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Research paper thumbnail of Fetus Through Novel Use

Cardiopulmonary bypass in the immature

Research paper thumbnail of Studies of fetal cardiac bypass. Authors' reply

Research paper thumbnail of Vacuum-assisted venous drainage during fetal cardiopulmonary bypass

Fetal bypass presents several perfusion challenges, including the need for high arterial flow rat... more Fetal bypass presents several perfusion challenges, including the need for high arterial flow rates using flexible arterial and small venous cannulae. We hypothesized that vacuum-assisted venous drainage (VAVD) would improve drainage and allow perfusion at higher flow rates which are thought to prevent placental dysfunction induced by fetal bypass. We conducted bypass for 60 minutes in 14 fetal lambs (90-105 days gestation; approximately 1-1.5 kg) using a roller pump and various angled venous cannulae (8-12 Fr). VAVD at -20 mm Hg or -40 mm Hg was compared with gravity drainage. Average flow using gravity drainage was 139 ml/kg/min; after VAVD, we achieved average flows of 285 ml/kg/min (range, 109-481 ml/kg/min). VAVD at -40 mm Hg caused right atrial trauma in four fetuses; no injury was seen at -20 mm Hg. Venous air entrainment during repair of the injuries did not result in any apparent air embolism. Spontaneous pulmonary hemorrhage occurred in two fetuses at the highest flows (> or = 400 ml/kg/min). In all but one case, termination of bypass was followed by placental dysfunction within 120 minutes. VAVD can be safely applied during fetal bypass provided pressures are kept < or = -20 mm Hg. However, the achieved higher flow rates do not prevent postbypass placental dysfunction and may indeed be detrimental to the fetus.

Research paper thumbnail of Orthopaedic bone saw and bone drill adapters

Research paper thumbnail of Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

The concept that the natural history of certain heart defects could be positively modified throug... more The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for ‘off-pump’ coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.

Research paper thumbnail of Adapters to Convert Output Motion of Orthopaedic Bone Saws and Bone Drills

Research paper thumbnail of Harmful effects of fentanyl on the fetus and placenta?

American journal of obstetrics and gynecology, 2005

Research paper thumbnail of Vacuum-assisted venous drainage during fetal cardiopulmonary bypass

Fetal bypass presents several perfusion challenges, including the need for high arterial flow rat... more Fetal bypass presents several perfusion challenges, including the need for high arterial flow rates using flexible arterial and small venous cannulae. We hypothesized that vacuum-assisted venous drainage (VAVD) would improve drainage and allow perfusion at higher flow rates which are thought to prevent placental dysfunction induced by fetal bypass. We conducted bypass for 60 minutes in 14 fetal lambs (90-105 days gestation; ϳ1-1.5 kg) using a roller pump and various angled venous cannulae (8 -12 Fr). VAVD at -20 mm Hg or -40 mm Hg was compared with gravity drainage. Average flow using gravity drainage was 139 ml/kg/min; after VAVD, we achieved average flows of 285 ml/kg/min (range, 109 -481 ml/kg/min). VAVD at -40 mm Hg caused right atrial trauma in four fetuses; no injury was seen at -20 mm Hg. Venous air entrainment during repair of the injuries did not result in any apparent air embolism. Spontaneous pulmonary hemorrhage occurred in two fetuses at the highest flows (> 400 ml/kg/min). In all but one case, termination of bypass was followed by placental dysfunction within 120 minutes. VAVD can be safely applied during fetal bypass provided pressures are kept < -20 mm Hg. However, the achieved higher flow rates do not prevent postbypass placental dysfunction and may indeed be detrimental to the fetus. ASAIO Journal 2005; 51:000-000. From the AQ: 1

Research paper thumbnail of Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

The concept that the natural history of certain heart defects could be positively modified throug... more The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.

Research paper thumbnail of Studies of fetal cardiac bypass

The Journal of Thoracic and Cardiovascular Surgery, 2005

difference in gestational age (eg, 78 vs 83 days for 21 weeks' human gestation) can lead to a dif... more difference in gestational age (eg, 78 vs 83 days for 21 weeks' human gestation) can lead to a difference of 180 g for a singleton fetus (720 vs 900 g). These weight differences can have substantial implications in surgical technique. At the latter part of the range (29 weeks' human gestation), when the fetus is growing more rapidly, the difference is even larger; for a 107-day (2.23 kg) versus 112-day (2.71 kg) singleton fetus, the difference is about 500 g. Finally, calculations based on these variations can also greatly influence results. For example, calculation of satisfactory fetal CPB flow rates (on the basis of milliliters per kilogram per hour) can be substantially different and potentially inadequate when using the wrong gestational age and fetal weight.

Research paper thumbnail of Harmful effects of fentanyl on the fetus and placenta?

American Journal of Obstetrics and Gynecology, 2005

Research paper thumbnail of Maternal-Fetal Interactions in Fetal Cardiac Surgery

The Annals of Thoracic Surgery, 2006

Background. We examined potential maternal-fetal interactions during fetal cardiopulmonary bypass... more Background. We examined potential maternal-fetal interactions during fetal cardiopulmonary bypass. these interactions, not previously described, may significantly influence attempts at fetal cardiac surgery.

Research paper thumbnail of Fetus Through Novel Use

Cardiopulmonary bypass in the immature

Research paper thumbnail of Studies of fetal cardiac bypass. Authors' reply

Research paper thumbnail of Vacuum-assisted venous drainage during fetal cardiopulmonary bypass

Fetal bypass presents several perfusion challenges, including the need for high arterial flow rat... more Fetal bypass presents several perfusion challenges, including the need for high arterial flow rates using flexible arterial and small venous cannulae. We hypothesized that vacuum-assisted venous drainage (VAVD) would improve drainage and allow perfusion at higher flow rates which are thought to prevent placental dysfunction induced by fetal bypass. We conducted bypass for 60 minutes in 14 fetal lambs (90-105 days gestation; approximately 1-1.5 kg) using a roller pump and various angled venous cannulae (8-12 Fr). VAVD at -20 mm Hg or -40 mm Hg was compared with gravity drainage. Average flow using gravity drainage was 139 ml/kg/min; after VAVD, we achieved average flows of 285 ml/kg/min (range, 109-481 ml/kg/min). VAVD at -40 mm Hg caused right atrial trauma in four fetuses; no injury was seen at -20 mm Hg. Venous air entrainment during repair of the injuries did not result in any apparent air embolism. Spontaneous pulmonary hemorrhage occurred in two fetuses at the highest flows (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 400 ml/kg/min). In all but one case, termination of bypass was followed by placental dysfunction within 120 minutes. VAVD can be safely applied during fetal bypass provided pressures are kept &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = -20 mm Hg. However, the achieved higher flow rates do not prevent postbypass placental dysfunction and may indeed be detrimental to the fetus.

Research paper thumbnail of Orthopaedic bone saw and bone drill adapters

Research paper thumbnail of Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

The concept that the natural history of certain heart defects could be positively modified throug... more The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for ‘off-pump’ coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.

Research paper thumbnail of Adapters to Convert Output Motion of Orthopaedic Bone Saws and Bone Drills

Research paper thumbnail of Harmful effects of fentanyl on the fetus and placenta?

American journal of obstetrics and gynecology, 2005

Research paper thumbnail of Vacuum-assisted venous drainage during fetal cardiopulmonary bypass

Fetal bypass presents several perfusion challenges, including the need for high arterial flow rat... more Fetal bypass presents several perfusion challenges, including the need for high arterial flow rates using flexible arterial and small venous cannulae. We hypothesized that vacuum-assisted venous drainage (VAVD) would improve drainage and allow perfusion at higher flow rates which are thought to prevent placental dysfunction induced by fetal bypass. We conducted bypass for 60 minutes in 14 fetal lambs (90-105 days gestation; ϳ1-1.5 kg) using a roller pump and various angled venous cannulae (8 -12 Fr). VAVD at -20 mm Hg or -40 mm Hg was compared with gravity drainage. Average flow using gravity drainage was 139 ml/kg/min; after VAVD, we achieved average flows of 285 ml/kg/min (range, 109 -481 ml/kg/min). VAVD at -40 mm Hg caused right atrial trauma in four fetuses; no injury was seen at -20 mm Hg. Venous air entrainment during repair of the injuries did not result in any apparent air embolism. Spontaneous pulmonary hemorrhage occurred in two fetuses at the highest flows (> 400 ml/kg/min). In all but one case, termination of bypass was followed by placental dysfunction within 120 minutes. VAVD can be safely applied during fetal bypass provided pressures are kept < -20 mm Hg. However, the achieved higher flow rates do not prevent postbypass placental dysfunction and may indeed be detrimental to the fetus. ASAIO Journal 2005; 51:000-000. From the AQ: 1

Research paper thumbnail of Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

The concept that the natural history of certain heart defects could be positively modified throug... more The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.

Research paper thumbnail of Studies of fetal cardiac bypass

The Journal of Thoracic and Cardiovascular Surgery, 2005

difference in gestational age (eg, 78 vs 83 days for 21 weeks' human gestation) can lead to a dif... more difference in gestational age (eg, 78 vs 83 days for 21 weeks' human gestation) can lead to a difference of 180 g for a singleton fetus (720 vs 900 g). These weight differences can have substantial implications in surgical technique. At the latter part of the range (29 weeks' human gestation), when the fetus is growing more rapidly, the difference is even larger; for a 107-day (2.23 kg) versus 112-day (2.71 kg) singleton fetus, the difference is about 500 g. Finally, calculations based on these variations can also greatly influence results. For example, calculation of satisfactory fetal CPB flow rates (on the basis of milliliters per kilogram per hour) can be substantially different and potentially inadequate when using the wrong gestational age and fetal weight.

Research paper thumbnail of Harmful effects of fentanyl on the fetus and placenta?

American Journal of Obstetrics and Gynecology, 2005

Research paper thumbnail of Maternal-Fetal Interactions in Fetal Cardiac Surgery

The Annals of Thoracic Surgery, 2006

Background. We examined potential maternal-fetal interactions during fetal cardiopulmonary bypass... more Background. We examined potential maternal-fetal interactions during fetal cardiopulmonary bypass. these interactions, not previously described, may significantly influence attempts at fetal cardiac surgery.