545025 research-article2014
PRF0010.1177/0267659114545025PerfusionCommentary
Commentary
Commentary on: Nanoparticle oxygen delivery to the ischemic heart
Perfusion 2014, Vol. 29(6) 544 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114545025 prf.sagepub.com
Presenter: T Swyers
MR. AARON HILL (Toano, Virginia): This paper was a great tour de force and I really think you have done some ground-breaking work. This area has been studied several times before in the cardiac catheterization laboratory and in heart surgery. What would be the mechanism for the elimination of the perfluorocarbon once it has been administered to the patient? MR. TREVOR SWYERS (Tucson, Arizona): About 99 percent of all of the perfluorocarbon is exhaled through the lungs after 90 minutes and then the lipid part of the emulsion used for injection is carried out through the body through normal metabolic means for lipids. MR. HILL: It appears you have a better answer than we had before and, of course, in the past, I think the fluorocarbon amounts we were giving were much higher. MR. SWYERS: Yes, that is correct. I believe it was 60 to 80 percent weight per volume before and the carbon chains were much longer, which makes this compound unique. Researchers have been able to make the carbon chain in the flurane shorter, which makes it easier for the body to excrete or exhale it. CO-MODERATOR PHILIP FERNANDES (London, Ontario, Canada): Your uses, or a potential use for this compound in cardioplegia, is fascinating. The debate of crystalloid versus blood cardioplegia is that, with blood,
at least, you have oxygen delivery, but with crystalloid, you get a very quick arrest and it is able to go past these blockages and arrest the whole heart. It is interesting. Could you comment on the possible use of this product in a crystalloid solution? MR. SWYERS: I think there are many more studies that will need to be done and much more understanding of this product to be able to use it in crystalloid cardioplegia or, possibly, in blood cardioplegia. The implications for future studies are amazing. CO-MODERATOR LINDA MONGERO (New York, New York): I know you said that you have many questions about how it is bound and how it is released. Is it possible potentially to cause micro-air embolism if it just sits in the patient or in the heart? MR. SWYERS: One of the reasons why they stopped using it clinically as an ultrasound contrast was because the high energy rays from the ultrasound probe would cause formation of microbubbles. Some of these bubbles would coalesce as they came out of solution, causing a potential problem. We have not seen any type of gaseous microemboli occur under these conditions. It is thought that the normal blood pressure in the arterial system helps to prevent the formation of microbubbles. It would definitely have to be a consideration because it is a potential danger of the compound.
This commentary is taken from the discussion that followed the presentation of the previous paper at the 35th Annual Seminar of the American Academy of Cardiovascular Perfusion. Although the paper has been through Perfusion’s stringent peer review process, the commentary is a transcript of the discussion, edited for clarity, and the views expressed in the commentary are those of the commentators and do not necessarily represent, and should not be attributed to, the journal Perfusion, the Editors or the Publisher, SAGE.
Downloaded from prf.sagepub.com at University of New England on June 3, 2015
PRF0010.1177/0267659114545025PerfusionCommentary
Commentary
Commentary on: Nanoparticle oxygen delivery to the ischemic heart
Perfusion 2014, Vol. 29(6) 544 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114545025 prf.sagepub.com
Presenter: T Swyers
MR. AARON HILL (Toano, Virginia): This paper was a great tour de force and I really think you have done some ground-breaking work. This area has been studied several times before in the cardiac catheterization laboratory and in heart surgery. What would be the mechanism for the elimination of the perfluorocarbon once it has been administered to the patient? MR. TREVOR SWYERS (Tucson, Arizona): About 99 percent of all of the perfluorocarbon is exhaled through the lungs after 90 minutes and then the lipid part of the emulsion used for injection is carried out through the body through normal metabolic means for lipids. MR. HILL: It appears you have a better answer than we had before and, of course, in the past, I think the fluorocarbon amounts we were giving were much higher. MR. SWYERS: Yes, that is correct. I believe it was 60 to 80 percent weight per volume before and the carbon chains were much longer, which makes this compound unique. Researchers have been able to make the carbon chain in the flurane shorter, which makes it easier for the body to excrete or exhale it. CO-MODERATOR PHILIP FERNANDES (London, Ontario, Canada): Your uses, or a potential use for this compound in cardioplegia, is fascinating. The debate of crystalloid versus blood cardioplegia is that, with blood,
at least, you have oxygen delivery, but with crystalloid, you get a very quick arrest and it is able to go past these blockages and arrest the whole heart. It is interesting. Could you comment on the possible use of this product in a crystalloid solution? MR. SWYERS: I think there are many more studies that will need to be done and much more understanding of this product to be able to use it in crystalloid cardioplegia or, possibly, in blood cardioplegia. The implications for future studies are amazing. CO-MODERATOR LINDA MONGERO (New York, New York): I know you said that you have many questions about how it is bound and how it is released. Is it possible potentially to cause micro-air embolism if it just sits in the patient or in the heart? MR. SWYERS: One of the reasons why they stopped using it clinically as an ultrasound contrast was because the high energy rays from the ultrasound probe would cause formation of microbubbles. Some of these bubbles would coalesce as they came out of solution, causing a potential problem. We have not seen any type of gaseous microemboli occur under these conditions. It is thought that the normal blood pressure in the arterial system helps to prevent the formation of microbubbles. It would definitely have to be a consideration because it is a potential danger of the compound.
This commentary is taken from the discussion that followed the presentation of the previous paper at the 35th Annual Seminar of the American Academy of Cardiovascular Perfusion. Although the paper has been through Perfusion’s stringent peer review process, the commentary is a transcript of the discussion, edited for clarity, and the views expressed in the commentary are those of the commentators and do not necessarily represent, and should not be attributed to, the journal Perfusion, the Editors or the Publisher, SAGE.
Downloaded from prf.sagepub.com at University of New England on June 3, 2015
