latest heart-lung machine

[windsurfer]

This is my first post though I have read many posts over the last few months. I'm 55 and have aortic stenosis. I am starting to evaluate hospitals and as part of that effort I'm interested in heart-lung machines. Are all heart lung machines equal or are there some recent innovations that have improved outcomes? How do you find out which hospitals have the best technology? Are there any metrics for AVR outcomes by hospital and/or surgeon? Are there other discussion groups where specialists discuss this and are lay people allowed to listen in?

Thank you,

Windsurfer

 

[PapaHappyStar]

Perhaps you have seen this forum for heart surgery professionals. I was able to register:
http://www.hsforum.com/forum
Regards,
Burair

 

[windsurfer]

hsforum

hsforum

I'll check it out. Thank you,

 

[Superbob]

Hospitals

Hospitals

Hi Windsurfer,

I'll see if I can scout up some stats and websites. But for my money, there's no finer heart facility in these parts than Inova Fairfax in Falls Church. They just opened a new Heart Institute last fall. Check it out at inova.org.

I can't say enough positive things about my surgeon, the nurses and whole hospital staff, and the professional way everything is handled there. As you can see from my "signature," I had my surgery -- a rather complicated one -- just this past February. Was there for five days. I have only good things to say about Inova Fairfax.

Welcome to vr.com!

Cheers,

Bob

 

[tobagotwo]

Many thanks for citing the site, Burair. I was also able to register.

Best wishes,

 

[Debrinha GT]

Help with registration, please!!

Help with registration, please!!

As usual, I'm finding it hard to register. I've filled in the first couple of questions but had trouble continuing! LOL!! Can you guide me through it? Bob or Burair? Thanks in advance!
Débora

 

[hensylee]

heart/lung machine is a subject that we have never discussed in depth - just talked about the use of one. Don't you think we ought to have an informational discussion here in VR on this subject? Comments, anyone?

 

[ALCapshaw2]

I asked the surgeon who performed my AVR about minimizing risks from the H/L machine. He commented that the FILTERS can be a factor and their hospital used the best.

Another thread discussed a simple technique that showed promise. That was to lengthen the time for bringing the body back up to normal temperature (by 5 or 10 minutes if I remember correctly). Apparently if the body (i.e. BRAIN) is brought up too quickly, damage can be done by overheating the brain. Sounds like a simple change to do and would be worth asking your surgeon about.

'AL Capshaw'

 

[Superbob]

Backgrounder

Backgrounder

Here is a link to an interesting backgrounder about heart-lung machines from a foundation in Arlington:

http://www.whitaker.org/glance/heartlung.html

Your questions are good ones. I wish I had more answers. Maybe others will bring some research results to the table.

Prior to my surgery, I did a lot of research into types of valves but didn't give the intricacies of the heart-lung machine much thought. (Maybe I preferred not to think about it.) Hope you didn't mind my spirited endorsement of Inova Fairfax. Just thought since you are not far away, you would be interested in that experience. The Medical College of Virginia in Richmond is another option, and there are a number of excellent facilities in DC.

When the time is near, the first step is finding a surgeon in whom you have confidence.

Best wishes,

Bob

 

[windsurfer]

H/L machine suppliers

H/L machine suppliers

Concise backgrounder, Bob. Thank you. It sounds like the filter technology to reduce clots and protect the brain and kidney are the key areas for improvement. Now we need to find out who makes them and which are considered the best. Some links I found are: http://www.cobecv.com/cobecv.htm, http://maquet.com/cardiopulmonary/, http://www.getinge.com/index_brands.asp?ID=5, http://www.antara.co.id/en/seenws/?id=3633 but not sure if there is overlap or if they sell into the US market. I also found a market study on the US H/L machines at http://www.researchandmarkets.com/reports/53413/ as well as valves by supplier as well as trends in the industry but it is expensive. Perhaps someone can figure out a way to get at least the names of the dominant suppliers and then each can give their story as to which is better in filter technology. Those running the machines have their own web sites at http://www.perfusion.com/ plus .net and .org sites.
Windsurfer

 

[Superbob]

Wow, you're really digging into detail I've never seen dug into before!

I guess my own approach was trust the surgeon, trust the hospital (after checking out its ratings and reputation), then not sweat about the machinery. Maybe your way is smarter. But I also think you can worry yourself crazy about some of the intricacies.

The way I figure: If my surgeon is top rate, he doesn't want to spoil his record by having a defective heart-lung machine mess up.

 

[windsurfer]

need data

need data

I'm driven by hard data and there is no consumer report for surgeons and hospitals that I have seen even though your health is more important than your TV. So one would expect that if the hospital and surgeons were good they would also have good equipment and there is usually good data for that. Thus the rationale.
windsurfer

 

[Jewel]

heart lung machine

heart lung machine

I just got into this topic. I wanted to know why it is sited as a reason for "mental confusion" and that it can last. My husband is a certified biomedical equipment technician and he buys and plans for the equipment you have in a hospital. Hmmm he told me I needed to be in a specific hospital and a specific Heart OR because they have "new heart-lung machines" - I will ask him what he knows or what he can find out for us!

p.s. My father owned a sailboat store (yeah in Arizona) and we were one of the first families to take a windsurfer out on the water. We got aLOT of funny stares

 

[Jewel]

heart lung machine

heart lung machine

Okay - I need that line that says "we are not doctors nor are we selling heart lung machines" . You could have good filters at an old hospital or an old unit...... filters do matter on who is maintaining the equipment and what they are buying. The technology hasn't changed too much, he said the reason he is happy they have a new machine where I am going is because all of these have rollers that 'squish' the blood and the finer tuning you can do the better on my blood He said it is very important for all of us to understand that heart-lung equipment is VERY well made. Great motors, parts etc. They rarely go down. The equipment should be the least of the worry - worry more about the person running the machine. A question my husband would ask is whether or not they have backup machines, just in case - maybe one for 2 rooms running. And ask more questions about your "team" such as the anesethiologist or the equipment people. He says you can always talk to the biomedical department or clinical engineering dept if you want to know about the machines, age or backup etc.

Also, he says he would look up the website with the hospital infection rates- and see where your facility might stand. He still did not answer my question on how heart-lung machine affects the brain

By the way - blood fluid warmers are really really good - he says again you could ask what kind of "new" warmers they are using, if you really want to know.

Hope this helps

Julie

 

[windsurfer]

the leader, the team

the leader, the team

Jewel - thank you for the information - it just confirms what a doctor told me about the importance of filtering to avoid damage. But your husband's point about who runs the equipment is really the dominant issue. You can have the best equipment with less than optimal operators and still have suboptimal outcomes. An earlier post about selcting the surgeon therefore is correct since I believe he is head of the team and is responsible for quality control.

However, I still look at other issues first since I believe it is hard to turn down a good surgeon for non-surgical reasons such as hospital, or valve type that he has never done or some of the other issues covered on this wonderful list.

As for windsurfing, I hope to resume after surgery that is why I'm leaning toward a tissue valve even though I know I will need surgery again. Stentless porcine or the Edwards Magna are the runner-ups so far with my preference for the cow valve - still researching durability data. But I'll ask questions on the other thread for valve selections.

windsurfer

 

[hensylee]

can one of you who has done extensive searching, explain from start to finish just exactly what is done in the OR with the heart/lung machine, how it works, how it's hooked up, what it does exactly, why it's used. That way members don't have to go searching the web. This has never been explained in a thread - that I know of.

Actually, a synopsis of the surgery itself has not been posted either, that I know of. Just that our chest is ripped open. Maybe we oughta do that one, too.

 

[windsurfer]

any perfusionists out there?

any perfusionists out there?

Great idea, I would also like to hear the whole process described. Perhaps a surgical nurse and/or perfusionist (www.perfusion.com) would be able to tell us about blood filtering - not just what is in circulation - body to machine - but also for blood conservation.

When the blood hits the mechanical surfaces of the H/L machine it wants to clot so they thin it out but still there are tiny clots and these have to be filtered out to protect the brain and kidneys,... if I remember correctly. Also blood that is reused from the surgery is also flitered and it is not clear if that is a separate device.

Most will not want to know these kinds of details but some may so it would be good to have a FAQ on this.

Windsurfer

 

[Debrinha GT]

I would love to..

I would love to..

I've often wondered it myself, but was reluctant to ask in case others would get upset. I think the heart and lung machine plays an essential part in the whole process and yet, most of us know so little about it and, at least here in Brazil, doctors only mention it briefly. I'm looking forward to hearing more details about it all!!????
Débora

 

[Jewel]

There is an article!

There is an article!

I read an article on the web - exactly what you all are talking about! For the life of me I can't remember the website nor could I find it again today. There are alot of 'medical' sites that talk about the OH surgery, but this one was a play-by-play "what to expect" as written by some RNs.

I have to admit - you are right - it will scare some people. For me I found a couple of parts scary, but overall I think it will help me visualize what I am doing next week and I am hoping to not be as scared, since I know what is coming next!

Try a search with "nurses viewpoint" or something like that to see if you can get it again. I just don't have time with everything else I am trying to jam into the next 4 days!

 

[hensylee]

HOW INTERESTING. Without pictures, tho.

HOW INTERESTING. Without pictures, tho.

The principle of the heart-lung machine (also known as pump-oxygenator or cardiopulmonary bypass) is actually quite simple. Blue blood withdrawn from the upper heart chambers is drained (by gravity siphon) into a resevoir. From there, the blood is pumped through an artificial lung. This component is designed to expose the blood to oxygen. As the blood passes through the artificial lung (also known as an oxygenator), the blood comes into intimate contact with the fine surfaces of the device itself. Oxygen gas is delivered to the interface between the blood and the device, permitting the blood cells to absorb oxygen molecules directly. Now the blood is red in color, indicating its rich content of oxygen destined to be delivered to the various tissues of the body. Finally, the heart-lung machine actively pumps the red blood back into the patient through a tube connected to the arterial circulation. The heart-lung circuit is a continous loop; as the red blood goes into the body, blue blood returns from the body and is drained into the pump completing the circuit.

The modern heart-lung machine is actually more sophisticated and versatile than the overview given above. In fact, the pump-oxygenator can do a number of other tasks necessary for safe completion of an open heart operation. Firstly, any blood which escapes the circulation and spills into the operating field around the heart can be suctioned and returned to the pump. This scavenging feature is made possible because the blood has been rendered incapable of clotting by large doses of heparin. Returning shed blood into the heart-lung machine greatly preserves the patients own blood stores throughout the operation. Secondly, the patients body temperature can be controlled by selectively cooling or heating the blood as it moves through the heart-lung machine. Thus the surgeon can use low body temperatures as a tool to preserve the function of the heart and other vital organs during the period of artificial circulation. And the bypass pump has connectors into which medications and anesthetic drugs can be given. In this way, medications arrive to the patient almost instantly by simply adding them to the blood within the heart-lung resevoir.

To initiate heart-lung bypass, the surgeon must first impair the bodies own clotting system. Otherwise, the patients blood would immediately clot upon exposure to the plastic tubing and artificial surfaces inside the heart-lung machine itself. Thinning of the blood (or anticoagulation) is done by first administering a powerful anticoagulant called heparin. Once clotting is impaired, a large drainage tube is placed in the upper chamber of the heart (called the right atrium). This tube drains the blue blood from the patient into the heart-lung machine. Then a smaller tube is placed into the arterial system so that red blood can be returned to the patients body where it is needed. The most common site for this tube is in the aorta (just above the place where the vein grafts will be connected). The photograph below illustrates the standard heart-lung tubing (also known as cannulas) after they were inserted into a patient undergoing CABG, but before artificial circulation has been established.



Once these "cannulae" are placed into the patient, and connections are made to the heart lung machine (via plastic extension tubing), the machine can now take over the pumping action of the heart, and the oxygen transfer action of the lungs, as described above. In the photograph below, the actual heart-lung machine and its attached equipment are easily seen.



During the period of artificial circulation, the machine is attended to at all times by a specialized technician, called the perfusionist. These individuals are highly trained in all aspects of artificial circulation and the equipment involved. Each heart operation requires a dedicated and trained perfusionist to manage all aspects of the heart-lung machine during the time period of artificial circulation. The perfusionist maintains the function of the pump and also monitors the delivery of blood back to the patient, the blood oxygen content, and other vital parameters. During this time, the surgeon is then freed up to concentrate on the technical aspects of the heart operation itself. The operation of the heart-lung machine is an excellent example of team work in action.



In this photograph, it is easy to see the plastic tubing used to connect the heart-lung machine to the patient during an actual surgery. As the surgeon repairs the heart, the perfusionist maintains the flow of oxygen-rich red blood to the rest of the body.

After the technical reconstruction of the heart is completed, the heart beat is restored. As the strength of the hearts own contractions gets stronger, the heart-lung machine can be gradually withdrawn. Then the tubes are removed from the patients circulation, and the anticoagulation medication is reversed with an antidote drug called "protamine".