Children with congenital heart disease (CHD) undergo open heart surgery in order to repair structural heart defects. Compared to adult heart surgery, performing cardiopulmonary bypass (CPB) in children has its own set of challenges.
Neonates and infants, in particular, have small body weight and blood volume but the fluid volume needed to prime the CPB extracorporeal circuit is relatively large. This imbalance causes hemodilution, inducing severe anemia and thus requiring multiple blood transfusion. Blood transfusion on its own, is also associated with increased postoperative risks. Moreover, the increased surface contact area between the blood cells and the walls of the extracorporeal circuit triggers the inflammatory response leading to coagulation problems. To mitigate these complications, various methods to minimize the initial priming volume have been suggested.
The use of a sterile sheet as part of the Technowood PTS Neo, in combination with the modular design of the Technowood roller pumps, have shown significant reduction in initial priming volume and contact surface area when compared to standard circuit designs.
The concept of the sterile sheet is simple - the transparent sheet enables the roller pumps of a heart-lung machine to be positioned very close to the surgical table without compromising the sterile field. With the shortened distance, the needed tubing length can be greatly reduced leading to a significant reduction of priming volume.
Latest data from Seirei Hamamatsu General Hospital in Shizuoka, Japan has shown a 67% reduction in the contact surface area when compared to the guideline-recommended circuit design. They were also able to achieve a low priming volume of 90ml for patients with less than 5kg body weight.
Furthermore, multiple studies from Kitamoto et al.1,2, and Miyaji et.al3 have reported not only reduced blood transfusion but even transfusion-free procedures from this kind of circuit layout.
A miniaturized CPB system with the Technowood PTS Neo sterile sheet can be effective in reducing priming volume needed for pediatric CPB procedures.
References:
1. 北本憲永、 神谷典男、小出昌秋、ほか：人工心肺初期充填量136mLを可能とするシステムの開発一低充填化への更なる飛躍－. 体外循環技術, 28(4);26-28,2001.
2. 北本憲永、 神谷典男、小出昌秋、ほか：熱交換機を組み込まない小児無輸血体外循環の試み－ 熱交換機は必要か－. 体外循環技術, 29(2):180-183,2002.
3. Miyaji, K., Kohira, S., Miyamoto, T., Nakashima, K., Sato, H., Ohara, K., & Yoshimura, H. (2007, August). Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight. The Journal of Thoracic and Cardiovascular Surgery, 134(2), 284–289. https://doi.org/10.1016/j.jtcvs.2007.02.020
Technowood’s PTS NEO perfusion tubing set can be optimized for pediatric surgeries with the inclusion of a sterile sheet. By placing the sterile sheet between the surgical field and the heart-lung machine, the oxygenator, reservoir and the pumps can be brought closer to the surgical field without compromising the sterile area. The tubing length can be greatly shortened, reducing the needed priming volume. This low priming volume method has been shown to reduce the complications from cardiopulmonary bypass in pediatric patients.
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