The Jena universal perfusion system: a universal cardiopulmonary bypass circuit for cardiac surgery.

Cardiopulmonary bypass (CPB) is a standard technique in cardiac surgery, which itself contributes to postoperative morbidity. Neurologic sequelae after CPB is caused by air embolism or systemic inflammatory response due to artificial surface and is closely related to the characteristics of the extracorporeal circuit. Minimized systems without a venous reservoir take these factors into account. They require a differentiated volume management to avoid excessive negative pressure in the venous line, which may lead to spontaneous formation of microbubbles and are said to cause air embolism. Perfusion technology also offers systems with closed soft-bag and open hard-shell reservoirs, that require individual setups with little flexibility. We developed an all-purpose perfusion system for application as cardiopulmonary bypass. The central part is a compound reservoir, consisting of a lower hard shell and an upper self-expanding shell, which is capable of actively increasing volume. It allows application of the circuit as closed or open system. Crossclamping the inflow turns the system into a minimized circuit, in which the reservoir compensates volume when backflow is low and safeguards against excessive subzero pressure. The system has been applied in pilot experiments. In cardiac surgery today patients present at higher ages and with complex comorbidities. Not all of them are suitable candidates for off-pump procedures and might profit from perfusion technology with reduced adverse effects. The Jena Universal Perfusion System (JUPS) may be applied as a minimized system with the option to compensate low venous backflow and allows flexible extension to a closed or open circuit anytime during the procedure.