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Ann Thorac Surg 2005;80:6-14
© 2005 The Society of Thoracic Surgeons

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Hawley H. Seiler resident award paper

Using a Miniaturized Circuit and an Asanguineous Prime to Reduce Neutrophil-Mediated Organ Dysfunction Following Infant Cardiopulmonary Bypass

^a Division of Pediatric Cardiac Surgery and Pediatric Perfusion Services, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon
^b Bonfils Blood Center, University of Colorado Health Sciences Center, Denver, Colorado
^c Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada

Accepted for publication February 1, 2005.

^_* Address reprint requests to Dr Ungerleider, Oregon Health & Science University, Dept. of Cardiothoracic Surgery, Mail Code DC8S, 3181 SW Sam Jackson Park Road, Portland, OR97201 (Email: ungerlei{at}ohsu.edu).

Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.

BACKGROUND: Contemporary infant cardiopulmonary bypass circuits require a blood prime. Blood, especially when stored, generates an inflammatory response, and may contribute to organ dysfunction following cardiopulmonary bypass. We determined whether using a miniaturized circuit and an asanguineous prime attenuated the post-bypass inflammatory response, and improved right ventricular and pulmonary function.

METHODS: Sixteen infant piglets were placed into 3 groups based on prime components: group I (fresh blood), group II (stored blood), and group III (miniaturized circuit and asanguineous prime). Piglets were placed on cardiopulmonary bypass (100 mL·kg^–1·min^–1), cooled to 18°C, and underwent continuous perfusion (50 mL·kg^–1·min^–1) for 30 minutes. They were rewarmed and separated from bypass. Serum tumor necrosis factor-, right ventricular function, and pulmonary function were measured before and 30 minutes after bypass. Neutrophil priming activity in fresh and stored donor blood was also assessed.

RESULTS: Animals in group III had significantly improved cardiopulmonary function than the groups receiving blood (right ventricular cardiac index [mL·kg^–1·min^–1]: group I [18.8 ± 4.8], group II [21.5 ± 6.2], and group III [81.2 ± 11.4], p < 0.001; and pulmonary vascular resistance index [dynes·mL^–1·kg^–1]: group I [1169 ± 409], group II [1610 ± 486], and group III [214 ± 63], p = 0.03). Tumor necrosis factor- (pg·mL^–1) was lower in group III (1465 ± 39) than in the groups receiving blood (3940 ± 777), p = 0.002. Neutrophil priming activity (nmol·min^–1) was also higher in stored blood (3.7 ± 6) than in fresh blood (1.9 ± 0.2), p = 0.02.

CONCLUSIONS: We have devised a unique miniaturized circuit that allows an asanguineous prime without hemodilution in an infant swine model. The employment of this circuit attenuates the post-bypass inflammatory response and has salutary effects on cardiopulmonary function.

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