To construct a perfusion database in Japan by modifying the input parameters of the adult perfusion registry of the International Consortium for Evidence-based Perfusion (ICEBP) to suit the present status of Japan, we surveyed basic information on perfusion using a questionnaire consisting of 108 questions (basic survey items and items regarding the practice of perfusion) in 557 institutions to which regular members of the Japanese Society of Extra-Corporeal Technology in Medicine (JaSECT) were affiliated. The questionnaire recovery rate was 48%. Access to the Internet was possible in 87% of the responder institutions. As applications for data processing, 81% possessed MS-Excel, and 51% possessed FileMaker. Concerning circuits, handwriting was used for perfusion recording for 53% of circuits, and selective cerebral perfusion was used for 35%. A crystalloid priming solution was used for 87%. The number of perfusion cases in these institutions accounted for 74% of that of registered cases during this year in the Japan Adult Cardiovascular Surgery Database (JACVSD). If all institutions where JaSECT members work participate in the perfusion case registration project, the number of registered cases will steadily increase, and a sufficient statistical power will be achieved early. This survey suggested that the database parameters used by the ICEBP can be used commonly in Japan. In addition, based on the results of the open heart surgery cases in Japan, almost equal numbers of perfusion cases of coronary heart diseases, those of valve disease, and those of aortic diseases can be registered, which allows globally valuable characteristic epidemiological evaluation.
The influence of vacuum-assisted venous return on the discharge characteristics of a roller pump was verified via water tests. Using the JIS method with a half inch inner diameter pump tube, the counter flow rates at the roller occlusion measured with a 100cmH2O load were 0.35-0.75mL/min(critical occlusion), 18mL/min(non-tight occlusion L), and 50mL/min(non-tight occlusion H), respectively. Under these conditions, a 20-100mmHg vacuum was applied at the venous reservoir. For non-tight occlusion H and with the pump stopped, a leak in the applied vacuum(approximately 25%)was confirmed at the exit side of the pump. With the pump operating at 100 RPM(no-load flow rate is approximately 4.2L/min)and critical occlusion, the flow rate decreased proportionally with vacuum and a 10% flow rate drop was observed at -100mmHg. For non-tight occlusion, the flow rate drop was not proportional with vacuum. At -20mmHg, the flow rate was approximately 2.3L/min for non-tight occlusion L, whereas for non-tight occlusion H, a minimum flow rate of 2.0L/min was observed. It is assumed that the flow rate drop was due to the vacuum reaching the pump intake area, thereby affecting the recovery of the occluded pump tube. Especially, for non-tight occlusion, the vacuum effect reaches the pump exit side as well, thereby causing a more pronounced flow rate drop. It has been determined that in order to obtain the accurate set flow rate, it is essential to adjust the critical occlusion. In addition, it appears necessary to measure the actual blood flow rate even when using a roller pump.
We have used sevoflurane(SEV)as a vasodilator during the pediatric cardio pulmonary bypass(CPB)from July 2010. The usefulness of the SEV as a vasodilator was investigated. Eighteen infants under 7.5kg undergoing CPB were included. During aorta cross clamping, pump flow was maintained at 2.7L/min/m2 and mean systemic blood pleasure(SBP)was maintained at 35-55mmHg. If SBP exceeds 55mmHg, we used some vasodilators. By two vasodilator strategy, we compared group S(SEV: n=8)and group C(Control: n=10). In group S, SEV(0.5-2.0%)was administrated 25±16min after starting CPB as a main vasodilator. In C group, SBP was controlled at only 1-3mg bolus infusion of chlorpromazine. Total amount of chlorpromazine was lower in group S(2±1mg)than in group C(9±4mg)(P<0.01). Although, in group C, there was no difference in SBP between at the start of CPZ and at the after 15min(56±11, 52±11mmHg), in group S, SBP was significantly decreased at the after 15min than at the start of SEV(58±6, 40±10mmHg)(P<0.01), and SBP was stabilized after that(after 20 min, 42±9mmHg). Furthermore, urine output during CPB was more in group S(206±113mL)than group C(86±93mL)(P=0.02). By SEV administration as a vasodilator during pediatric CPB, not only rapid vasodilation but also maintenance of urine output were obtained, therefore SEV is an useful option as a vasodilator during pediatric CPB.