Ann Thorac Surg 2005;80:1892
© 2005 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Brian F. Buxton, MB, MS
Department of Cardiac Surgery, Austin Hospital, HSB-5 Studley Rd, Heidelberg, Melbourne, Victoria, 3084 Australia
(Email: brian.buxton{at}austin.org.au).
Mehlhorn and colleagues [1] have to be congratulated for exploring and developing a modification of the standard coronary bypass systems. The portability and speed in which the LIFEBRIDGE (Medizintechnik GmbH, Ampfing, Germany) can be implemented are attractive features. The LIFEBRIDGE has limited, potentially useful applications for as great as 6 hours of use during transportation, transplantation, and cardiogenic shock. It may also be useful in beating heart surgery as an adjunct to off-pump cardiopulmonary bypass. It is probably unsuitable for a substitute for a conventional bypass circuit because of the limited visibility of the vital components, such as the reservoir, circuit, and arterial filter, thereby limiting trouble-shooting capacity for removal of clots and particulate matter. The lack of a purge or bypass line from the arterial filter further inhibits evacuation of potentially harmful matter from the circuit. Other potential limitations are the adequacy of bypass capacity for very large patients and limited duration for cardiopulmonary support, which makes it unsuitable as a substitute for extracorporeal pulmonary membrane oxygenation. The lack of integrated cardiotomy, vent pumps, and circuits means that these must be added if required, thus somewhat reducing the inherent advantages of compactness and speed of setup.
This article confirms the ability of the LIFEBRIDGE to detect and eliminate air from the circuit and thereby prevent air embolism. For a modified bypass circuit to be acceptable, the LIFEBRIDGE will be required to match other safety and efficacy features of current bypass systems (eg, evaluation of the quality of the pump and bypass circuit, effects on hemolysis, coagulation, blood gas exchange, and prevention of over distension of the left ventricle to name a few). Accurate documentation of these features will be required before clinical testing in safety and efficacy trials. Comparison with other minimized extracorporeal circuits would be of value to potential users.
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References
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- Mehlhorn U, Brieske M, Fischer UM, et al. LIFEBRIDGEA portable, modular, rapidly available "plug-and-play" mechanical circulatory support system. Ann Thorac Surg 2005;80:1887-1892.[Abstract/Free Full Text]
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