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Baylor College of Medicine. Baylor College of Medicine. Tayama: Department of Surgery. should be disposable. The pumping motion should not damage the cellular or acellular components of blood. Houston. Four types of blood pumps are currently available for CPB: roller. All parts in contact with the bloodstream should have a smooth continuous surface with no dead space to cause stagnation or turbulence. Various types of blood pumps are available for cardiopulmonary bypass (CPB). y In the event of a power failure. ROLLER PUMPS . and nonocclusive roller. The ideal pump for CPB should have the following characteristics: y y y It must be able to pump blood at a flow rate of 7 L/min against a pressure of 500 mm Hg. S. centrifugal. Houston. TX 77030. Y. y Calibration of pump flow should be exact and reproducible so that blood flow can be accurately monitored. Nosé Department of Surgery. A. Raskin Department of Surgery. pulsatile.<BACK TO: CD-ROM Main Contents | Contents of Resource Shown: Cardiopulmonary Bypass: Principles and Practice < Previous Chapter | Next Chapter > CHAPTER 3: BLOOD PUMPS EIKI TAYAMA STEVEN A. 830 Japan. Kurume City. and should not contaminate the permanent parts of the pump. TX 77030. the pump should be manually operable. RASKIN YUKIHIKO NOSÉ Quick Links to Sections in this Chapter ±ROLLER PUMPS ±CENTRIFUGAL PUMPS ±PULSATILE PUMPS ±NONOCCLUSIVE ROLLER PUMP ±KEY POINTS ±References E. Kurume University School of Medicine.

one roller pump is used to pump blood into the systemic circulation (usually through a membrane oxygenator) and other separate roller pumps are used for delivery of View Figure cardioplegic solutions. suction from the surgical field. The volume depends on the size of tubing and length of the track. blood is pushed ahead of the moving roller. These arms are arranged in such a manner that one roller is compressing the tubing at all times. Original DeBakey roller pump.753) in 1855 by Porter and Bradley (1). A simple continuous-flow blood transfusion instrument.1). and as an apparatus for injection. and/or left ventricular venting. although its popularity has recently fallen as a result of improvements in systems using centrifugal pumps. In 1959. In 1934. FIG 3. New Orleans Med Surg J 1934. In 1887. Austin.) Structures Roller pumps contain a length of tubing located inside a curved raceway. DeBakey et al. 3. Allen patented a pump designed for blood transfusion. The output of the rotary pump is determined by the revolutions per minute (rpm) of the pump and the volume displaced with each revolution.) . It has been the most commonly used type for CPB for the past five decades. (Model HL-20. courtesy Jostra USA. History The roller pump was first patented (patent 12.87:387. This was accomplished by placing a flange on the outer circumference of the tubing that was then clamped into the pump housing. 3. B: Side view.998) (Fig. D: Cross-section of tube. with five roller pump modules. Note dual rollers and knob for View Figure rotating roller assembly. TX. (Reprinted from DeBakey ME. The tube guides prevented lateral motion of the tubing during operation. FIG 3. (2) made a modification to the Porter-Bradley infusion pump to prevent creepage of the latex rubber tubing during blood transfusion (patent 2. in which the roller ran along the tubing held in place by a grooved backplate. Conventional heart±lung machine.2.018. This pump required specially edged tubing (D. Typically.C: Cross-section. right) for securing it between plates in the roller mechanism. Melrose proposed a more advanced design. A: Plane view of instrument. Potential applications listed in this patent included use as a scavenger for cleaning of privies. By compressing a segment of the blood-filled resilient tubing.Back to Quick Links The roller pump is one type of positive displacement pump.1. as a stomach pump. with permission. thereby producing continuous blood flow (Fig.2). This raceway is placed at the travel perimeter of rollers mounted on the ends of rotating arms.

Because one of the two rollers is always compressing the tubing. At nonocclusive settings. 3. Although controversial. roller pump output can be sharply decreased. When one roller ends its occlusive phase.) View Figure Tubing There are three basic materials currently used for tubing: silicone rubber. and multiple roller pumps. latex rubber. roller pumps are classified as single. which are displayed digitally on the front of the console. whereas too little occlusion may also aggravate hemolysis but. (10) found no difference in hemolysis between a roller pump with a standard set occlusion and a centrifugal pump at a 4. which has been the most commonly used pump for CPB. This compression appears to be critical. (Courtesy Jostra USA.3. it is not clinically available because it causes more hemolysis.3). TX. The occlusion is set by holding the outflow line vertically so the top of the . PVC is most widely used for roller pumps because of its durability and acceptable hemolysis rates (3.According to the number of rollers.4). the double-roller pump generates a relatively nonpulsatile flow. Although the multiple-roller pump has been proposed for extracorporeal blood handling.4). Rawn et al.5-L/min blood flow rate with an afterload of 250 mm Hg. Austin. Silicone rubber tubing releases more particles than PVC (7). Excessive compression induces hemolysis and tubing wear. The exact output of the roller pump may vary during CPB. Latex rubber generates more hemolysis than PVC. Occlusiveness Occlusion can be adjusted by either increasing or decreasing the compression of the tubing by the rollers. more important. These tubing materials have all been used in CPB. it is generally believed that adjusting tubing compression to be barely nonocclusive results in the least hemolysis (3. FIG 3. and it is difficult to determine the exact flow rate due to occlusion variance throughout the bypass (8). the other has already begun its occlusive phase. double. consists of a 210-degree semicircular backing plate and two rollers with the rotating arms set 180 degrees apart (Fig. The single-roller pump consists of a circular raceway in which a 360-degree loop of tubing is inserted. Single-roller pumps were used for CPB in the 1950s and early 1960s because they produced more pulsatility than conventional double-roller pumps. the roller pump induces less hemolysis than a centrifugal pump. and polyvinyl chloride (PVC). PVC tubing stiffens during hypothermic CPB and tends to induce spallation. Double-roller pump module. When the occlusion is opened such that pumping at 5 rpm against occluded tubing maintains a pressure of 150 to 225 mm Hg. which refers to the release of plastic microparticles from the inner wall of tubing as a result of roller pump compression (3±6). The double-roller pump. resulting in hypoperfusion (3.9). showing a large knob (right) that controls revolutions per minute. compromises forward output (3). whereas silicone rubber produces less hemolysis when the pump is completely occluded (4).

and N4 are the arbitrary rotational pump speeds. At many institutions. The magnet inside the disposable pump head spins in conjunction with another magnet spinning in the drive console. percutaneous cardiopulmonary support. Complications Some problems arising from roller pumps include malocclusion (over. a negative pressure at the inlet port of the pump pulling blood into the pump housing and a positive pressure at the outlet port expelling blood). the pressure-flow relationship deviates from ideal as a result of pressure head loss in the pump head and in the inflow and outflow cannulas. Characteristics The basic design of a centrifugal pump consists of an impeller arranged with either vanes or a nest of smooth plastic cones inside a plastic housing. If the inflow becomes limited. CENTRIFUGAL PUMPS Back to Quick Links Centrifugal pumps for CPB have been commercially available since 1976 (14). pressure in the line will progressively increase until either the tubing or connectors disconnect or break. Roller pumps may also develop pinhole leaks. In actual centrifugal pumps. (13) attributed 92 deaths and 61 permanent injuries to arterial line embolism from roller pumps between 1972 and 1977. N3. Figure 3. spallation.fluid is about 60 to 75 cm above the pump and then gradually decreasing occlusiveness until the fluid level falls at a rate between 1 and 12 cm/min (3. If the outflow becomes occluded. which can generate constant pressure regardless of flow rate. N2. which may lead to pushing microscopic air bubbles toward the patient (3). loss of power. fracture of the tubing. Stoney et al. Excessive rotational speed can cause decoupling. This magnetic coupling means that the speed (rpm) of the driver magnet inside the console equals the rotational speed of the pump. it generates a pressure differential causing blood flow (i. however. This relationship can be modeled as follows: . pressure head loss increases. with negligible loss of pressure head inside the pump. and extracorporeal membrane oxygenation (15±17). The impeller couples magnetically with an electric motor either directly or through a tether. As flow rate increases.or underocclusion). The tether is driven either by a turning shaft or by an electrically powered remote magnet. miscalibration. N1. including ventricular assistance.4 shows the relationship between the pressure differential created (pressure head) and flow rate of a centrifugal pump. the centrifugal pump has replaced roller pumps for routine CPB for cardiovascular surgery.11). They are also used for mechanical circulatory support. the roller pumps will develop a high negative pressure producing microscopic air bubbles ("cavitation"). and the capacity to pump grossly visible air (3). in which the impellers or cones cannot spin as fast as the driver motor (3). When the impeller rotates rapidly. In this figure.. "runaway" pumping (12). The dotted lines indicate the pressure-flow characteristics of an ideal centrifugal pump.e.

Centrifugal pumps have become popular mainly because unlike roller pumps. Also. because they are nonocclusive.S. Q is the flow rate. . This property should not be perceived as a safety feature or a method of preventing the pumping of air. Likewise. The pressure head for an ideal pump can be described as P = K1 x N2.) or more to the cost of an individual procedure as compared with the cost of performing the procedure with a roller pump. Typical relationship between total pressure head and flow rate for a centrifugal pump. Both centrifugal and roller pumps are capable of actively sucking blood from an open venous reservoir and thus are susceptible to emptying the reservoir and pumping air to the patient. thereby reducing the risk of cavitation and microembolus as compared with roller pumps (3. the most recognized hazard is overpressurization and circuit rupture if the tubing downstream from the pump (outlet side) is accidentally kinked or clamped. they will not generate high negative pressures (reaching about ±400 to ±500 mm Hg). N 1 through N 1 4 each represent a constant level of revolutions per 4 minute (rpm).4. Similar to roller pumps. if the inflow line occludes. which requires only a piece of tubing integrated into the extracorporeal circuit/oxygenator disposable kit. in which the generated pressure head would be proportional to the square of the impeller rotational speed.18). hemolysis. Centrifugal pumps are disposable and add approximately $150 (U. however. Additionally. With the standard roller pump. if the tubing upstream from the pump (inlet side) is accidentally kinked or clamped. and suction of room air through loose stopcocks or tubing connectors. The most commonly used extracorporeal perfusion blood pumps (roller and centrifugal) have adverse pressure regulation properties that can lead to fatal accidents. with N View Figure representing the highest rpm value and N the lowest. the roller pump will generate dangerously low negative pressures that could result in blood cavitation. centrifugal pumps can generate very large negative pressures if the tubing upstream from the pump is restricted.1 compares advantages and disadvantages of roller pumps and centrifugal pumps.where N is the pump rotational speed. Positive and negative pressure control in occlusive roller pumps is typically accomplished with additional electronic equipment such as pressure control modules or with a mechanical bladder that shuts off the pump if dangerous pressures are generated (18). Comparison with roller pumps Table 3. the centrifugal pump will not generate excessive pressure (peaking at about 700 to 900 mm Hg). FIG 3. and K1 and K2 are constants appropriate to each particular pump. retrograde flow can occur with loss or severe reduction in forward flow from any cause. This equation allows prediction of the pump head pressure drop from the pump rotational speed and flow. It has been claimed that centrifugal pumps hinder passage of air pulled in from an empty reservoir (18±20). they cannot overpressurize. If the arterial inflow line occludes.

Varying sensitivities to preload and afterload preclude determination of pump flow directly from rotational speed. both roller pumps and centrifugal pumps have advantages and disadvantages. Standard ultrasonic flow devices measure the maximal blood velocity and calculate the flow based on the assumption of a simple parabolic (laminar) velocity distribution (actual flow profiles are not parabolic). probably from a combination of shear force and positive pressure generation within the pump head (21). DeBois et al. Also. centrifugal pumps are nonocclusive. the centrifugal pump becomes deprimed and stops pumping (3). When the impeller is not spinning. The frequency shift in the Doppler signal is related to the velocity of blood flow through the tube.however. Electromagnetic flow probes depend on the fact that blood flowing through an electromagnetic alters a magnetic field in a manner that can be measured continuously ("right-hand rule"). Clearly. whenever the centrifugal pump is not running. a sharp decrease in systemic vascular resistance must be accompanied by an increase in the frequency of roller head rotation if one wishes to maintain a constant arterial pressure. The study demonstrated a significant reduction in length of hospital stay. If more than 32 to 52 mL of air is introduced into the circuit. With centrifugal pumps. The flow probe should be located downstream of any purge or recirculation line in the circuit to accurately measure blood flow delivered to the patient. and a net reduction in hospital cost in the centrifugal group. blood can flow retrograde through the pump head unless the arterial line is clamped. so most ultrasonic flow probes do not measure low flows accurately (24). the flow rate automatically increases without a change in rotational speed when systemic vascular resistance decreases (23). whereas electromagnetic devices assess mean velocity distribution. (25) prospectively compared centrifugal pumps and roller pumps in 200 patients undergoing elective coronary bypass grafting. ultrasonic flow probes do not contact the blood but instead wrap around the tubing. the CPB arterial line must be clamped. and afterload dependent. In contrast. a reduced 24-hour postoperative weight gain. Centrifugal pumps generate increased flow when either the preload increases or the afterload decreases (preload dependent and afterload dependent). Therefore. When using a roller pump. preload dependent. A reduced risk of passing clinically significant amounts of macroscopic air into and through the arterial line to the patient has been a reported advantage of the centrifugal pump over the roller pump. Although clinicians may believe strongly that one or the other should be used . such as decoupling. a flow meter must be incorporated into the arterial outflow. Electromagnetic flow probes require blood-contacting electrodes and are designed as connectors. When the pump stops running for any reason. the Doppler signal becomes very noisy at low velocities. which possess the disadvantages inherent to transition gaps. because it has been well established that centrifugal pumps do pump air to various degrees (21). This backflow can cause exsanguination of the patient or aspiration of air from around the purse-string sutures securing the arterial cannula (22). the centrifugal pump transmits fewer microscopic air bubbles. By design. therefore. Electromagnetic and ultrasonic flow meters are used clinically for centrifugal pumps. fluid can flow through the pump head in either direction (nonocclusive). Additionally.

there are insufficient clinical outcome studies available as yet to reach a conclusion about the desirability of one pump type over the other for routine cases. To sustain a pressure adequate to maintain forward flow. The U. as when the patient is weaned from CPB. such valves have not gained widespread use. Human errors are cited as the factor believed responsible for 73. The pump head is acrylic. the theoretic advantages of centrifugal pumps over roller pumps become more compelling.000 mL/min (29). compared with 19. the potential for valve failure. 1/3. The reverse flow occurs even though the rotor is still spinning and can rise up to 2. Shear rates between the cones were estimated at 100 to 400 s± 1 at flow rates of 400 to 2.S.763 cases) (28). For more prolonged applications of CPB or circulatory support. Complications Centrifugal pumps are generally safe. Retrograde flow can create a hemodynamic siphon that can exsanguinate the patient and can draw air into the arterial line at the cannulation site (22). Eden Prairie. the perfusionist should partially occlude the arterial inflow line when low flows are requested.. Inc. This pump was first marketed in 1978 as an alternative to the roller pumps (14).5% for device malfunctions or failures (27).preferentially for cardiac surgery requiring CPB. which is not susceptible to inaccuracy from turbulence. Figure 3. To prevent retrograde flow associated with pump malfunction. and other factors. and its priming volume is 80 mL (Fig. possible stasis and cavitation. MN). Although clinically available. In vitro studies demonstrated that retrograde flow could commence 540 ms after power to the pump is shut off.3.5B). and human errors. 22 electrical burning smells. Although these pumps will not pass large quantities of gas. Pump flow rate is measured by an electromagnetic flowmeter in the CPB arterial line. and the overwhelming majority of cardiac operations are completed without incident. The rotor consists of a stack of parallel cones driven by magnetic coupling to the external console (Fig. and 3 speed surges were reported out of 350. the shear rates between the rotating outer .3% of perfusion accidents. Food and Drug Administration records about centrifugal pump malfunctions from November 1991 through October 1993 revealed that 68 pump malfunctions. incidents have occurred where the perfusionist has forgotten to clamp the arterial line. Rotation of the parallel cones induces centrifugal force and radial flow to the blood that passes between the cones (constrained force-vortex principle). 3. stops. with inlet and outlet ports oriented at right angles to each other.6 demonstrates the pressure-flow relationship for this pump. low flow. and cost effectiveness need to have further evaluation.5 L/min after another 470 ms (26).5A). hematocrit levels. temperature. Specific clinically available centrifugal pumps BioMedicus pump In 1976. centrifugal pumps are nonocclusive.000 open heart operations using centrifugal pumps (failure rate. and therefore retrograde flow can occur whenever the pump malfunctions. and such issues as blood trauma. In contrast. However. incorporating a oneway valve into the arterial line has been recommended (26). or when the pump slows enough so that the pressure produced is less than that needed to maintain forward flow (26). the first centrifugal pump was used for CPB (Medtronic BioMedicus. The only way to prevent retrograde flow is for the perfusionist to clamp the arterial line when the pump slows or stops.

MN. This console is reasonably representative of those used for the centrifugal pumps of other manufacturers. BioMedicus pumps are thought to prevent the transmission of macroscopic and microscopic air and clots better than roller pumps and other impeller pumps. with a peak value of about 2. FIG 3. Wheeldon et al. Inc. (Courtesy Medtronic BioMedicus. (Courtesy Medtronic BioMedicus.6. being a function of the pump rotational speed rather than of the flow rate. (32) compared the BioMedicus pump with the Stockert roller pump in a prospective randomized study of 16 patients undergoing coronary artery bypass grafting and found the BioMedicus pump to be associated with greater preservation of platelet numbers.In vitro studies demonstrated that the BioMedicus pump induces less hemolysis at pressureto-flow ratios below 1 mm Hg/mL/min.. MN) B: Console that drives and regulates the BioMedicus centrifugal pump. and D-dimer were significantly less . These pumps are also less likely to churn air -thromboglobulin. MN. altered with the BioMedicus pump.31). (Courtesy Medtronic BioMedicus. Part of the pump is seen mounted at the View Figure top rear. whereas a roller pump produces less hemolysis at the ratios above 1 mm Hg/mL/min (29).34). whereas others have reported the contrary (14. A: Cross-sectional schematic of the BioMedicus Bio-Pump centrifugal pump. plasma hemoglobin. less complement activation.32) or no difference between the two (33. Eden Prairie.5. Eden Prairie. this distinction may have no clinical importance. Hydraulic performance curves for the Bio-Pump.) View Figure Some investigators have reported less hemolysis with the BioMedicus pump than with roller pumps (30. Eden Prairie.. Because pressure-to-flow ratios during CPB nearly always remain well below that threshold.. Parault and Conrad (36) found less blood damage with the BioMedicus pump than with roller pumps when CPB time exceeded 90 min.57 s±1/rpm. In patients with CPB times over 2 hours and in those over the age of 70. and less microbubble transmission. Platelet counts. perfusion with the BioMedicus pump resulted in higher postperfusion platelet counts (35). Digital displays and the knob controlling the revolutions per minute are located on the console's top panel and other controls are on its front.cone and the stationary conical pump housing vary. Inc.) View Figure FIG 3. Inc.

8: stainless steel shaft. whereas other types of impellers may permit them to pass into the patient.7.7). The impeller is composed of curved vanes to minimize eddies and cavitation and to optimize overall flow patterns (Fig. Cross-sectional schematic of the Delphin centrifugal pump. 5:nonsealed ball bearing. Chelmsford. and bearings have been modified to reduce the risk of blood contact and potential pump failure.into the blood than roller pumps (14). Cross-sectional schematic of the Life Stream centrifugal pump. 4. Ann Arbor.. seal.8). Platelet counts were significantly lower with the BioMedicus pump at 2 and 4 L/min of flow.10) (37).2: curved vane..9. and 6 L/min of flow (36). An in vitro comparative study demonstrated similar rates of hemolysis between the BioMedicus and Life Stream pumps after 4 hours of pumping. In vitrocomparison of the Delphin and BioMedicus pumps demonstrated that mean plasma hemoglobin levels were significantly higher with the Delphin pump at 2. 5 and 6: quad-ring double seal. 9: thrust View Figure bearing. The pressure±flow relationships at various rpm are shown in Figure 3. and the priming volume is 40 mL. The shaft. Jude Medical Inc. The shaft is magnetically coupled to the driver console with integrated battery backup. MI. both of which were significantly lower than that found with the Delphin pump (37). The Life Stream and Delphin pump heads were almost identical in the rotational speeds required to achieve a given flow rate and were 20% to 30% lower than those required for the same flows with the BioMedicus pump (Fig. 4: absence of stagnant flow area behind the impeller.8. 1: blood path. 7: sleeve bearing.) View Figure Life stream pump The Life Stream centrifugal pump (St. 4: back side of vane.) . 6: magnet. 1: roller shaft. Clots and air bubbles tend to remain in the BioMedicus pump. An electromagnetic flowmeter measures blood flow. Delphin pump The Sarns 3M Delphin centrifugal pump (Sarns 3M. (Courtesy St. 3: vane. 3. MI) has a vaned magnetically coupled impeller within an acrylic housing (Fig. MA) was introduced clinically in 1988. Ann Arbor. Blood flow is measured by an ultrasonic flowmeter along the outlet tubing and is proportional to the rotational speed. 3. 3. As with the BioMedicus pump. MA. 2:sealing part. (Courtesy Sarns 3M. with no difference found at 6 L/min of flow. Jude Medical Inc. the inflow and outflow ports are oriented at right angles to each other. Chelmsford. FIG 3. 3: thin metal drive plates. FIG 3.

Jude Medical Inc. Chelmsford..1 mL of air was introduced into the Capiox pump under a negative pressure of 200 mm Hg. Comparison of Delphin and BioMedicus pumps. which is noteworthy for less afterload sensitivity at higher flows when compared with other centrifugal pumps.36:M616± View Figure M619. Sekela ME.) View Figure FIG 3.FIG 3. et al. (Courtesy St.11).3. less platelet depletion. Tokyo.10. and lower (39).) View Figure . Hydraulic performance curves for the Life Stream (Isoflow) pump. with permission.9.) Capiox pump The Capiox centrifugal pump (Terumo Corp. Comparison of the performance curves among the Delphin pump. ASAIO Trans 1990. Glueck J. A clinical study demonstrated less hemolysis.11. Tokyo.. Japan) consists of a rotor with a unique straightpath design to reduce pump rotational speed without decreasing hydraulic efficiency (38±40) (Fig. and BioMedicus pump. (Courtesy Terumo Corp. The straight-path design with a constant cross-sectional area minimizes the change of blood flow velocity and direction. The small priming volume of approximately 46 mL may reduce stagnant flow within the rotor. Japan. Cross-sectional schematic of the Capiox centrifugal pump. MA. In vitro tests revealed that the Capiox pump caused less hemolysis than a roller pump (35) and the BioMedicus pump (41±43). In vitro studies revealed that the time required for blood temperature to increase from 37° to 42°C after outlet clamping was four times longer in the Capiox pump than in the Delphin pump and two times longer than in BioMedicus pump (40). These studies also demonstrated that no cavitation was observed when 0. Figure 3. -thromboglobulin levels in the Capiox group than in the roller pump group FIG 3..12 demonstrates the pump's performance. Life Stream pump. (Reproduced from Noon GP.

g. Tokyo. a height of 58 mm. Cross-sectional schematic of the Nikkiso centrifugal pump.14shows the hydraulic characteristics of the Nikkiso pump. Japanese investigators (47±52) reported most of the clinical experience. These holes prevent thrombus formation in the areas behind the impeller and around the sealing part. Japan. a priming volume of 25 mL. Houston. Although very small. This seal. Lower plasma free hemoglobin concentrations accompany perfusion with the Nikkiso pump than with the roller pump or the BioMedicus pump (48±51).. which is made of fluororubber. FIG 3.12. TX. - .. Hydraulic performance curves for the Nikkiso pump.FIG 3. the pump can generate 6 L/min of flow against a total pressure head of 400 mm Hg at a rotational speed of 3. and a weight of 145 g. Inc. Japanand HIMEX Production.) View Figure FIG 3.) View Figure Because the Nikkiso pump has been marketed primarily in Japan. (Courtesy Nikisso.. suppresses heat generation and prevents blood leakage (44). Inc.14. Inc. Houston. which is made of polycarbonate. Six washout holes are incorporated into the impeller to generate blood flow from the back to the front surface of the impeller.500 rpm.. TX) is the smallest commercially available centrifugal pump (44±46).. Inc. Houston. It has an impeller diameter of 50 mm. with a V-shape ring seal that separates the pump housing and actuator chamber.13. Tokyo. platelet factor 4 and thromboglobulin) increased less with the Nikkiso pump than with other pumps (52. Inc. and HIMEX Production.. Figure 3. Hydraulic performance curves of the Capiox pump. (Courtesy Terumo Corp. TX.13 shows the design of the pump. Japan. It was also reported that the parameters of platelet destruction and activation (e. Tokyo. Figure3. (Courtesy Nikisso. an outer diameter of 66 mm.. Japan. Tokyo. Inc.53). and HIMEX Production.) View Figure Nikkiso pump The Nikkiso centrifugal pump (Nikkiso..

Inc." . Significant safety advantages gained with an improved pressure-regulated blood pump. originally Affinity model 2000. Avecor Cardiovascular. and will not allow retrograde flow. the Metaplus pump is considered nonocclusive because there is no backing plate against which the tubing can be compressed with rollers. Forward flow occurs with roller rotation. Schematic drawing of nonocclusive roller pump..) The pumping chamber shape is normally flat from being stretched over the rollers when the pump is not rotating.. However. This pump chamber segment is stretched under tension over three rollers.15. A dramatic increase in postoperative ejection fraction was observed in the pulsatile perfusion group with intraaortic balloon pumping (56). The priming volume is 120 mL (Fig. The rollers are mounted on a rotor that spins to impart a peristaltic action on the fluid within the pump chamber. A: Operating principle of the triple-roller pump and pumping chamber. one of the methods to generate more pulsatile blood flow during CPB is to use intraaortic balloon pumping (55). with permission. B: Pumping chamber inlet collapsed when blood is not supplied at a pressure above ambient.15). Polyurethane pumping chamber is stretched over the rollers. forward flow ceases. (Reprinted from Montoya JP. Unlike a conventional roller pump. Cardiovascular Group. MN) is a new type of blood pump that appears to incorporate some advantages of a centrifugal pump while minimizing some disadvantages of a conventional roller pump (18). However. J Extra-Corp Technol 1996. with any hydrostatic filling pressure above ambient levels. 3. Merz SI. will not overpressurize. This pump will not drain the venous reservoir. If the tubing upstream from the pump (pump inlet) is kinked or clamped. FIG 3. Forward fluid flow is accomplished by a passive-filling tapered pumping chamber fabricated of two sheets of flat polyurethane tubing bonded at the edges (58). CA. Minneapolis. as it does with a conventional roller pump. NONOCCLUSIVE ROLLER PUMP Back to Quick Links The Metaplus pump (Baxter Healthcare Corporation. Bartlett RH. F-F: Cross-sectional view of the collapsed pumping chamber.28:72±73. will not create negative pressure and cavitation. Irvine. EView Figure E: Cross-sectional view of pumping chamber distended when blood is supplied at a pressure above ambient.PULSATILE PUMPS Back to Quick Links Even conventional roller pumps produce some pulsatile flow (54). the pumping chamber expands and fills with fluid. Other devices and techniques used to achieve pulsatile flow during CPB are discussed more thoroughly in Chapter 10. The pump chamber lacks the tendency to return to an inflated condition because it has no "memory. When this occurs. the pump chamber will collapse into its natural flat shape. and roller rotation is counterclockwise.

Reservoir volume changes will have little effect on pump flow rate until the volume drops to a minimum level. the pump chamber flattens and becomes occlusive as it wraps around the individual rollers to prevent retrograde flow from the patient. Cardiovascular Group. Metaplus pump rotor and motor assembly (right) and membrane oxygenator (left). semirigid. and a separate modular pump console must be used to control the pump (Fig. should create no turbulence or stagnation. should provide flows that are exact and easily monitored. View Figure U-shaped tubing connecting the outlet of the venous reservoir to the inlet of the pump. demonstrating the preload sensitivity of the pump. blood flow resumes gradually. CA. (59) and a clinical study by Crockett et al. With the Metaplus pump. the flat segment of the pump chamber becomes distended and the pump then becomes nonocclusive. there is insufficient hydrostatic pressure to fill the pump chamber and flow ceases. (Courtesy Baxter Healthcare. . and lower or comparable hemolysis rates. As stated earlier. When venous return is reestablished. Pump position is fixed in relationship to the hard-shell venous reservoir to supply the inlet of the pump. Note requirement for large-bore. As a result. decreased microbubble emission when compared with conventional roller or centrifugal pumps. and should be manually operable in the event of a power failure. air is not entrained nor does a potentially cavitating vortex form at the outlet of the CPB reservoir.) In vitro testing (57) has confirmed the inability of the pump to empty a CPB reservoir when the height of the pump inlet is placed slightly above the reservoir outlet. 3. a noninvasive electronic flow probe must be used to accurately measure blood flow. KEY POINTS Back to Quick Links y The ideal pump for CPB would be able to deliver physiologic blood flows against high resistance without damaging blood. (60) further characterized the performance of the pump under varying preload and afterload conditions typically encountered during CPB. Irvine. The cost of disposables for this new pump system are intermediate between those of the less expensive roller pump and the more expensive centrifugal pump.Thus. Once that level is reached.16. The pump chamber fills passively as a function of the height of the fluid column within the reservoir. FIG 3. Additional in vitro studies by Jaggy et al. the potential for retrograde flow is a key safety concern with nonocclusive pumps. Because the system is both preload and afterload sensitive. If the arterial line occludes. because the pressure it generates is limited. the pump cannot generate negative pressures and will not tend to damage blood and tissue or to suck air through loose tubing connectors upstream. This occurs at pressures lower than those required to induce failure of tubing connections. The pump is also afterload sensitive.16).

and virtually no spallation. less blood trauma. In: Gravlee GP. Surgery 1967. principles and practice . and possibly blood trauma. Roller pumps have the advantages of simplicity. Cooley DA. Utley JR . and the ability to pump against high resistance without reducing flow.61:432±442. Cardiopulmonary bypass circuitry and cannulation techniques. capability for pumping large volumes of air. and afterload-dependent flow requiring constant flow measurement. y Compared with roller pumps. Texas Heart Inst J 1987.87:386±389. Disadvantages include the need to assess occlusiveness. Development of the roller pump for use in the cardiopulmonary bypass circuit. spallation of the inner tubing surface that potentially produces particulate arterial emboli. 2. the lack of occlusiveness (creating the possibility of accidental patient exsanguination). Factors influencing hemolysis with roller pumps. This pump is undergoing clinical evaluations to establish its appropriate clinical applications. This pump appears to be incapable of generating dangerously high positive or negative pressures or of permitting retrograde flow. New Orleans Med Surg J1934. eds. Baltimore: Williams & Wilkins. ability to transmit air. y A nonocclusive roller pump has been recently introduced. Hessel EA. ease and reliability of flow calculation. centrifugal pumps offer the advantages of lesser air pumping capabilities. References Back to Quick Links 1. it remains uncertain whether the selection of a roller pump over a centrifugal pump or of any specific centrifugal pump over another has clinical significance. lesser abilities to create large positive and negative pressures. DeBakey ME. Cardiopulmonary bypass. y In the setting of short-term CPB for cardiac surgery. Bernstein EF.14:113±118. afterload sensitivity. . y Four commercially available centrifugal pumps demonstrate some differences in hydraulic performance. 4.y y The two pumps used most commonly for CPB are roller pumps and centrifugal pumps. Gleason LR. and ability to create large positive and negative pressures. 3. Davis RF. A simple continuous-flow blood transfusion instrument. priming volumes. Disadvantages include higher cost. low cost. 1993:55±92.

Pfaender LM. 14.6:140±146. Williams EH. Feldman L. Cardiopulmonary bypass . Baker V. et al. 16. Christman EW. Coles JG. Riley JB. Kitamura M. Kurusz M. Kurusz M. Houston: Medical Press. 9. AmSECT Proc 1975. Reduction of blood trauma in roller pumps for long-term perfusion. Christman EW. Peterson D. J Extra-Corp Technol 1980. Rawn DJ.29:336±340. Curtis JJ. 7.Ann Thorac Surg 1980. Nishida H.5. J Thorac Cardiovasc Surg 1979.77:792±795.11:78± 88. 11. Artif Organs 1993. Dane LE. et al. . Burrus GR. 8. Williams WG. 12. An under-occluded roller pump is less hemolytic than a centrifugal pump. Stoney WS.Perfusion 1987. Spallation using roller pumps and its clinical implication. Lynch MF. Black MD. 15. Reed CC. 13. Shaffer CW. 1984: 17. 10. 2nd ed. MI: University of Michigan Dept. Roller pump induced tubing wear: another argument in favor of arterial line filtration. Olsen DA. Ann Arbor.2:9±17. Air embolism and other accidents using pump oxygenators. 7th edition . 18.61:536±537. Yoda DN.29:15±18. J Extra-Corp Technol 1979. 1985:376. Percutaneous cardiopulmonary support as the second generation of venoarterial bypass: current status and future direction. of Surgery. ECMO Technical Specialist Manual . Alford WC. J Extra-Corp Technol 1997. Noon GP. Minn Med1978. Landsburg G. 6.3:27±32. Riley JB. Blackwell MM. University of Michigan Hospitals. 17. Kletchka HD. Hubbard LC. Harris HK.World J Surg 1985. Analysis of microembolic particles originating in extracorporeal circuits. Ann Thorac Surg 1995. Cohn D.12:49±59. et al. Runaway pump head. Determinants of success in pediatric cardiac patients undergoing extracorporeal membrane oxygenation. Stafford TB.17:906± 913.60:133±138. et al. Centrifugal blood pumping for open-heart surgery.9:65±71. Uretzky G. Semin Thorac Cardiovasc Surg 1994. An in vitro comparison of the effects of temperature on the stroke volume and occlusion setting of various tubing types in a roller pump. Centrifugal mechanical assist for postcardiotomy ventricular failure. Shibuya M.

J Thorac Cardiovasc Surg 1993. 25. 23. A comparison of three centrifugal pumps' ability to expel micro-air under conditions of cavitation or bolus air injection. and limitations. 20. Anonymous.26:123±134. Centrifugal pumping: the patient outcome benefits following coronary artery bypass surgery.16:195±202. Results of the unidirectional Centri-Safe arterial valve for prevention of retrograde flow during cardiopulmonary bypass. Gill RD. Devineni R. 1993. 22.27:77±80. . Oku T. Schima H. 30. Moritz A.28:118±122. Tamari Y. Wheeldon DR. Lee-Sensiba K. Ann Arbor: Sarns 3M Health Care. et al. Risk containment during cardiopulmonary bypass. Vasc Surg1992. a comparative study of four non-pulsatile pumps. Ingram JM. 29. Ankney RN. 31. et al. DeBois WJ. 28. 32. Medtronic BioMedicus presents more than just a pump ? Eden Prairie.106:997±1007. Wheeldon DR. Kurusz M. J Extra-Corp Technol 1996. Cardiopulmonary bypass using centrifugal pump.2:400±409. Sarns Delphin II centrifugal system . Artif Organs 1992. Leonard EF. Anonymous. Trubel W. 24. Trans Am Soc Artif Intern Organs 1988. Bethune DW. Isik O. et al. possibility. Semin Thorac Cardiovasc Surg 1990. J Extra-Corp Technol 1995.34:500±504. 27. 21.40:M540±M546. Kolff J. Pacheco DA. Vortex pumping for routine cardiac surgery: a comparative study. Beware centrifugal pumps: not a one-way street. but a dangerous siphon! [letter]. Kutshcera Y. In-vitro assessment of centrifugal pumps for ventricular assist. Wurzel D. 1991. Kolff J. 26. Palzer B. Berki T. Wein E. Guürbuüz A. Alpern JB. Shah NS. et al.5:135±143. et al.19.50:512. Technical compendium. ASAIO J 1994. Noninvasive monitoring of rotary blood pumps: necessity. Harasaki H. Pacheco SL. et al. Proc Am Acad Cardiovasc Perfus 1992. et al. Centrifugal pump failures. Smith W.Artif Organs 1990. Hemolysis. McClurken JB.14:278±283.Perfusion 1990.13:73±77. Brennan R. Ann Thorac Surg 1990. MN: Medtronic BioMedicus. Jacob H. The effects of pressure and flow on hemolysis caused by BioMedicus centrifugal pumps and roller pumps. Esper E.

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et al. Am J Cardiol 1976. Crockett G. Maresca L. Merz SI.37:1000±1006. Carvalho J.18:706±710. Lachat M. MN: Avecor Cardiovascular. Taguchi S. et al. Clinical evaluation of a new type of centrifugal pump. et al. Less blood damage in the impeller centrifugal pump: a comparative study with the roller pump in open heart surgery. et al. et al. et al. Artif Organs1994. Artif Organs 1994. et al. Sasaki T. Kondo C. Tanaka S. Orime Y. . et al. Clinical experience with the Nikkiso centrifugal pump. Bartlett RH. Montoya JP. Artif Organs 1996.15:77±83. Takatani S. Nishinaka T.20:707±710. The roller pump does produce pulsatile flow. Clinical comparative study of cardiopulmonary bypass with Nikkiso and BioMedicus centrifugal pumps.. 48. 59. Minneapolis. Pappas G. Artif Organs1994. J Extra-Corp Technol 1996. James SD. Cardiopulmonary bypass with Nikkiso and BioMedicus centrifugal pumps. Mori A. 53. 50. Anonymous. Affinity pump system: a new peristaltic pump for cardiopulmonary bypass.18:702±705. Perfusion 2000.47. 57. et al.18:11±16. 49. 56. Leskosek B. Artif Organs 1996. Kopriva CJ. Pappas G. 52. Significant safety advantages gained with an improved pressure-regulated blood pump. Jenkins M. Vocelka C. Onoda K. New Orleans.77:34±44. Winter SD. 55. et al. 37th International Conference of the American Society of Extra-Corporeal Technology . A miniaturized centrifugal pump for assist circulation. Ohtsubo S. Shomura Y.18:664±668. Artif Organs 1996. 1997. Maddox G. Technical manual. Improvement of myocardial and other vital organ functions and metabolism with a simple method of pulsatile flow (IABP) during clinical cardiopulmonary bypass. Shimono T. et al. Endo M. Inc. Surgery1975.19:376±383. Tayama E. Nishida H. Jaggy C. 8±11 April 1999. Yozu R. Predicting the blood flow rate from the Affinity model 2000 pump system. Mizumoto T. J Extra-Corp Technol1987. Affinity Pump System 2000 . 60.20:725±730. Peters J. Effect of pulsatile and nonpulsatile flow during cardiopulmonary bypass on left ventricular function early after aortocoronary bypass surgery. (abst). 51. 58. Shoji T.20:711±714. Artif Organs 1994. Short D.28:71±78. Clinical experience with Nikkiso centrifugal pumps for extracorporeal circulation. et al. Ninomiya J. 54. Onoda K.

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