Objective To introduce the method and effect of common cardiop ulmonary bypass(CPB) switched to closed extracorporeal circulation by medtronic extracorporeal membrane oxygenation(ECMO) package. Methods From Junuary 2007 to June 2008, common CPB switched to closed extracorporeal circulation by Medtronic ECMO package adding blood reservoir and artery microembolus filtrator was used to 15 patients with grave heart disease to provide CPB support during operation on heart and cardiac function support after operation. The circulation was built through femoral arteryfemoral veinsuperior vena cava intubation or aortaright auricle intubation. There were 10 male and 5 female aged from 6582 years (74.0±9.3 years) and weighed from 6389 kg (69.0±11.4 kg). There were 11 cases with old myocardial infarction, 1 case with acute myocardial infarction, 1 case with old myocardial infarction complicated with mitral stenosis and mitral incompetence, and 2 cases reopened and undergone double valve replacement. Results For all the 15 patients, the closed circulation time was 31112 min（77.3±21.5 min）. The CPB time was 51-84 min（69.7±9.8 min）. The ostoperative mechanical ventilation time was 414 h（8.3±2.9 h）. The 24 hchest drainage was 110-360 ml（227.3±80.4 ml）. All patients were cured and discharged successfully with cardiac function classification in grade ⅠⅡ. Thirteen cases were followed up. The followup time was 412 months. Their cardiac function recovered well and no complication occurred. Conclusion This method could provide effective support for heart and lung before operation，during operation and after operation. This method could save material cost. The heparin paintcoat could reduce inflammatory reaction and it is good for patients’ recovery.
Objective To analyze the current situation of civil cardiopulmonary bypass, then to give suggestion and prediction for the future of civil cardiopulmonary bypass (CPB). Methods Civil hospitals carrying out cardiac operations were inquired with questionnaires annually concerning the scope of cardiac operations being carried out, the ratio of onpump operations and offpump operations, the situation of extracorporeal membrane oxygenation(ECMO), the composition of CPB technicians, and oxygenators being utilized, et al. Results 76 319 cases of cardiac operations were performed in 2003, while 136 015 cases of cardiac operations were performed in 2007 (among them 113 465 cases were CPB, account for 83.42% of cardiac operations). 41 hospitals carried out 153 cases of extracorporeal membrane oxygenation(ECMO) in 2007. The rate of membrane oxygenator(import) utilization was 46.16%, and the rate of membrane oxygenator(made in China) utilization was 23.9% in 2007. There were 1 497 persons engaged in of CPB in 2007, and among them 55% were doctors. All the perfusionisters had not been trained normally so far. Conclusion Cardiac surgery and CPB technique make rapid progress in china, so persons engaged in CPB need to be trained normally and systematically. In recent years, more and more membrane oxygenators are utilized, and there is a trend that bubble oxygenators would be abandoned finally.
ObjectiveTo evaluate the efficacy of bipolar radiofrequency ablation procedure for atrial fibrillation (AF) during the open-heart surgery. MethodsWe retrospectively analyzed the clinical data of 137 heart disease patients combined with AF (21 patients combined with left atrial thrombus) who underwent one-stage operation of open-heart surgery and bipolar radiofrequency ablation from May 2009 to June 2014. There were 61 males and 76 females at age of 35-73(48.3±11.6)years. The patients received amiodarone treatment for 6 months after surgery and regular follow-up. The sinus rhythm conversion rate, cardiac function before and after operation, survival rate after operation, the incidence of thromboembolism and other complications were recorded. ResultsThe average cardiopulmonary bypass time during operation was 122±38 min, the average aortic crossclamp time was 78±22 min, and the average radiofrequency ablation time was 20±4 min. The atrial fibrillation was successfully ablated in 130 patients on the same day of surgery with conversion rate of 94.9%. The atrial fibrillation was converted to sinus rhythm in 114 patients, and converted to junctional cardiac arrhythmia in 16 patients. Two patients died during the perioperative period with death rate of 1.5% in hospital. The conversion rate was 81.5% (110/135), 88.1% (111/126), 83.1% (74/89), and 83.0% (39/47) respectively at one month, six months, one year, and two years after surgery, respectively. The survival rate was 96.6% (86/89) and 93.6% (44/47) at one year and two years after surgery. No thromboembolism occurred during the long-term follow-up period. ConclusionBipolar radiofrequency ablation procedure selectively performed during open-heart surgery can cure atrial fibrillation, only increases cardiopulmonary bypass and aortic crossclamp time slightly. The short- and mid-term efficacy is satisfactory with high conversion rate of sinus rhythm. The long-term effect still needs further observation.