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Iloprost (ZK36374), a prostacyclin analogue, has been shown to preserve platelet ultrastructure and reactivity. In an effort to reduce adverse platelet alterations, iloprost was utilized in three patients undergoing extended extra-corporeal support (EECS).

A retrospective data collection was carried out in order to determine the efficacy of blood cardioplegia in the community hospital setting. A total of 97 patient charts were reviewed and divided into two groups. Group A consisted of 72 patients undergoing coronary artery bypass grafting including three patients requiring concurrent left ventricular aneurysm resection. Group B consisted of all other procedures. Eleven (15%) patients in Group A required vasopressor support and eight (11%) patients required the use of an intra-aortic ballon. While six patients had elevations in enzyme levels, only one of them required the use of an intra-aortic balloon. Two of the patients had balloons inserted pre-operatively for pre-infarction angina. Five (20%) patients in Group B required vasopressor support and two (8%) patients required use of an intra-aortic balloon. There were two early deaths in this group. Four (16%) patients were identified as having a perioperative infarct. There was an overall mortality of 2% in the review. This may indicate that our use of blood cardioplegia was safe and effective.

(J. Extra-Corpor. Technol. 19( 4) pp. 415-419 Winter 1987,) The temperature of the myocardium during cardioplegic arrest is an indication of the extent to which that area has received both hypothermic and chemical protection. Regional myocardial temperatures were examined during asanguineous cardioplegic arrest to assess differences in temperatures, examine regional rates of rewarming, and to identify maximum temperature gradients. Myocardial temperatures were measured at the left ventricular apex, the right ventricular free wall and the interventricular septum in twenty patients undergoing coronary artery bypass using multidose asanguineous cardioplegic arrest. Aortic root temperatures were measured to identify the temperature of the cardioplegia and left heart blood temperatures during venting. Temperatures in the left ventricular apex ranged from 13.9° to 21.3°, right ventricular free wall from 15.9° to 21.9°, and the interventricular septum from 13° to 23.6°. Temperature variations in the three areas were as great as 15 ° and as little as 2 °. Myocardial temperatures are 1) not predictable due to the nature of coronary artery disease, 2) variable despite optimal delivery technique, and 3) may vary due to cannulation and systemic blood temperature.

A technique is presented for the perfusionist who does not have the time nor the facilities to do literature searches for research projects or for basic education, but who has access to a microcomputer. The software program PROFILEawas presented and reviewed as a possible solution to that problem. After developing the working program and entering a database of 300 article titles, it is concluded that PROFILE and a microcomputer can fill the need for the perfusionist who does not have access to other literature searches.

The technological development of portable percutaneous cardiopulmonary bypass systems has expanded the use outside of the operating room. Two of the major indications have been for resuscitation and supported angioplasty. The use of a decision-making algorithm will decrease the learning curve for the perfusionist and cardiologist when dealing with a closed circuit CPB system.

Extracorporeal circulation is associated with extensive alterations in platelet number and function. In certain individuals these adverse platelet changes are exacerbated by heparin. ZK36374 (ZK), a stable analogue of prostacyclin, reversibly inhibits all phases of platelet activation. A patient was presented with heparin induced platelet activation and paradoxical thrombosis who required cardiopulmonary bypass to correct severe tricuspid stenosis and ASD. We employed full heparinization and ZK to prevent surface and heparin induced thrombocytopenia. Prior to heparinization, a constant infusion of ZK was begun at 10 nanograms/kilogram/minute, tapered to 2 nanograms/kilogram/minute during bypass, and maintained until heparin was reversed with protamine. Prior to bypass, platelets demonstrated 50% reactivity and 2% reactivity when challenged by ADP and epinephrine, respectively, indicating inhibition of platelet function by ZK. Two hours after arrival in recovery 92% prebypass circulating platelet count, 90% preservation of platelet reactivity to ADP, and a template bleeding time near control were achieved. ZK was used safely to prevent both heparin and surface induced platelet changes during cardiopulmonary bypass in this patient.

(J. Extra-Corpor. Technol. 18[4] p.225–227 Winter 1986) The use of a modified extracorporeal circuit has many uses in the treatment of several disease processes. Chief among these are partial and total support for cardiac and respiratory failure, isolated limb perfusion for the administration of chemical agents in the treatment of some forms of cancer, and in support of certain neurological procedures. Previously unreported in perfusion literature is the use of extracorporeal circulation in support of bronchopulmonary lavage as a treatment for severe pulmonary alveolar proteinosis. A 31-year-old male with this condition was successfully treated using bronchopulmonary lavage with a modified extracorporeal circuit. The technique is described.

There is a small percentage of patients, who having undergone cardiac surgery, are unable to be weaned from cardiopulmonary bypass. Some reports in the literature seem to indicate some success with extended extra-corporeal support. In an effort to reduce the amount of supplies needed and the resulting confusion of utilizing a completely different oxygenator, a hollow fiber membrane oxygenator was selected as the oxygenator of choice for an extended extra-corporeal support system.