall of the ascending aorta. (Fransen,2005) A venous cannula is passed through the right atrium for withdrawing blood from the patient. The venous cannula is coupled to an approximately eight foot length of 1/2 inch diameter polyvinyl chloride (PVC) tubing 20 (volume of 304 ml). All prior art systems have mandated the use of at least 1/2 inch diameter tubing at this location in order to ensure proper blood flow. Tubing leads to a blood reservoir adapted to store a blood volume of 300 to 600 ml. A one foot length of 3/8 inch diameter tubing (volume of 21 ml) couples the reservoir to a centrifugal pump which has a volume of 80 ml. The centrifugal pump is connected to a heart/lung console which powers the pump. A one foot length of 3/8 inch diameter tubing (volume of 21 ml) transfers blood from the pump to an oxygenator (volume 280 ml). Another one foot length of 3/8 inch diameter tubing (volume of 21 ml) transfers blood from the oxygenator to a forty micron arterial filter (volume of 50 ml). The arterial filter is adapted to capture gaseous and fatty embolisms. From the filter, an eight foot length of 3/8 inch diameter tubing (volume 168 ml) completes the circuit back to the arterial cannula. The reservoir, oxygenator, and arterial filter are an integrated unit. Nevertheless, tubing’s are required to connect the various sections thereof. Blood is pulled from the patient through the venous cannula, circulated through the tubing, reservoir, pump, oxygenator and filter, which are together referred to as the perfusion circuit, and back to the patient through the arterial cannula. The entire bypass circuit is mounted on a pole fixed to the console which powers the centrifugal pump, and is thus constrained to the location of the console.(McCusker,2001)
Prior to use, the two lengths of eight foot tubing of the circuit are coupled together at a pre-bypass filter having an 80 ml volume. One length of the tubing is then decoupled from about the pre-bypass filter and the circuit is primed with an isotonic solution, e.g., saline, to remove air and any other impurities from within the components and tubing. The priming volume is relatively high, calculated from the above stated individual volumes of the tubing and components to be approximately 1325 to 1625 ml (not including the cannula). Note that the 1/2 inch diameter tubing has a volume of 38 ml/foot, and 3/8 inch diameter tubing has a volume of 21 ml/foot. After the perfusion circuit is primed with saline, the pre-bypass filter is removed and respective ends of the circuit are coupled to the arterial and venous cannula.(McCusker, 1989)
Referring to prior art, a cardioplegia circuit is then coupled to the heart. The cardioplegia circuit generally includes a roller pump which pulls blood from the oxygenator and feeds the blood into the heart. To the circuit, cardioplegia fluid is added. The cardioplegia fluid is generally potassium suspended in a one liter isotonic solution. A length of flexible tubing extends from the roller pump to a bubble trap and a catheter extending from the bubble trap into the heart. The components and tubing of the cardioplegia circuit must also be primed with approximately 300 to 400 ml of an isotonic solution to remove air and foreign matter prior to use. After priming, the roller pump is operated to induce cardioplegia.(Nollert,2005) Once the perfusion circuit pump is operated, cardioplegia is induced and the patient's blood is oxygenated outside the body and circulated back to the patient. When the perfusion pump is operated, the priming saline is also circulated through the patient's body.
This standard procedure is undesirable for several reasons. First, the relatively large priming volume, and particularly the length of tubing, of the system requires that the patient's blood come into contact with a large non-vascular surface area for a relatively long period of time. When blood contacts plasticizer components such as the tubing, there tends to be an inflammatory response by the body. This is so even when the tubing and other components are coated with modern anti-inflammatory coatings. This response can compromise the recovery of the patient. Second, there are instances in prior art perfusion circuits where a section of the tubing or cannula kinks, inhibiting blood flow through the perfusion circuit. In such a situation, the pump may draw in air through the reservoir, which is open to the atmosphere, and circulate the air into the patient's vascular system. This is extremely dangerous to the patient and may even be deadly. Third, the large amount of isotonic fluid required for priming the perfusion bypass and cardioplegia circuits is circulated into the patient's body in addition to units of blood that may have been administered to the patient prior to the procedure. This extraordinary volume of fluid in the human body taxes the patient, as the kidneys are forced to process a substantial amount of additional fluid. (von Seggeser, 2003)
KEVIN, THE ABOVE IS A DETAILED PROCEDURAL ANALYSIS SO LITTLE REVISION WAS DONE.
2.5 ORIGINAL
“What are the surgical outcomes and cost benefits from utilization of a novel extracorporeal circuit (Pinnacle System) in first time coronary artery bypass grafting procedures?”
Are there differences in standard extracorporeal circuits and condensed extracorporeal circuits?
Are there differences in standard uncoated conventional extracorporeal circuits and fully coated conventional extracorporeal cardiopulmonary bypass circuits?
Are there differences between a newly introduced, fully biocompatible, interchangeable open-closed circuit with a dual configuration (hard shell with a bypass shunt)? ADDED PARENTHESIS
Are there differences between standard conventional extracorporeal cardiopulmonary bypass circuits and hard shell with a bypass shunt, reduced venous and arterial lengths tubing?
Are there differences between standard conventional extracorporeal cardiopulmonary bypass circuits and reduced prime of less than 800 ml?
