Skip to main content

Table 2 Advantages and disadvantages of mCPB and cCPB

From: Miniaturized cardiopulmonary bypass: the Hammersmith technique

  

mCPB

cCPB

Venous cannula

 

29 Fr OptiFlow (Sorin)

34/46 Fr 2-stage (Medtronic)

 

Advantage

• Multi-stage and longer length (increasing drainage and structural support in IVC)

• Convenient and easy placement

• Less prone to collapse and blockage due to side holes and grooves

• This type of cannulae is used in common practice

 

Disadvantage

• Rigid (requiring careful placement) as it extends further down the IVC

• Larger – increased risk of interaction with IVC/RA wall

• 2 stage cannula less support in IVC thus more prone to collapse and decreased drainage from Hepatic veins and circulation

Venous line and drainage

 

3/8 inch tubing

½ inch tubing

 

Advantage

• Smaller, active kinetic drainage

• Gravity syphon based

  

• Monitored controlled drainage

• Simple, standard and convenient

  

• Tailored to patient specific venous collapse pressure

 
 

Disadvantage

 

• Uncontrollable

   

• Not routinely monitored

VARD

 

Advisable to use in mCPB but not compulsory

VARD is not required due to the presence of the Venous reservoir but it has been proven to be of benefit in all CPB circuits [8]. However, it is not commonly used.

 

Advantage

• Enhances safety

• Cheaper

  

• Efficient gross air removal

• Simple open system

  

• Active micro air removal

• The reservoir filters and removes gross air easily

  

• Decreases FSA versus standard filters used in CPB venous reservoir’s

• Continuity

  

• All air introduction into system

 
 

Disadvantage

• Require perfusion experience

• No active removal of micro-embolic air (just passive)

  

• Extra Component of circuit

• Venous reservoir in series (continued FSA exposure)

  

• Vented blood has to be manually returned back into the systemic system

• Increases FSA

Reservoir*

 

SSR or Midi card

Venous reservoir (Sorin Evo)

 

Advantage

• Closed (no ‘in series’ blood-air interface- limits FSA exposure)

• Open

  

• Decreased damage to blood cells

• Common practice

  

• Optimises vent management

• Venting possible

  

• Midi card ‘in parallel’ automatic air removal

• Low Pressure Suction and blood venting possible

  

• Vented blood is automatically returned to the systemic circulation

 

Disadvantage

• SSR requires manual air bubble removal

• ‘In series’ Blood-air interface

  

• No Low Pressure Suction (an issue in cases where there are high volumes of LPS)

• Damage to blood cells

  

• Vented blood has to be manually returned back into the systemic circulation

• Disguises poor suction/vent management

Centrifugal pump

 

Revolution (Stöckert, Germany)

Standard roller pump

 

Advantage

• Non-occlusive

• ½ inch silicon tubing

  

• Pressure regulates

• Cost-effective

  

• Gross safety mechanism

 
  

• Less blood cell trauma

 
 

Disadvantage

• Cost and training

• Occlusive (No pressure regulation)

Heat exchanger and oxygenator

 

Eos (Sorin Group, Italy)

Avant (Sorin Group, Italy)

 

Advantage

• 1.1 m2 (decreased) FSA

• High ‘factor of safety’

  

• Efficient use of fibre bundle capacity

• 7.5 L/min blood flow

  

• high ratio of gas exchange surface area to FSA

 
 

Disadvantage

• Reduced (but acceptable) ‘factor of safety’

• 1.8 m2 FSA

   

• Excessive ‘factor of safety’ for our patient population

Arterial line filter

 

Pall AL6 low prime

Pall AL6 low prime

  1. * We begin training junior perfusionists with Midi card and after experience is gained, we move to SSR for routine cases. With further experience both by surgical and perfusionist teams, we move forward to Soft Shell Reservoir (SSR) for all cases regardless of complexity. The characteristics of these two options are described below.