Without any aid, the heart cannot be opened because that could lead to fatal hemorrhage or air embolism and its consequences.
To deal with massive bleeding we have to use the "machine" to suck blood and reinfuse to the patient. Furthermore, the bleeding vessel (or cardiac chamber) needs to be excluded from the circulation by proximal control (proximal clamp) and distal control (distal clamp). For example, to control the bleeding from the right atrium, we have to exclude the right atrium by occluding the SVC and IVC. However, we cannot have distal control in such case. What we need is suctioning residual blood in the chamber which is not supposed to be too much.
To prevent thromboembolic phenomenon, the patient needs adequate heparinization. Even heparinization, risk of thromboembolism is not zero.
Circulating blood to the "non-self" circuit has caused systemic inflammatory responses. It is inevitable in this case. Sometimes it is overwhelming or even fatal. In order to minimize the magnitude of systemic inflammatory responses, many strategies need to be used.
1. shorten operative time2. minimize tissue injury
3. ?? steroids
4. ?? ultrafiltration
5. ?? leukocyte depletion technique
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