Written by a veteran perfusionist at one of the world´s leading hospitals, this neww book provides practical, expert guidance on developing a safe and successful plan for cardiac bypass for patients undergoing surgery for CHD.
This book comprises chapters devoted to the hardware and disposables required for cardiopulmonary bypass and a diagnosis that provides the reader with a sense of the surgical repair required for each defect, what equipment is needed, and what to expect from bypass.
Blank notes sections after each defect will allow the reader to make the book their own by documenting institutional and surgeon-specific variances they may encounter. This is important since some defects are rarely seen and approaches to the same defect or procedure may vary between surgeons.
This is the only book on the market which provides practioners with the full range of information they do confidently device "a plain of the pump run" in CHD surgery.
- Confidently devise a safe and successful 'plan for the pump run' for patients undergoing surgery for congenital heart disease. This practical guide for perfusionists and other members of the cardiac surgical team provides information on the devices, technology and techniques required for successful bypass of patients with congenital heart defects
- A practical, spiral-bound, go-to reference designed to answer the most frequently-posed questions about bypass for CHD, the surgical treatment of which is often complicated
- Focuses on the latest technology and techniques and provides clear, matter-of-fact guidance based on specific diagnoses
- Written by a seasoned perfusionist who is co-chief and educator at one of the world's leading children's hospitals
- Spiral binding allows the book to be laid flat for easy referral in the operating room
- A notes section following each diagnosis enables readers to add institution and/or surgeon-specific information to tailor a bypass plan for each CHD lesion
From the ContentsForeword x
Preface xi
Acknowledgments xii
1 Equipment for bypass 1
- Oxygenators
- Arterial line filters
- Tubing packs
- Cardioplegia systems
- The heart-lung machine
- The heater-cooler system
- Cannulae
2 Priming the bypass circuit
- Prime constituents
- Steps for priming
3 The bypass plan
- Communication agreement for case
- Anticoagulation management
- Blood gas management
- Carbon dioxide management
- Oxygenation strategy
- Hematocrit management
- Blood pressure management
- Temperature management
- Flow rates regional perfusion and hypothermic circulatory arrest
- Methods of ultrafiltration
- Before bypass
- On bypass
- After bypass
- SMUF specifications
- Standard and augmented venous return
- Standard venous return with gravity siphon drainage
- Augmented venous return
- The prebypass checklist
- The surgical safety checklist for congenital heart surgery
4 Typical phases of cardiopulmonary bypass
- Commencement of bypass
- Standard support phase of bypass
- Termination of bypass
- Post bypass
5 Additional notes based on bypass tasks
- Prebypass
- Heart-lung machine (HLM)
- Reoperations
- Cannulation
- Transfusion during cannulation
- On bypass
- Verification of adequate drainage when caval tapes are used
- Blood gas management
- Cardioplegia delivery
- Planned circulatory arrest
- Induced ventricular fibrillation
- Administration of blood products
- Atrial line placement
- LV vent placement
- Bed rotation during bypass
6 Bypass considerations based on diagnosis
- Anomalous coronary arteries
- Aortic regurgitation/insufficiency
- Aortic stenosis
- Aortopulmonary collaterals
- Aortopulmonary window
- Atrial septal defect
- Cardiomyopathy requiring orthotopic heart transplantation
- Coarctation of the aorta
- Common atrioventricular canal defect
- Cor triatriatum
- Corrected transposition of the great arteries (L-TGA Levo-TGA or C-TGA) or congenitally corrected TGA
- Critical aortic stenosis
- Double chambered right ventricle
- Double inlet left ventricle
- Double outlet left ventricle
- Double outlet right ventricle
- Ebstein's anomaly
- Hypoplastic left heart syndrome
- Stage 1 (Norwood) procedure
- Hybrid stage 1 palliation
- Stage 2 or bidirectional Glenn shunt
- Fontan procedure (total cavopulmonary anastomosis)
- Interrupted aortic arch
- Left superior vena cava
- Lung transplantation
- Mitral regurgitation/insufficiency
- Mitral stenosis
- Patent ductus arteriosus
- Pulmonary artery abnormalities
- Pulmonary atresia
- Pulmonary atresia with an intact ventricular septum
- Pulmonary atresia with ventricular septal defect
- Pulmonary regurgitation/insufficiency
- Pulmonary stenosis
- Pulmonary vein stenosis or pulmonary venous obstruction
- Tetralogy of Fallot
- Total anomalous pulmonary venous return and partial anomalous pulmonary venous return
- d-Transposition of the great arteries
- Tricuspid atresia
- Tricuspid regurgitation/insufficiency
- Truncus arteriosus
- Ventricular septal defect
7 Notes on select issues during bypass
- Blood pressure higher than expected
- Blood pressure lower than expected
- Bypass circuit pressure higher than expected
- Bypass circuit pressure lower than expected
- Central venous pressure elevated
- Heat exchange issue (slow cooling or warming)
- NIRS values lower than expected
- PaCO2 higher than expected
- PaCO2 lower than expected
- PaO2 lower than expected
- Reservoir volume acutely low
8 Notes on select emergency procedures during bypass
- Arterial pump failure (roller head)
- Failure to oxygenate
- Massive air embolization
- Acute aortic dissection at the initiation of bypass
Venous air lock- Inadvertent arterial decannulation
- Inadvertent venous decannulation
9 Brief overview of named procedures and terms
10 Abbreviations for congenital heart surgery
11 Recommended reference books
12 Comprehensive experience-based equipment selection chart select medications administered during bypass
Index 190
