Myocardial Protection System (MPS®)
Myocardial Injury is the Number One Complication in Cardiac Surgery
Quest MPS® Microplegia System
The single biggest change you can make for your patient
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Technology so unique, Quest Medical was awarded six U.S. patents. At the heart of the MPS2 system are Spline-Piston pumps coupled with state of the art pressure sensors enabling unparalleled drug delivery accuracy. Whether you are performing on pump or off pump cardiac surgery, the Quest MPS2 system enables you to safely go where you want, with what you want, exactly when you want it.
The Quest Myocardial Protection System, consisting of the MPS2 Console and the MPS2 Delivery Set used together, is intended for use by perfusionists and physicians to deliver whole blood (from any arterial source) and / or cardioplegia solutions to the heart during open heart surgery on either an arrested or beating heart.
- Strategies
- On-Pump Microplegia
- Off-Pump Microplegia
- Targeted Blood Perfusates
- Technology
- Patient Safety – Superior Patient Outcomes
- Pump
Strategies
Technology that brings
realization to visionary
strategies
Reduced Ischemia
Reduced Dilution
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Microplegia |
4:1 Blood to Crystalloid Ratio |
The Quest MPS2 system is designed to enable accurate and safe drug delivery. The combination of Spline-Piston pumps and state of the art pressure sensors have enabled the development of advanced techniques, drug therapies, and perfusion support. Used in over 200,000 cardiac procedures, the MPS2 system is the primary delivery system for ongoing research and development targeting advanced myocardial protection and recovery protocols, treatment for reperfusion injury, and acute myocardial infarction.
Microplegia On-Pump Strategy
Microplegia is blood cardioplegia without the crystalloid, and is rapidly being adopted by surgeons and perfusionists as the new standard of care to reduce morbidity and improve outcomes. Quest's enabling MPS2 technology enhances tight control over K+ and Mg++ to arrest the heart and promotes the use of target specific cardioprotective agents to both the myocytes and endothelium. Essentially, you have patient-specific cardioplegia, with total control over the composition and conditions (delivery temperature, delivery mode and method).
Combining the benefits of all blood cardioplegia with precise control of K+ results in:
- Reduced hemodilution and myocardial edema -- better microvascular preservation
- Reduced hemoconcentration and blood usage -- less cost, less morbidity
- Improved K+, glucose management -- better spontaneous defibrillation
- Advanced pressure, air and temperature control -- better outcomes
PADCAB™ Off-Pump Support Strategy
PADCAB (Perfusion Assisted Direct Coronary Artery Bypass), was developed by Dr. Robert Guyton and his research team at Emory University using the MPS system. PADCAB is a cardio-protective therapy that enables immediate restoration of coronary blood flow and supports the heart during beating heart procedures. Key to the clinical benefits delivered by the MPS system and PADCAB is the capability to deliver supra-systemic blood flow to the coronary circulation, at a flow rate above the normal systemic flow generated by the heart and significantly above the sub-systemic flow of passive intracoronary or Aorto-graft shunts. Blood is perfused with cardioprotective agents (i.e., NTG, ADO) either directly to targeted coronary arteries or into individual vein grafts for distal perfusion, thus increasing collateral perfusion. Other drugs currently used include those used to attenuate reperfusion injury and promote recovery in ischemic myocardium.
PADCAB benefits:
- Medicated blood provides hemodynamic stability
- Minimize cumulative ischemia
- Confidence of graft patency
- Security to provide complete re-vascularization
- Lower Myocardial injury (lower Tni, lower CPK - MB)
- Promotes more stable post-op recovery
The Circuit
- Arterial blood is sourced from the aorta or femoral artery. Unique pump technology allows utilization of passive gravity flow.
- MPS2 Myocardial Protection System provides precise control of coronary flow rate, pressure and intracoronary medication delivery. Medicated blood is delivered through vein graft perfusion set.
- Multiple graft connections remain simplistic. Continuous perfusion delivery through completion of all distals and proximal anastomoses.
- Pressure line connected directly to MPS2 system. Pressure management includes dual system and delivery pressure monitoring, adjustable pressure limits, and a pressure controlled delivery mode that automatically adjusts flow to maintain a constant delivery pressure.
Targeted Blood Perfusates
There is continuing research in the development and implementation of advanced cardioprotective agents, which have the potential to prevent or ameliorate reperfusion injury and promote earlier recovery of the myocardium. For example, adenosine has been shown to improve myocardial recovery after ischemia when administered in precise concentrations. Adenosine has well known systemic hypotensive effects in addition to a short systemic half-life of less than 15 seconds. Clinical outcome studies are underway to verify the clinical utility of targeted adenosine delivery at precise concentrations in cardiac surgery. As new drug therapies evolve, the importance of safe accurate drug delivery, as provided by the MPS2 Spline-Piston pump technology, will increase. Some of the drugs being tested clinically are Na+/H+ exchange inhibitors, Glucose/Insulin, NO donors and Endothelin -1 Blockers.
The MPS2 system provides:
- Site specific drug delivery
- Accuracy to deliver short-acting drugs
- Safety of pressure controlled delivery
- Flexibility of drug sequence
Technology
Gain the power of control with
sophistication and ease of use |
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It's about control
Everything's under control. Simply put, the MPS2 system puts you in control of every aspect of cardioplegia delivery. You can delivery all blood to minimize hemodilution and myocardial edema. You also control potassium delivery to within 1mEq/L, with independent control over magnesium or anything else you wish to add. That means the MPS2 system is ready to handle future protocols that call for new cardioprotective and arresting agents.
The MPS2 system offers you independent and precise command over the following parameters:
- Blood: crystalloid ratio (all crystalloid, 1:9 to 1:1, 2:1 to 66:1, or all blood)
- Cardioplegia flow rate (10 - 999 ml/min)
- Arrest agent delivery concentration (0 - 40 mEq/L)
- Additive delivery concentration (0 - 50 ml/L)
- Warm / Cold Operating mode
- Delivery temperature (4 - 42º C)
- Cyclical flow for pulse action delivery
- Low Volume mode for minimal prime applications
- Separate Preset antegrade / retrograde pressure limits (high and low)
- Auto-pressure controlled delivery mode – Regulates flow to maintain a desired delivery pressure
- Delivery route (antegrade, retrograde, and simulgrade)
- Saved protocols allow quick access to routine case parameters
Simplicity
If so much control sounds complicated, relax. Since the design resulted from listening to your requirements, operation is simple and intuitive. Change any parameter at any time in a matter of seconds with a simple Select - Adjust - Confirm approach.
Warm or Cold - Your Choice
Choose from maximum cold to selectable warm temperatures between 4 and 42º C. The combination of integrated heat exchanger, sophisticated circulation subsystem, and several temperature sensors provide precise temperature regulation and measurement.
A single motion installs the stainless-steel bellows heat exchanger on the MPS2 system and automatically connects the two water ports and the pressure, temperature, and level sensors. A temperature probe in the heat exchanger mounting block measures water temperature at the inlet to the heat exchanger. Delivery temperature is measured near the heat exchanger outlet using an infrared sensor. A single solenoid valve controls whether warm or cold water circulates through the heat exchanger. Within the circulation subsystem, water is accessed from either the internal warm water reservoir or the external ice water reservoir. Based on heat exchanger performance characteristics at the set delivery flow rate, the software assesses the required water temperature differential then applies and regulates the heater duty cycle or opens the warm / cold valve in variable increments. The continuous temperature management process remains responsive to changes in flow rate, inlet temperature and temperature set point. Implemented safeguards are part of the MPS2 system, to prevent excessive heating.
Safety
Integrated safety allows you freedom
for other priorities |
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Air Handling
Air is processed and removed from the system via the bubble trap integrated within the heat exchanger. When sufficient air enters the bubble trap, an ultra-sonic level detector notifies the microprocessor which in turn opens the vent valve to expel the air. A downstream air-in-line detector will also stop flow in the event that gross air bypasses the heat exchanger.
Pressure Management
The MPS2 system incorporates three pressure management features:
- Preset upper and lower pressure limits for antegrade and retrograde delivery
- Pressure autoregulation
- Automatic pressure-controlled mode
The MPS2 system goes beyond simply alerting you to upper pressure limit violations. The microprocessor reduces flow, monitors the error condition, and then continues to reduce flow until the condition is resolved or the microprocessor determines the outlet line is occluded. In an occluded line situation, flow is discontinued and a message is displayed. The vent valve also opens momentarily to vent the excess pressure. The automatic flow reduction enhances safety during heart manipulation by reacting to possible pressure spikes. The lower pressure limit alarms are intended to notify you of a displaced catheter.
The automatic pressure-controlled delivery mode (Auto Mode) enables the MPS2 system to maintain a set delivery pressure. After manually setting the desired flow rate and pressure, you simply engage the Auto button. The MPS2 system increases or decreases pump flow rate to maintain the target delivery pressure. This feature can ensure consistent and safe pressures when pressure control is important, such as during coronary sinus or coronary graft perfusion. Another effective utilization is assessing graft patency by monitoring the flow rate increase or decrease as each graft is opened or closed while delivering in Auto Mode.
Pump
Spline pump offers safe passive fill plus
precision and accuracy |
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Spline Piston Pump Technology
Quest's background in fluid delivery pumps brings a new perspective to the challenges of myocardial perfusion delivery. A pumping system concept was developed through the collaboration of Quest Medical, Inc. engineers, a board of perfusionists, and surgeon advisors. This unique pump and control technology enables perfusionists to safely and precisely mix the desired drugs directly with blood and provide overall integrated control and monitoring of cardioplegia delivery.
Three separate but coordinated pump assemblies deliver the essential cardioplegia elements of blood and crystalloid, an arrest agent, and an additive. Flexible pump cassettes contain the sterile fluids, up to 50 milliliters per cassette.
Spline pistons displace the contents of the cassette. Alternating splines on piston and the surrounding inserts, reinforce the cassette and ensure accurate volume displacement over the full piston stroke. Microprocessors control and monitor pump status. A pressure transducer provides data indicating fill status, plus an optical encoder provides data verifying piston movement. The microprocessor issues movement commands to the stepper motors. With piston stroke traversing over 9,700 motor step counts, extreme accuracy is maintained for drug delivery over the range of selectable delivery concentrations.
Depending on piston position, delivery volume per motor step averages between 0.5 and 5.1 microliters. The piston displaces more volume per step through the pump stroke as illustrated in the volumetric displacement curve (Figure 1). Software recalculates motor movements based on piston position. Drug delivery is greater than 95% accurate. The MPS2 system incorporates three microprocessors to allow redundancy and to increase safety.
Figure 1:
Volumetric Displacement Curve |
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Dual Pump / Fill Cycle
The alternating two-chamber configuration of the main pump maintains continuous flow. While one chamber is expelling fluid, the other is being filled and prepared for delivery. Valves are positioned on formed channels within the main pump cassette and control the influx of blood and crystalloid and whether a chamber is expelling fluid or is being refilled. The piston retracts a specific distance for the required volume. The passive refill process relies on the fluid hydrostatic head pressure. Approximately 50 mmHg is required depending on flow rate. The pump confirms correct refill volume by moving the piston forward and verifying chamber fluid pressure. After completing the refill process, the piston moves forward to equalize chamber pressure with the opposite chamber. The balanced pressure results in minimal evidence of the chamber transition.
Product Catalog List
DISPOSABLES
| Cat. No. |
Product Description |
Qty/Case |
| 5001102 |
Cardioplegia Delivery Set with Arrest Agent and Additive Cassettes, 10ft. 3/16” ID Extension Line |
10 |
| 5001102-AS |
Cardioplegia Delivery Set with Arrest Agent and Additive Cassettes, 6ft. 3/16” ID Extension Line |
10 |
| 5001104 |
Arrest Agent Cassette |
10 |
| 5001105 |
Additive Cassette |
10 |
| 5001106 |
Extension Line (3/16" ID) |
10 |
| 5001108 |
Antegrade/Retrograde Y-Set |
10 |
| 5051101 |
Retrograde Extension Pressure Line with Transducer |
10 |
| 5051102 |
Retrograde Extension Pressure Line with Transducer and Y-Set |
10 |
| 5051103 |
Pressure Line with Transducer |
10 |
| 6001101 |
PADCAB™ Delivery Set and Table Kit |
10 |
| 7001102 |
Low Volume Delivery Set |
10 |
| 7001103 |
Low Volume Extension Line 3/16" ID, 6 ft. length |
10 |
| 7001104 |
Low Volume Extension Line 1/8" ID, 6 ft. length |
10 |
