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Ann Thorac Surg 2000;69:356
© 2000 The Society of Thoracic Surgeons
Discussion
DR RICHARD N. PIERSON III (Nashville, TN): That was an excellent paper, and this would appear to be very exciting technology. Two points of clarification about the model. Were your cannulae proximal and distal on the main pulmonary artery, and is that how you are able to divert full flow through the device? And secondly, is any anticoagulation required to maintain perfusion through this device?
DR LYNCH: Thank you for your comments. To your first question, the grafts used were 20-mm vascular grafts. The pulmonary artery of a sheep is quite long, and that lends itself well to this particular type of study. The grafts were end-to-side anastomoses, and allowed upwards of 3 L, and at times 6 L, of flow through the device.
DR PIERSON: So both grafts were sewn to the main pulmonary artery, and the entire cardiac output was diverted through the device?
DR LYNCH: This was the main pulmonary artery. The series flow was established by shunting the flow through the device, from the proximal pulmonary artery, and then returning it to the main pulmonary artery, which then went through the pulmonary vasculature.
In answer to your second question, yes, we heparinized the animals with a bolus infusion at grafting and then kept ACTs of 200 to 220.
DR CAROLYN E. REED (Charleston, SC): Doctor Lynch, could you share with us what your next project will be using the model, what your next series of experiments are that you plan?
DR LYNCH: The ultimate goal of this kind of technology is to have a device that could hopefully perfuse from pulmonary artery (PA) and return to left atrium. Two chronic studies that are underway: one PA-PA for 5 days, and one PA-LA for 5 days.
DR SI M. PHAM (Miami, FL): Did the resistance across the oxygenator increase with time?
DR LYNCH: No, it did not. And at the conclusion of the study, there is no minimal thrombus and no evidence or reason for the resistance to change.
DR FLORIAN M. WAGNER (Dresden, Germany): Congratulations, a very interesting study. Obviously, if I understood it correctly, this device is very similar to the membrane oxygenator as we use on cardiopulmonary bypass during cardiac operation. Therefore the most important concern would be that it causes hemolysis and stimulation of all sorts of inflammatory responses, particularly if you keep any kind of circulation going through this device for more than, let us say, 12 hours. So I am wondering, did you get a chance to look at any of these inflammatory response parameters, or hemolysis?
DR LYNCH: The hemolysis and inflammation with cardiopulmonary bypass is caused by coronary suction. In these experiments hemolysis and inflammation was negligible.
Related Article
Ann. Thorac. Surg. 2000 69: 351-356.
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