Integrated Pump Switch for Antegrade/Retrograde Cardioplegia Floyd D. Loop, MD, Robert Foster, BA, CCP, David Ogella, BS, CCP, and Donna Teplitsky Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
A method of centralizing management of antegrade and
retrograde blood cardioplegia delivery at the heart-lung machine is described. Operation of a manually flowdirected pump switch, controlled by the perfusionist, improves safety and efficiency. (Ann Thoruc Surg 1991;52:320-1)
cardioplegia set to the infusion cannula via two 2.4-m (8-ft) lengths of tubing with an inner diameter of 4.8 mm (%6 inch). Color-coded connectors ensure proper hook-up of these lines to the appropriate cannula at the operative field. A universal adapter kit allows for easy connection to any cardioplegia heat exchanger currently on the market.
T
he use of antegrade and retrograde blood cardioplegia preserves myocardial function and contributes to lower morbidity and mortality for patients undergoing cardiac operations [l].Problems associated with cardioplegia delivery from a heart-lung machine may include over-pressurization of the system due to miscommunication between the surgical team and the perfusionist, which poses a potential risk to the patient. We propose centralizing the functions of cardioplegia delivery and control of the delivery site by the perfusionist at the heart-lung machine. At the direction of the surgeon, the perfusionist uses an antegradelretrograde integral selector pump switch (ARISS; DLP, Grand Rapids, MI) to deliver blood cardioplegia.
Material and Methods Our current blood cardioplegia system delivers antegradel retrograde cardioplegia in a blood and crystalloid mixture (ratio, 4:l) according to the Buckberg protocol [l].The system (Fig 1) consists of a Bentley heat exchanger (HE100; Bentley Laboratories, Irvine, CA), which receives heating and cooling from a Sarns heaterlcooler unit (Sarns, Inc, Ann Arbor, MI). Line pressure is monitored with an aneroid sphygmomanometer. The antegrade catheter is connected to a Y-type adapter (10005, DLP) that accommodates a 12G aortic root cannula (10012, DLP). The other arm of the Y-type adapter is attached to a 1.8-m (6-ft) piece of tubing with an inner diameter of 6 . 3 mm (?A inch), which functions as a vent. The 15F retrograde cannula (94315, DLP) is placed in the coronary sinus. Pressure is monitored with an electronic transducer (DTX Pressure Transducer Kit; ViggoSpectramed, Oxnard, CA). The pressure line is zeroed for measurement of intracoronary sinus pressure and is monitored by the perfusionist, who maintains pressures not to exceed 50 mm Hg during retrograde infusions. The pump switch consists of two lengths of tubing and a flow direction device (see Fig 1).The switch connects the Accepted for publication April 16, 1991 Address reprint requests to Mr Ogella, Department of Perfusion, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.
0 1991 by The Society of Thoracic Surgeons
Fig 1 . Blood cardioplegia circuit with pump switch.
0003-4975/91/$3.50
HOW TO DO IT LOOP ET AL CARDIOPLEGIA PUMP SWITCH
Ann Thorac Surg 1991:52:32&1
The pump switch uses a manually operated, integral flow direction device, allowing the perfusionist t o choose antegrade, retrograde, prime, or off positions. The switch has a directional a r r o w clearly marked and a positive “click” i n each position t o verify proper flow direction.
Comment Control of cardioplegia delivery by t h e perfusionist eliminates miscommunication and interruptions of t h e surgi-
321
cal team. The perfusionist is able to ascertain that the appropriate cannula is open a n d that cardioplegia delivery is proceeding as requested by the surgeon. This pump switch is safe, relatively inexpensive, and effective.
Reference 1. Buckberg G. Strategies and logic of cardioplegic delivery to prevent, avoid, and reverse ischemic and reperfusion damage. J Thorac Cardiovasc Surg 1987;93:127-39.
REVIEW OF RECENT BOOKS
Current Therapy in Cardiovascular Disease, 3rd Edition Edited by 1. Willis Hurst, M D Philadelphia, B.C. Decker Inc, 1991 453 pp, illustrated, $69.00
Reviewed by V . C. Smith, M D This book is a well-written, concise description of exactly what the title describes, that is, current therapy in cardiovascular diseases. The book has been divided into 12 major areas of cardiovascular disease and one additional section on other important related topics. Ninety-six topics are covered by 90 authors, most of whom are cardiologists with a few chapters written by surgeons. The topics span the entire spectrum of cardiovascular disease and include topics specific to medical, surgical, congenital, and combinations of these. Each topic is relatively short, spanning only three to four pages, and can be easily read in 5 to 7 minutes. Each author was asked to describe briefly the disease process including the pathophysiology and then describe therapeutic alternatives. Perhaps the most informative portion of each section is then presented as the author relates a preferred approach, which is a generally accepted standard of practice
treatment plan for the particular problem. Appropriate medications, surgical options, and expected outcomes are presented. The topic is then completed by a very concise selected reading list with most of the references published within the last 10 years. Each author has eliminated the esoteric, scientific, and statistical clutter that sometimes makes review articles difficult to read and comprehend. By doing this, the authors have made the topics appealing to all who deal with cardiovascular disease. The book would be particularly helpful to family practitioners and internists who do not deal with cardiovascular diseases every day, but because it offers a wide range of rarely seen conditions, it should appeal to all. For the surgeon, it is definitely not a “how to do it” book but rather a book that would serve as a reference to the common treatment of medical conditions in surgical patients. For the internist, it does have the descriptive drawings of surgical procedures that would help in the explanation of operations to a patient. In summary, this book is a comprehensive collection of cardiovascular problems. It should be considered a valuable reference to all people dealing with cardiovascular diseases.
Las Vegas, Nevada
A method of centralizing management of antegrade and
retrograde blood cardioplegia delivery at the heart-lung machine is described. Operation of a manually flowdirected pump switch, controlled by the perfusionist, improves safety and efficiency. (Ann Thoruc Surg 1991;52:320-1)
cardioplegia set to the infusion cannula via two 2.4-m (8-ft) lengths of tubing with an inner diameter of 4.8 mm (%6 inch). Color-coded connectors ensure proper hook-up of these lines to the appropriate cannula at the operative field. A universal adapter kit allows for easy connection to any cardioplegia heat exchanger currently on the market.
T
he use of antegrade and retrograde blood cardioplegia preserves myocardial function and contributes to lower morbidity and mortality for patients undergoing cardiac operations [l].Problems associated with cardioplegia delivery from a heart-lung machine may include over-pressurization of the system due to miscommunication between the surgical team and the perfusionist, which poses a potential risk to the patient. We propose centralizing the functions of cardioplegia delivery and control of the delivery site by the perfusionist at the heart-lung machine. At the direction of the surgeon, the perfusionist uses an antegradelretrograde integral selector pump switch (ARISS; DLP, Grand Rapids, MI) to deliver blood cardioplegia.
Material and Methods Our current blood cardioplegia system delivers antegradel retrograde cardioplegia in a blood and crystalloid mixture (ratio, 4:l) according to the Buckberg protocol [l].The system (Fig 1) consists of a Bentley heat exchanger (HE100; Bentley Laboratories, Irvine, CA), which receives heating and cooling from a Sarns heaterlcooler unit (Sarns, Inc, Ann Arbor, MI). Line pressure is monitored with an aneroid sphygmomanometer. The antegrade catheter is connected to a Y-type adapter (10005, DLP) that accommodates a 12G aortic root cannula (10012, DLP). The other arm of the Y-type adapter is attached to a 1.8-m (6-ft) piece of tubing with an inner diameter of 6 . 3 mm (?A inch), which functions as a vent. The 15F retrograde cannula (94315, DLP) is placed in the coronary sinus. Pressure is monitored with an electronic transducer (DTX Pressure Transducer Kit; ViggoSpectramed, Oxnard, CA). The pressure line is zeroed for measurement of intracoronary sinus pressure and is monitored by the perfusionist, who maintains pressures not to exceed 50 mm Hg during retrograde infusions. The pump switch consists of two lengths of tubing and a flow direction device (see Fig 1).The switch connects the Accepted for publication April 16, 1991 Address reprint requests to Mr Ogella, Department of Perfusion, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.
0 1991 by The Society of Thoracic Surgeons
Fig 1 . Blood cardioplegia circuit with pump switch.
0003-4975/91/$3.50
HOW TO DO IT LOOP ET AL CARDIOPLEGIA PUMP SWITCH
Ann Thorac Surg 1991:52:32&1
The pump switch uses a manually operated, integral flow direction device, allowing the perfusionist t o choose antegrade, retrograde, prime, or off positions. The switch has a directional a r r o w clearly marked and a positive “click” i n each position t o verify proper flow direction.
Comment Control of cardioplegia delivery by t h e perfusionist eliminates miscommunication and interruptions of t h e surgi-
321
cal team. The perfusionist is able to ascertain that the appropriate cannula is open a n d that cardioplegia delivery is proceeding as requested by the surgeon. This pump switch is safe, relatively inexpensive, and effective.
Reference 1. Buckberg G. Strategies and logic of cardioplegic delivery to prevent, avoid, and reverse ischemic and reperfusion damage. J Thorac Cardiovasc Surg 1987;93:127-39.
REVIEW OF RECENT BOOKS
Current Therapy in Cardiovascular Disease, 3rd Edition Edited by 1. Willis Hurst, M D Philadelphia, B.C. Decker Inc, 1991 453 pp, illustrated, $69.00
Reviewed by V . C. Smith, M D This book is a well-written, concise description of exactly what the title describes, that is, current therapy in cardiovascular diseases. The book has been divided into 12 major areas of cardiovascular disease and one additional section on other important related topics. Ninety-six topics are covered by 90 authors, most of whom are cardiologists with a few chapters written by surgeons. The topics span the entire spectrum of cardiovascular disease and include topics specific to medical, surgical, congenital, and combinations of these. Each topic is relatively short, spanning only three to four pages, and can be easily read in 5 to 7 minutes. Each author was asked to describe briefly the disease process including the pathophysiology and then describe therapeutic alternatives. Perhaps the most informative portion of each section is then presented as the author relates a preferred approach, which is a generally accepted standard of practice
treatment plan for the particular problem. Appropriate medications, surgical options, and expected outcomes are presented. The topic is then completed by a very concise selected reading list with most of the references published within the last 10 years. Each author has eliminated the esoteric, scientific, and statistical clutter that sometimes makes review articles difficult to read and comprehend. By doing this, the authors have made the topics appealing to all who deal with cardiovascular disease. The book would be particularly helpful to family practitioners and internists who do not deal with cardiovascular diseases every day, but because it offers a wide range of rarely seen conditions, it should appeal to all. For the surgeon, it is definitely not a “how to do it” book but rather a book that would serve as a reference to the common treatment of medical conditions in surgical patients. For the internist, it does have the descriptive drawings of surgical procedures that would help in the explanation of operations to a patient. In summary, this book is a comprehensive collection of cardiovascular problems. It should be considered a valuable reference to all people dealing with cardiovascular diseases.
Las Vegas, Nevada
