Perfusion Insider Fall 2015

Procedure on Obese Patient Successfully Uses Single Affinity Fusion® Oxygenator

The cardiac surgery team at Westchester Medical Center, Valhalla, NY, performed a successful CABG procedure on a 170 kg patient in early December 2014. "When I learned of the patient's size, I was unsure whether our new Affinity Fusion® Oxygenator could handle it," said Anatole Kanefsky, CCP, Chief Perfusionist. "At 182 cm, 170 kg, and with a BSA of 3.0 m2, we knew the patient was obese. But Medtronic assured me that the Affinity Fusion Oxygenator is rated to flow up to 7L/min and could handle this patient."

After consulting with his perfusion team and the cardiac surgeons, Kanefsky decided to splice two oxygenators together in parallel to be safe. "With the new Fusion Oxygenator holder and orbit arm, the set-up was easy," Kanefsky noted. "There were no kinks in the lines and no hard-to-reach areas."

Affinity Fusion® Oxygenators set up in parallel for use on an obese patient.

The procedure was a three-vessel revascularization, including the internal mammary artery (IMA). The following equipment was used:

  • Medtronic 1/2 x 3/8 A-V loop
  • Medtronic Myotherm Cardioplegia
  • Affinity Fusion® Venous Reservoir
  • 2 Affinity Fusion® Oxygenators
  • Medtronic CM2 36/46 venous cannula
  • EOPA 3D 20Fr arterial cannula

Intraoperative Perfusion

  • Arterial pressures maintained at 60-80 mmHg.
  • Arterial line pressure never exceeded 275 mmHg at full flow of 7.2L/min (index 2.4).
  • Patient's flow maintained at 2.0 - 2.4 Cardiac Index.
  • Blender sweep ranged from 4.3L/min to 5.0L/min to keep a PCO2 level of 40-45.
  • ViO2 kept at 80%

The patient was cooled to 34 degrees Celsius and throughout the case, cerebral oximetry (RSO2) ranged from 70% on the right brain to 72% on the left brain. Arterial and venous gases were within normal limits during the procedure, and the lactic acid level never increased over 2.0.

"I was cautiously optimistic and pleasantly surprised that we did not need to use the second oxygenator on a patient of this size," noted Kanefsky. "It was good to know, however, that if we ever need to use a parallel set-up in the future, it's easy and requires no duct tape."

For more information about the Affinity Fusion® Oxygenation System, contact your Medtronic representative.