Low Invasive Pediatric Cardiac Surgery

Description

This book demonstrates the significance of minimally invasive extracorporeal circulation and reduced time as two of the most important factors for pediatric cardiac surgery and early postoperative recovery. The content is divided into three major thematic sections: low invasiveness; pitfalls and countermeasures before, during and after operations; and suggestions on time-saving and team building. Abundant figures aid in comprehension, while videos of the surgery offer practical insights for readers at all levels. Advances in extracorporeal circulation devices and management have led to new clinical problems such as decreased perfusion pressure, high pressures in oxygenators, and changes in acid-base equilibrium. The book explains these problems both clinically and experimentally, and describes countermeasures.  Low Invasive Pediatric Cardiac Surgery provides valuable evidence and practical suggestions for all surgeons, perfusionists, scrub-nurses, and anesthesiologists who are engaged in pediatric cardiac surgery. It will also appeal to pediatric cardiologists and medical device manufacturers. The book is intended to share the author’s experience and actual data with readers who have clinical experience, and to help prepare beginners.  Preface Contents About the Author Part I: Extracorporeal Circulation and Low Invasiveness 1: Experience of Minimally Invasive Extracorporeal Circulation 1.1 Introduction 1.2 Implications of Invasion and Minimally Invasiveness in Cardiac Surgery 1.3 Extracorporeal Circulation Method for Minimally Invasive 1.4 History of Minimally Invasive Measures at Sakakibara Heart Institute 1.4.1 Establishment and Clinical Effect of Ultrafiltration Method 1.4.1.1 ECUM Effect in Infant VSD (1990) 1.4.1.2 ECUM Effect in Complete Atrioventricular Septal Defect (AVSD) (1992–1993) 1.4.2 Problems with Ultrafiltration 1.4.2.1 Protein Leakage (1991–1992) 1.4.2.2 Arrhythmia (1991–1993) 1.4.3 Advances in Ultrafiltration Methods 1.4.3.1 Measurement of Inflammatory Reactive Substances (1991–1993) ECUM Only After the Start of Rewarming Ultrafiltration During Aortic Cross-Clamp + During Rewarming 1.4.3.2 Measurement of Inflammatory Reactive Substances (1994–1995) 1.4.3.3 New Heart-Lung Machine and Inflammatory Reactive Substances (1997–1998) 1.5 Summary of Minimally Invasive References 2: Development of Cardiopulmonary Bypass System and Devices Aiming for Minimally Invasive 2.1 Introduction 2.2 Development History 2.2.1 Low-Volume Oxygenator 1 2.2.2 Component Type Heart–Lung Machine 2.2.3 Low-Volume Oxygenator 2 2.2.4 Low-Volume Oxygenator 3 2.2.5 Isolated Pump-Controller Heart–Lung Machine 1 2.2.6 Low-Volume Oxygenator 4 2.2.7 Isolated Pump-Controller Heart–Lung Machine 2 2.2.8 Isolated Pump-Controller Heart–Lung Machine 3 2.2.9 The New Sakakibara Heart Institute 2.2.10 Transition of Priming Volume Reduction, Vacuum-Assisted Venous Drainage (VAVD) 2.2.11 Isolated Pump-Controller Heart–Lung Machine 4 2.2.12 Change in Priming Volume New Device 2.2.13 Current Priming Volume 2.3 Summary of Extracorporeal Circulation Devices References 3: Advances in Bloodless Open-Heart Surgery 3.1 Introduction 3.2 Bloodless Open-Heart Surgery and Homologous Blood Transfusion 3.3 Bloodless Open-Heart Surgery for Acyanotic Congenital Heart Disease with Pulmonary Hypertension 3.3.1 1983–1992 3.3.2 1993 3.3.3 1994 3.3.4 Possibility of Bloodless Open-Heart Surgery for VSD Infant Weighing 4 kg (1995) 3.3.5 Bloodless Open-Heart Surgery in VSD Infants Weighing 3–4 kg (1997) 3.3.6 Bloodless Open-Heart Surgery for Complete AVSD: Comparison with VSD 3.3.7 Number of Blood Transfusions Used in Blood Priming Cases 3.4 Management and Measures for Bloodless Open-Heart Surgery in Low-Weight Infant 3.4.1 Determination of Indication for Bloodless Open-Heart Surgery 3.4.1.1 Indication Decision by Clinical Evaluation 3.4.1.2 Indication Decision by Hemodilution 3.4.2 Surgery 3.4.3 Anesthesia Management 3.4.4 Management of Extracorporeal Circulation 3.4.4.1 Initial Priming Composition 3.4.4.2 Extracorporeal Circulation Method 3.4.5 Postoperative Management 3.5 Bloodless Open-Heart Surgery for Cyanotic Congenital Heart Disease 3.5.1 Characteristics of Cyanotic Heart Disease in Bloodless Open-Heart Surgery 3.5.2 Autologous Blood Donation After Induction of Anesthesia 3.5.3 Disadvantages of Autologous Blood Donation After Induction of Anesthesia 3.5.4 Bloodless Open-Heart Surgery for Cyanotic Heart Disease Since 1997 3.5.4.1 108 TOF Cases 3.5.4.2 26 Rastelli Procedure Cases 3.5.4.3 52 Fontan Procedure Cases 3.5.4.4 39 Glenn Operation Cases (Since 2001) 3.5.4.5 Nine AVSD with TOF Cases 3.5.4.6 Eight Jatene Procedure Cases 3.5.5 Causes of Blood Transfusion in Cyanotic Heart Disease (Since 1997) 3.6 Future Blood Transfusion Therapy and Blood Transfusion Reduction 3.7 Summary of Bloodless Open-Heart Surgery References Part II: Pitfalls in Recent Extracorporeal Circulation and Countermeasures 4: Problems with New Devices 4.1 Introduction 4.2 Correction During Extracorporeal Circulation 4.2.1 Bolus Injection Correction During Extracorporeal Circulation 4.2.2 Experiment on Bolus Injection Correction 4.2.2.1 Red Reagent Administration 4.2.2.2 Measurement of Na Concentration 4.3 Vacuum Assisted Venous Drainage 4.4 High-Pressure Excursion in Oxygenator 4.4.1 Experiment on High-Pressure Excursion Across Oxygenator 4.4.1.1 Increase in Pressure Gradient Across Oxygenator Due to Alkalization 4.4.1.2 Study on Factors of High-Pressure Excursion 4.4.2 Clinical Study on High-Pressure Excursion Across Oxygenator 4.4.2.1 Type of High-Pressure Excursion Across Oxygenator 4.4.3 Change-Out of Oxygenator 4.5 Problems in Pediatric Oxygenators 4.6 Summary of New Problems References 5: Microbubbles in Extracorporeal Circulation and Its Countermeasures 5.1 Introduction 5.2 Measuring Method 5.2.1 Experiment 5.2.2 Clinical 5.3 Generation Path of Microbubble 5.4 Measurement of Microbubbles in Experiments 5.4.1 Neonatal and Pediatric Oxygenator 5.4.1.1 Air Injection from Venous Inlet Port 5.4.1.2 Air Injection from Cardiotomy Port 5.4.2 Adult Oxygenator 5.4.2.1 Air Injection from Venous Inlet Port 5.4.2.2 Air Injection from Cardiotomy Port 5.4.3 Summary of the Experiment 5.5 Measurement of Microbubbles in Clinical Practice 5.5.1 Suction and Venting 5.5.2 Reservoir Level 5.5.3 Reservoir Selection 5.5.4 Correction and Replenishment 5.5.5 ECUM 5.5.6 Oxygenator 5.5.7 Arterial Filter 5.5.8 Microbubbles Generated After Aortic Unclamp 5.5.9 Difference in Number of Microbubbles by Physique 5.5.10 Conventional Extracorporeal Circuit 5.6 Microbubble Summary 5.7 PART II Summary References Part III: Minimally Invasive and Time Saving 6: Time Saving and Team Development 6.1 Time Saving and Team Development 6.2 Objective of Time Saving 6.3 Explanation of VSD Surgery Video 6.3.1 From Anesthetic Induction to Skin Incision (22 min) 6.3.1.1 Viewpoint (1) Surgeon, First Assistant, Second Assistant Scrub Nurse 6.3.2 From Skin Incision to Pericardial Fixation (33 min and 20 s) 6.3.2.1 Viewpoint (2) Surgeon First Assistant Second Assistant Scrub Nurse 6.3.3 From Cannulation to Aortic Cross-Clamp (8 min 35 s) 6.3.3.1 Viewpoint (3) Surgeon First Assistant Second Assistant Scrub Nurse 6.3.4 VSD Closure (9 min 10 s) 6.3.4.1 Viewpoint (4) 6.3.4.2 Surgeon First Assistant Second Assistant Scrub Nurse 6.3.5 From Aortic Unclamp to Weaning from Extracorporeal Circulation (6 min 52 s) 6.3.5.1 Viewpoint (5) Surgeon First Assistant Second Assistant Scrub Nurse 6.3.6 Chest Closure (11 min and 13 s) 6.3.6.1 Viewpoint (6) Surgeon First Assistant Second Assistant Scrub Nurse 6.4 Significance of Time Saving 6.5 Operation Planning 6.5.1 Operation Planning 1 6.5.1.1 Research Paper at S.H.I Study on Surgical Planning 1 Introduction Methods Result Discussion Conclusion 6.5.2 Operation Planning 2 6.5.2.1 Research Paper at S.H.I Study on Surgery Planning 2-a Introduction Methods Results Discussion Conclusion 6.5.2.2 Research Paper at S.H.I Study on Surgery Planning 2-b Introduction Methods Results Discussion Conclusion 6.5.3 Operation Planning 3 6.5.3.1 Research Paper at S.H.I Study on Surgery Planning 3 Introduction Methods Conclusion 1 Discussion 1 Conclusion 2 Discussion 2 Conclusion 3 Discussion 3 Summary 6.5.4 Operation Planning 4 6.5.4.1 Research Paper at S.H.I Study on Surgery Planning 4 Introduction Subjects and Methods Results Discussion and Conclusion 6.6 ePTFE Valve 6.6.1 Result 6.6.2 Discussion 6.7 Junior High and High School Students 6.8 Education for Young Surgeons and Build Up of Surgery Team 6.9 Summary References Postscript