Purpose : This study investigated the relationship between blood clotting in the circuit soon after initiating cardiopulmonary bypass (CPB) and echinocytes that appear with alkalemia, using a recirculation circuit filled with heparinized bovine blood.

Methods : Alkalemic conditions in the recirculation circuit were prepared by adding various concentrations of NaHCO₃ to the priming fluid. Albumin was also added to confirm its inhibitory effect on blood clotting. Blood pH, hold-up, the pressure gradient, and red blood cell (RBC) reduction rate were monitored. Blood clots were examined microscopically.

Results : Although blood pH was elevated under all experimental conditions, clotting in the circuit increased with increased concentrations of HCO₃^-. Albumin inhibited the clotting under the same alkalemic conditions. Microscopic findings revealed echinocytes in the blood clots.

Conclusions : The shape of echinocytes was transformed by a reduction in the Donnan equilibrium ratio because of changes in pH inside and outside the RBC membrane. Blood clotting in the circuit soon after initiating CPB may be caused by echinocytes that appear under alkalemic conditions. This was inhibited by albumin, suggesting that the addition of albumin to the priming fluid may prevent such clotting in the circuit after initiating CPB.

Purpose : This study investigated the relationship between blood clotting in the circuit soon after initiating cardiopulmonary bypass (CPB) and echinocytes that appear with alkalemia, using a recirculation circuit filled with heparinized bovine blood.

Methods : Alkalemic conditions in the recirculation circuit were prepared by adding various concentrations of NaHCO₃ to the priming fluid. Albumin was also added to confirm its inhibitory effect on blood clotting. Blood pH, hold-up, the pressure gradient, and red blood cell (RBC) reduction rate were monitored. Blood clots were examined microscopically.

Results : Although blood pH was elevated under all experimental conditions, clotting in the circuit increased with increased concentrations of HCO₃^-. Albumin inhibited the clotting under the same alkalemic conditions. Microscopic findings revealed echinocytes in the blood clots.

Conclusions : The shape of echinocytes was transformed by a reduction in the Donnan equilibrium ratio because of changes in pH inside and outside the RBC membrane. Blood clotting in the circuit soon after initiating CPB may be caused by echinocytes that appear under alkalemic conditions. This was inhibited by albumin, suggesting that the addition of albumin to the priming fluid may prevent such clotting in the circuit after initiating CPB.

Objective: During cardiopulmonary bypass (CPB) on Minimally Invasive Cardiac Surgery (MICS), there are few reports that gave Mannitol of CPB continuously, and the clinical response is not clear. The aim of this study is to inspect influied balance in the perioperative period by giving Mannitol in CPB continuously and influence on oxygenicity.

Method: We collected 84 CPB cases which went by MICS from November, 2012 to December, 2014. The detail of it, 39 cases after September, 2013 were the things which we gave Mannitol to continuously (C group), and, 45 cases before September, 2013 did not use Mannitol continuously (nonC group).

Results: The urine until 12 hours after an operation from all over the operation and balance growth rate (IBGR) during CPB were no significant. However, the IBGR significantly recognized improvement after during the operation and an operation in C group over 12 hours. After distributing two groups according to renal function more, IBGR rose in RF group, but tended IBGR was improved in C group. Also A-aDO₂ and P/F ratio were no significant between C group and the nonC group, but P/F ratio significantly relates to IBGR.

Conclusions: Efficacy of continuous infusion of Mannitol during extracorporeal circulation is control IBGR, and it may also prevent postoperative respiratory complications in MICS.