Cardiopulmonary bypass

simple ppt

1. CARDIOPULMONARY BYPASS

2. CARDIOPULMONARY BYPASS Cardiopulmonary bypass is a technique that temporarily takes over the function of heart and lungs during surgery maintaining the circulation of blood and the oxygen content of patient’s blood It is often referred to as heart-lung machine or “the pump ” Cardiopulmonary bypass pump are operated by perfusionists CPB is a form of extracorporeal circulation

3. USES: The machine pumps the blood by using an oxygenator , allows the RBC to pickup oxygen as well as allowing carbondioxide levels to decrease. This mimics the function of heart and t he lungs respectively. CPB can be used for the induction of total body hypothermia, a state in which the body can be maintained for up to 45 minutes without perfusion Similarly CPB can be used to rewarm individuals suffering from hypothermia More than 1000 patient’s life are saved every year due to this procedure

4. WHY CPB machine is used ? To facilitate a surgical intervention The CPB machine maintains perfusion to other body organs and tissues while the surgeon works in blood-less surgical field To provide a motionless field

5. Surgical procedures in which CPB is used : Coronary artery bypass surgery Cardiac valve repair or replacement Repair of large septal defects Repair or palliation of congenital heart defect Transplantation Repair of some aneurysms Pulmonary thromboendarterectomy Pulmonary thrombectomy

6. COMPONENTS OF CPB MACHINE The cardiopulmonary bypass machine contains 6 main parts : ► C annulae ► Reservoir ► Oxygenerator ► Temperature control ► Filter ► P ump ……….These are connected by series of silicon or PVC tube

7. PUMPS: Various types of blood pumps are available for cardiopulmonary bypass. The ideal pump for CPB should have the following characteristics: ►It must be able to pump at a flow rate of 7L/min against a pressure of 5oomm Hg. ►The pumping motion should not damage the cellular or acellular components of blood ►All parts in contact with the bloodstream should have a smooth continuous surface with no dead space to cause stagnation or turbulence, should be disposable, and should not contaminate the permanent parts of the pump. ►Calibration of pump flow should exact and reproducible so that blood flow an be accurately monitored ►In the event of a power failure, the pump should be manually operable.

8. TYPES OF PUMP: Roller Centrifugal Pulsatile Non occlusive roller

9. PUMPS

10. ROLLER PUMP

11. OXYGENATOR: Ξ The oxygenator is designed to add oxygen to infused blood and remove some of the carbondioxide from the venus blood Ξ It serves as a artificial lungs Ξ There are 3 types of oxygenator ►Bubble oxygenator ►Membrane oxygenator ►Heparin coated oxygenator

12. CANNULAE: Multiple cannulae are sewn into the patient’s body in a variety of location depending on the type of the surgery All cannula pursestring sutures must be inserted before the heparine is given A full heparine dose must be given under circulated before any cannulae are inserted In the simplest form CPB requires a cannulae in assending aorta and in the right side of the heart The type of the procedure to be performed will dictate where the cannulae is placed in assending aorta and what type of cannulation is performed on the right side of the heart A venus cannulae removes oxygen depleted venus blood from the patient’s body REMEMBER: pursestring sutures first then heparine then cannulation

13. ►A venus cannulae removes oxygen depleted venus blood from the patient’s body ► An arterial cannulae infuses oxygen rich blood into arterial system ►REMEMBER : pursestring sutures first then heparine then cannulation

14. TEMPERATURE CONTROL: Heat exchangers are designed to remove or add heat from the blood, thereby controlling the patient’s body temperature During its flow in the CPB circuit the blood cools and hence heat must be added to avoid patient cooling In addition the patient’s temperature is often deliberately lowered and then restored to normothermia before disconnecting CPB

15. HEAT EXCHANGER

16. CARDIOPLEGIA: A CPB circuit consists of systemic circuit for oxygenating blood and reinfusing blood into a patient’s body and a separate circuit for infusing a solution into the heart itself to produce cardio plegia And therefore providing myocardial protection ( i.e ) to prevent the death of the heart tissue

17. VENTRICLE

18. CORONARY ARTERY

19. CAPILLARY

20. VICRYL SUTURE

21. CAPREOMYCIN

22. CABG CABG

23. CORONARY ARTERY BYPASS GRAFT: It’s a surgical procedure to restore a normal blood flow to an obstructed coronary artery Arteries or veins from elsewhere in the patient’s body are grafted (internal thoracic arteries, radial arteries and saphenous) to the coronary arteries to bypass atherosclerotic narrowing and improve the blood supply to the coronary circulation supplying the myocardium This surgery is usually performed with cardioplegia

24. TYPES OF CABG:

25. PURPOSE: Restores blood flow to heart Relieves chest pain and ischemia Improves the persons quality of life Enable the patient to resume a normal lifestyle Lower the risk of a heart attack

26. INDICATION: Patients with blockage in coronary artery(50-99%) the obstruction being bypassed is typically due to atherosterosis Patients with angina Patient who cannot tolerate PTCA

27. CONTRAINDICATIONS FOR CABG: Aneurysms Valvular diseases Congenital diseases Diseases of blood

28. COMPLICATIONS: Postperfusion syndrome Nonunion of sternum Internal thoracic artery harvesting increases the sternum devascularisation risk Graft failure Pneumothorax Pleural effusion Infection Sepsis Deep vein thrombosis Keloid Chronic pain

29. ANY QUESTIONS