Challenges of Cardiopulmonary Bypass—A Review of the Veterinary Literature

Abstract

Cardiopulmonary bypass (CPB) has been used in veterinary medicine in experimental surgery and to address congenital and acquired diseases. We review the veterinary literature and expose common challenges of CPB in dogs and cats. Specifically, we describe the most specific elements of this technique in veterinary patients. The variety in animal size has made it difficult to standardize cannulation techniques, oxygenators, and priming volumes and solutions. The fact that one of the most common cardiovascular disorders, mitral valve disease, occurs predominantly in small dogs has limited the use of bypass in these patients because of the need for small, low prime oxygenators and pumps that have been unavailable until recently. Coagulation, hemostasis, and blood product availability have also represented important factors in the way CPB has developed over the years. The cost and the challenges in operating the bypass machine have represented substantial limitations in its broader use.

Degeneração mixomatosa de valva mitral em cães: Revisão

“…Embora ocorra incremento da expectativa de vida que extrapola os limites da terapia clínica, tal procedimento é pouco usual na Medicina veterinária, dados os altos custos com equipamentos, dificuldades para realização das diferentes técnicas e complicações intraoperatórias, como a lesão do nervo fênico, as provocadas pelo uso do uso de bypass e pós-operatórias, com destaque para a trombose. (Orton et al, 2005;Orton & Monnet, 1995;Pelosi et al, 2013).…”

Symptomatic partial anomalous pulmonary venous connection in a kitten

“…Diffuse bronchial and interstitial pattern on the A, ventraldorsal; B, right recumbent; and C, left recumbent views small blood volume, risks of electrolyte disturbance, hemodilution, and limitation of small vessel diameter for cannulation. 14 After discussion with the owner, cardiac medications including furosemide (4.3 mg/kg PO q12h), pimobendan (0.25 mg/kg PO q12h), benazepril (0.32 mg/kg PO q12h), and spironolactone (1.6 mg/kg PO q12h) were prescribed to control heart failure and maintain quality of life. Two months after diagnosis, the referring veterinarian reported that the kitten had died of heart failure; permission for necropsy was denied.…”

Combined interventional procedure and cardiopulmonary bypass surgery in a dog with cor triatriatum dexter, patent foramen ovale, and pulmonary stenosis

“…The disadvantages of surgical correction under CPB are the need for special equipment, its potentially high cost (approximately 15 000 euros) and limited availability of treatment centers. Moreover, CPB is considered a high morbidity and mortality approach, with several intraoperative and postoperative complications (eg, hemorrhage, embolism, infection) that could lead to patient death . However, the use of CPB in dogs has increased considerably in the last 10 years, as has safety, because of improvement in surgical and perfusion techniques, specialized equipment, and operator expertise.…”

“…Moreover, CPB is considered a high morbidity and mortality approach, with several intraoperative and postoperative complications (eg, hemorrhage, embolism, infection) that could lead to patient death. 31 However, the use of CPB in dogs has increased considerably in the last 10 years, [32][33][34][35][36][37] as has safety, because of improvement in surgical and perfusion techniques, specialized equipment, and operator expertise. Finally, our group had already started using CPB with success for surgical treatment of other cardiac diseases in dogs and therefore had experience with this technique.…”