Amanda Wood, CCP
Justin Hong, CCP
Scientific Poster Award - This Award will be presented to the individual who has displayed the most outstanding scientific poster at the Carolina Perfusion Symposium.
Amanda Wood, CCP
“A Modified Hybrid Extracorporeal Bypass Circuit Used for Repair of Descending and Thoracoabdominal Aortic Aneurysms”
Ashlyn Strickland, CCP MS
“ABO-incompatible Orthotopic Heart Transplant: A Case Report"
“A Modern Applicant's Journey to Perfusion School"
2021 CPS Award Winners
Amanda is from Greenville, SC and attended the University of South Carolina in Columbia, SC for her undergraduate degree. She received a Master of Science in Cardiovascular Perfusion from the Medical University of South Carolina in 2019 and is currently a staff Perfusionist at Emory Healthcare in Atlanta, GA. She is part of the Transmedics DCD Heart Transplantation team and the Descending Thoracic/Thoracoabdominal Aortic Aneurysm repair team at Emory. Her professional interests consist of DTAA/TAAA repairs using Modified Left Heart Bypass & Full Cardiopulmonary bypass.
Title: A Modified Circuit for Repair of DTAA/TAAA
Overview: Perfusion techniques for distal aortic operations vary and are continually evolving. Current techniques consist of Full CPB with HCA, LHB with or without an oxygenator, and the utilization of visceral & renal artery perfusion. Extensive blood loss, coagulation issues and ischemic events are perpetual complications associated with DTAA/TAAA repairs. We seek to combine current perfusion techniques into a modified circuit that will help us abate these complications.
Description: We modified our CPB circuit into a hybrid circuit that allows us to employ true LHB with low heparinization, rapid volume resuscitation, temperature management, and visceral & renal artery perfusion if necessary. This hybrid circuit gives us the flexibility to quickly & safely convert to ECMO or full CPB in the case of cardio-pulmonary instability.
Comment: We drafted a protocol for DTAA/TAAA repairs with Modified LHB. Throughout the 25 cases completed with this technique we have found that less heparinization is required for a pump run versus full CPB, we have better volume resuscitation capability than with true LHB, temperature management is possible similar to that of full CPB, cold blood perfusion to the visceral arteries and cold crystalloid perfusion to the renal arteries is also possible.
Keywords: DTAA: Descending thoracic aortic aneurysm, TAAA: thoracoabdominal aortic aneurysm, CPB: cardiopulmonary bypass, HCA: hypothermic circulatory arrest, LHB: left heart bypass, ECMO: extracorporeal membrane oxygenation
Edwards JT, Brown DM, Neil KW, et al. A versatile extracorporeal circuit for use during repair of descending and thoracoabdominal aortic aneurysms in high-risk patients with cardiac and/or pulmonary dysfunction: a novel approach to a significant perfusion management dilemma. J Extra Corpor Technol. 2004;36:245-249
Barnard CN and Schrire V. The surgical treatment of acquired aneurysm of the thoracic aorta. Thorax (1963), 18, 101
Justin Hong is a recent graduate of the Medical University of South Carolina Cardiovascular Perfusion Program. He earned a Masters Degree in CVP. He is currently working in New York City as a staff perfusionist at NewYork Presbyterian-Columbia University Medical Center. He is a member of AmSECT and active in the perfusion community.
Vasoplegic syndrome poses a major operative risk for cardiac surgical patients, particularly when resistant to traditional catecholamine therapy. The off-label use of hydroxocobalamin may treat vasoplegia and decrease overall vasopressor requirements in the setting of cardiopulmonary bypass. A 63-year-old male with a past medical history significant for percutaneous coronary interventions, mitral valve repair, tricuspid valve repair, and a HeartMate 3 left ventricle assist device (LVAD) (Abbott Cardiovascular, Plymouth, MN, USA) presented to the operating room with a driveline infection requiring a device exchange. During the weaning of cardiopulmonary bypass, refractory vasoplegia was suspected due to low systemic arterial pressures despite supranormal cardiac output and high-dose catecholamine therapy. Hydroxocobalamin was administered to treat the vasoplegia. Within 15 minutes of hydroxocobalamin administration, systemic arterial pressures stabilized to allow weaning from cardiopulmonary bypass. The total cardiopulmonary bypass time was 2 hours and 41 minutes. The patient remained hemodynamically stable throughout the postoperative course, weaning off vasopressor support on postoperative day six. The patient recovered from surgery without any major complications and was extubated postoperative day one and discharged out of the hospital on postoperative day 13. Hydroxocobalamin was used successfully off-label to treat refractory vasoplegia during cardiopulmonary bypass for an LVAD exchange patient.