Adequately delivered blood flow is necessary for effective hemodialysis, which according to a 2008 national Japanese survey, was on average 197 ± 31 ml/min. With this in mind, a group of Japanese clinicians sought to find the discrepancies between actual delivered flow and the pump flow reported by the dialysis machine.
As a perfusionist, you love what you do—you’re making a positive impact on people’s lives. For this very clinical profession that has been consigned to the OR, you might be surprised to learn that technology advancements and changes in procedures are allowing perfusionists to leave the OR and make their way to patients’ bedsides.
To get more insight into what’s on the horizon for cardiac perfusion, we spoke to an expert. Here are a few of the trends to watch if you’re a cardiac perfusionist.
Using smaller cannulas for minimally invasive surgery or aggressive cardiopulmonary bypass circuitry miniaturization have increased the need to augment venous drainage to achieve adequate flow rates. This is achieved through vacuum-assisted venous drainage (VAVD) which has been associated with a number of side effects, including:
The surgical challenges to correct the cardiac abnormalities in children born with only a single ventricle are enormous and fraught with pitfalls.
Although overall outcomes of the three-staged surgical repair of patients with a functional single ventricle have improved, a high mortality rate still persists after stage I repair, mainly due to “in- parallel” circulation. Stage II repair involves creation of a bidirectional cavopulmonary shunt or BCPS to create an “in- series” circulation to correct this problem.
Surgeons at the University of Sapporo Japan analyzed the relationship between intraoperative transit-time flow values and post-op angiographic results of gastroepiploic arterial grafts to the right coronary artery to determine whether the flow values are reliable indicators of early graft patency in gastroepiploic to right coronary artery grafts.
Their study pool included 169 patients who underwent off-pump CABG with GEA-RCA bypass grafts. Eighty-three grafts were anastomosed and flows were measured. An angiogram was taken one week after surgery and the anastomosis of each graft was graded using FitzGibbon grading (Study 1) and graft-flow grading (Study 2).
Pulmonary artery banding (PAB) has been the standard treatment for patients with high pulmonary blood flow who are awaiting subsequent surgery. The band is designed to provide adequate systemic flow to the body by restricting pulmonary flow. This allows the patient to grow and therefore become a better candidate for follow-up surgery.
Clinicians at the University of Calgary, Alberta, Canada sought to evaluate transit-time flow (TTF) as a tool to detect technical errors in arterial bypass grafts intraoperatively and predict outcomes. They measured flow in 336 consecutive patients who had an average of 3.02 grafts each. Ninety-nine percent of these bypass grafts were arterial. Three parameters: pulsatility index (PI), flow (cc/min) and diastolic filling (DF) were measured in 990 of the total 1,000 grafts.
A new challenge. A change of pace. For a profession that involves a lot of intense clinical work, these phrases might seem foreign to many cardiovascular perfusionists. But they don’t have to be.
The profession is evolving thanks to advancements in technology and medical procedures, and like other medical professionals, you can take advantage of locum tenens opportunities to expand your horizons, face new challenges or simply travel. It can be a career-shaping opportunity for many professionals.
In 2010, the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Task Force on Myocardial Revascularization released guidelines on myocardial revascularization that state the following with respect to intraoperative graft flow patency assessment following bypass graft construction:
In his 2005 paper “Intraoperative Bypass Flow Measurement Reduces the Incidence of Postoperative Ventricular Fibrillation and Myocardial Markers after Coronary Revascularization,” Dr. Stefan Bauer from the Department of Cardiovascular and Thoracic Surgery, Heart Institute, Lahr/Baden, Germany, presents definitive data that demonstrate that intraoperative flow measurements for graft assessment during coronary artery bypass grafting (CABG) reduces ventricular fibrillation and postoperative complications.