Device-Supported Myocardial Revascularization

  • Joseph J. DeRoseJr.
  • Robert K. Jarvik
Part of the Contemporary Cardiology book series (CONCARD)


Cardiopulmonary bypass (CPB) elicits a well-described systemic inflammatory response that results in significant end organ dysfunction in a subset of high-risk patients (1–3). Contact of blood with the nonphysiologic surfaces of the bypass machine causes coagulopathy and bleeding (4), complement activation (5), neutrophil-mediated pulmonary injury (6), hemodilution, and capillary leak (7,8). In patients with left ventricular dysfunction, myocardial arrest can result in ischemia with temporary or permanent cardiac impairment.


Beating Heart Myocardial Revascularization Coronary Bypass Grafting Minimally Invasive Direct Coronary Artery Bypass Axial Flow Pump 
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  1. 1.
    Kirklin JK. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass [editorial]. Ann Thorac Surg 1991; 51: 529–531 (editorial).PubMedCrossRefGoogle Scholar
  2. 2.
    Westaby S. Organ dysfunction after cardiopulmonary bypass: a systemic inflammatory reaction initiated by the extracorporeal circuit. Intensive Care Med 1987; 13: 89–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Kirklin JK. The postperfusion syndrome: inflammation and the damaging effects of cardiopulmonary bypass. In: John Tinker, ed. Cardiopulmonary Bypass: Current Concepts and Controversies. Monograph. Saunders, Philadelphia, 1989: pp. 131–146.Google Scholar
  4. 4.
    Friedenberg WR, Myers WO, Plotka ED, et al. Platelet dysfunction associated with cardiopulmonary bypass. Ann Thorac Surg 1978; 25: 298–305.PubMedCrossRefGoogle Scholar
  5. 5.
    Chenoweth DE, Cooper SW, Hugley TE, et al. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med 1981; 304: 497–503.PubMedCrossRefGoogle Scholar
  6. 6.
    Kirklin JK, Westaby S, Blackson EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 845–857.PubMedGoogle Scholar
  7. 7.
    Komai H, Yomamoto F, Tanaka K, et al. Increased lung injury in pulmonary hypertensive patients during open heart operations. Ann Thorac Surg 1993; 55: 1147–1152.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith EJ, Naftel DC, Blackstone EH, Kirklin JW. Microvascular permeability after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1987; 94: 225–233.PubMedGoogle Scholar
  9. 9.
    Buffolo EA, Andrade JCS, Branco JNR, Aquiar LF, Ribiero EE, Jatene AD. Myocardial revascularization without extracorporeal circulation: seven year experience in 593 cases. Eur J Cardiothorac Surg 1990; 4: 504–508.PubMedCrossRefGoogle Scholar
  10. 10.
    Benetti FJ, Naselli G. Wood M, Geffner L. Direct myocardial revascularization without extracorporeal circulation: experience in 700 patients. Chest 1991; 100; 312–316.PubMedCrossRefGoogle Scholar
  11. 11.
    Pfister AJ, Zaki MS, Garcia JM, et al. Coronary bypass without cardiopulmonary bypass. Ann Thorac Surg 1992; 54: 1085–1192.PubMedCrossRefGoogle Scholar
  12. 12.
    Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74: 1124–1136.PubMedCrossRefGoogle Scholar
  13. 13.
    Alkhulaffi AM, Jenkins DP, Pugsley WB, Treasure T. Ischemic preconditioning and cardiac surgery. Eur J Cardiothorac Surg 1996; 10: 792–798.CrossRefGoogle Scholar
  14. 14.
    Flemeng WJ. Role of myocardial protection for coronary artery bypass grafting on the beating heart. Ann Thorac Surg 1997; 63: S18 - S22.CrossRefGoogle Scholar
  15. 15.
    Pierce WS, Aaronson AE, Prophet GA, Williams DR, Waldenhausen JA. Hemodynamic and metabolic studies during two types of left ventricular bypass. Surg Forum 1972; 23: 176–178.PubMedGoogle Scholar
  16. 16.
    Pennock JL, Pierce WS, Waldenhausen JA. Quantitative evaluation of left ventricular bypass in reducing myocardial ischemia. Surgery 1976; 79: 523–533.PubMedGoogle Scholar
  17. 17.
    Shiiya N, Zelinsky R, Deleuze PH, Loisance DY. Changes in hemodynamics and coronary blood flow during left ventricular assistance with the Hemopump. Ann Thorac Surg 1992; 53: 1074–1079.PubMedCrossRefGoogle Scholar
  18. 18.
    Waldenberger FR, Meyns B, Wouters P, de Ruyter E, Pongo E, Flameng W. Mechanical unloading properties of axial flow pumps and their effect on myocardial stunning. Int J Artif Organs 1995; 18: 766–771.PubMedGoogle Scholar
  19. 19.
    Lachterman BS, Felli P, Smalling RW. Improved infarct salvage by left ventricular unloading with the Hemopump immediately prior to and during reperfusion after 2-hour coronary occlusion. J Am Coll Cardiol 1991; (Suppl 2A)17: 134A.Google Scholar
  20. 20.
    DeRose JJ Jr, Umana JP, Madigan JD, et al. Mechanical unloading with a miniature in-line axial flow pump as an alternative to cardiopulmonary bypass. ASAIO J 1997; 43: M421 - M426.PubMedCrossRefGoogle Scholar
  21. 21.
    Brazier J, Cooper N, Buckberg GD. The adequacy of subendocardial oxygen delivery: the interaction of determinants of flow, arterial oxygen content and myocardial oxygen need. Circulation 1974; 49: 968–977.PubMedCrossRefGoogle Scholar
  22. 22.
    Sweeney MS, Frazier OH. Device-supported myocardial revascularization: safe help for sick hearts. Ann Thorac Surg 1992; 54: 1065–1070.PubMedCrossRefGoogle Scholar
  23. 23.
    DeRose JJ Jr, Argenziano M, Sun BC, Reemtsma K, Oz MC, Rose EA. Implantable left ventricular assist devices: an evolving long-term cardiac replacement strategy. Ann Surg 1997; 226: 461–470.PubMedCrossRefGoogle Scholar
  24. 24.
    DeRose JJ Jr, Umana JP, Argenziano M, Gardocki MT, Catanese KA, Flannery MA, Levin HR, Sun BC, Rose EA, and Oz M. Improved results for postcardiotomy cardiogenic shock using implantable left ventricular assist devices. Ann Thorac Surg 1997; 64: 1757–1763.PubMedCrossRefGoogle Scholar
  25. 25.
    Casmir-Ahn H, Lonn U, Peterzen B. Clinical use of the hemopump cardiac assist system for circulatory support. Ann Thorac Surg 1995; 59: S39 - S45.CrossRefGoogle Scholar
  26. 26.
    Wampler RK, Frazier OH, Lansing AM, et al. Treatment of cardiogenic shock with the Hemopump left ventricular assist device. Ann Thorac Surg 1991; 52: 506–513.PubMedCrossRefGoogle Scholar
  27. 27.
    Wampler RK, Aboul-Hosn W, Cleary M, Saunders M. The sternotomy Hemopump: a second generation intraarterial ventricular assist device. ASAIO J 1993; 39-M218–M223.Google Scholar
  28. 28.
    Waldenberger FR, Wouters P, deRuyter E, Flameng W. Mechanical unloading with a miniaturized axial flow pump (Hemopump): an experimental study. Artif Organs 1995; 19: 742–746.PubMedCrossRefGoogle Scholar
  29. 29.
    Meyns BP, Sergeant PT, Daenen WJ, Flameng W. Left ventricular assistance with the transthoracic 24F hemopump for recovery of the failing heart. Ann Thorac Surg 1995; 60: 392–397.PubMedCrossRefGoogle Scholar
  30. 30.
    Wiebalck AC, Wouters PF, Waldenberger FR, et al. Left ventricular assist with an axial flow pump (Hemopump): clinical application. Ann Thorac Surg 1993; 55: 1141–1146.PubMedCrossRefGoogle Scholar
  31. 31.
    Lonn U, Peterzen B, Granfeldt H, Casimir-Ahn H. Coronary artery operation with support of the Hemopump cardiac assist system. Ann Thorac Surg 1994; 58: 519–523.PubMedCrossRefGoogle Scholar
  32. 32.
    Kaplon RJ, Oz MC, Kwiatowski PA, et al. Miniature axial flow pump for ventricular assistance in children and small adults. J Thorac Cardiovasc Surg 1996; 111: 13–18.PubMedCrossRefGoogle Scholar
  33. 33.
    Macris MP, Parnis SM, Frazier OH, Fuqua JM, Jarvik RK. Development of an implantable ventricular assist system. Ann Thorac Surg 1997; 63: 367–370.PubMedCrossRefGoogle Scholar
  34. 34.
    Westaby S, Benetti FJ. Less invasive coronary surgery: consensus from the Oxford meeting. Ann Thorac Surg 1996; 62: 924–931.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Joseph J. DeRoseJr.
  • Robert K. Jarvik

There are no affiliations available

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