Use of a low-prime circuit for bloodless heart transplantation in xenotransplant of 5-7 kilogram primates

D. Gomez, V. F. Olshove, S. Weinstein, J. T. Davis, R. E. Michler

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

There is a great effort to decrease blood product use during open-heart surgery in pediatrics. We were presented with a research challenge to accomplish heart xenotransplantation from donor cynomologous monkey (Macaca fascicularis) to recipient olive baboon (Papio anubis) of 5-7 kilograms without benefit of donor or banked blood products. The purpose of this study was to design and implement a practical, low-volume circuit to minimize hemodilution and avoid the use of blood products. A simple circuit was assembled using a low-volume oxygenator with hardshell venous reservoir, an 1/8-inch arterial line, an 1/4-inch venous line, and gravity drainage. Three xenotransplants were performed and evaluated. The mean recipient weights were 6.3 ± 0.7 kg. Circuit prime volume was 228 ± 5.8 mL, and bypass time was 85 ± 6.7 min. Blood flow rates were 585 ± 113 mL/min with postmembrane arterial line pressures of 344 ± 81 mmHg, and patient mean arterial pressures (MAP) of 51.4 ± 16.7 mmHg. Venous saturations were 63.7 ± 8.0%. The hematocrit prebypass was 37.4 ± 3.2, bypass 20.7 ± 0.9, post-MUF 27.8 ± 3.3, and 7 days postoperative 24.5 ± 7.5%. Platelet count was 289 ± 1.1 K/μL, 147 ± 37.1 K/μL, and 322 ± 292.7 K/μL prebypass, postbypass, and 7 days postoperative, respectively. Plasma-free hemoglobin prebypass was 7.5 ± 4.4 mg/dL and postbypass 22.2± 16.5 mg/dL with no noted hematuria during and after the procedure. All patients survived and were successfully weaned from cardiopulmonary bypass (CPB) with same day extubation. A low-prime circuit for bloodless heart surgery is possible. To achieve low reservoir levels, especially without the use of an arterial line filter (ALF), it is necessary to have a full armament of monitoring and alarm devices.

Original languageEnglish (US)
Pages (from-to)138-141
Number of pages4
JournalJournal of Extra-Corporeal Technology
Volume32
Issue number3
Publication statusPublished - Nov 22 2000
Externally publishedYes

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Keywords

  • Bloodless
  • Cardiopulmonary bypass
  • Hemodilution
  • Low-prime
  • Pediatric

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Professions (miscellaneous)
  • Cardiology and Cardiovascular Medicine

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