202 T . Takeichi et al .: J Extra Corpor Technol 2023 , 55 , 201 – 205
Figure
1 . Preoperative contrast-CT indicates patch repair for pseudoaneurysm of the ascending aorta . CT : Computed Tomography .
LivaNova , Tokyo , Japan ) placed in the right femoral vein and an arterial cannula 16Fr ( PCKC-A , MERA , Tokyo , Japan ) placed in the right femoral artery . Centrifugal pump ( MERA Centrifugal Pump HCF-MP23 , SENKO MEDICAL INSTRUMENT , Inc ., Tokyo , Japan ) was used for CPB , which target pump flow was 2.6 L / min per m 2 . Phenylephrine and noradrenaline were administered to maintain a mean arterial pressure above 70 mmHg . Anticoagulation was given at an initial dose of 300 IU / kg to achieve a goal-activated clotting time of at least 480 s and if activated clotting time was less than 480 s , an additional dose of 4000 IU was given . A CDI Blood Parameter Monitoring System 500 ( Terumo , Tokyo , Japan ) was recalibrated every 30 min , and an arterial blood gas sample was also checked every 30 min . The patient was cooled to 28 ° C centigrade . To perform myocardial protection due to systemic hyperkalemia , we used 10 mL of MgSO 4 and a mixture solution that mixed 500 mL of bicarbonate ringer solution with 50 mL of KCL 10 mEq / L .
When VF occurred at 28.0 °, the left atrium opened via right thoracotomy . We administered an initial dose of 10 mL of MgSO 4 and 500 mL of mixture solution to achieve cardiac arrest . Immediately following the administration , VF stopped and the duration was 3 min . To maintain cardiac arrest , we continuously infused a solution to maintain a blood potassium level of 9 mEq / L and administered 10 mL of MgSO 4 every 30 min .
Because it was not possible to obtain cardiac arrest at a blood potassium concentration of 8.0 mEq / L ( Figures 3 and 4 ). The body temperature was maintained at 28.0 °. After thorough debridement of the extensive vegetation and removal of the artificial valve , redo MVR was performed using Epic 25 mm ( Abbott Medical ) valve . When a left ventricular vent through the MV was useful in preventing aortic valve release , we started rewarming the temperature and lowering potassium levels in the blood by using dilutional ultrafiltration ( DUF ). Also , we used continuous glucose-insulin therapy . To decrease from 9 mEq / L to 5.5 mEq / L level of potassium in the blood , we took about 60 min . The potassium level after CPB weaning was 5.5 mEq / L . The peak potassium level was 9.9 mEq / L , the minimum was 8.0 mEq / L , and the total potassium administered was 250mEq . Weaning from CPB was performed using catecholamines , primarily dobutamine which could easily wean . Cardiac arrest time and CPB time were 180 min and 273 min , respectively .
The patient ’ s postoperative maximum CK-MB level was 19 . The duration of mechanical ventilation and length of stay in the intensive care unit ( ICU ) was 16 h and 3 days , respectively . The postoperative course was uneventful and she was discharged after undergoing antibiotic treatment for 6 weeks .
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