- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices
(p. 188) Perfusion Considerations
- Chapter:
- (p. 188) Perfusion Considerations
- Author(s):
Phillip Scott
and Jeffrey Riley
- DOI:
- 10.1093/med/9780190909291.003.0025
The effects of hemodilution during cardiopulmonary bypass (CPB) negatively impact a patient’s hemodynamic and coagulopathic states throughout all operative stages and into the postoperative care environment. Decisions by the surgical team to minimize fluid administration prove beneficial, and combining contemporary perfusion circuit prime reduction techniques, such as body mass index (BMI) correction, venous autologous priming (VAP), retrograde autologous priming (RAP), and antegrade prime displacement, greatly enables efforts of maintaining proper colloidal osmotic pressures (COP) while maximizing delivery of oxygen (DO2) during CPB. Adjuncts such as ultrafiltration (UF), use of vacuum assist venous drainage (VAVD), hyper-osmotic/oncotic solutions administration, and proportional volume replacement better prepare a patient for post-bypass management. Minimizing hemodilution tools facilitates transition onto mechanical circulatory support (MCS) devices such as extracorporeal membrane oxygenation (ECMO) and/or right or left ventricular assist device (RVAD/LVAD). Avoiding heparin rebound and dilutional coagulopathy in the intensive care unit further prevents additional blood product transfusions.
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- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices