Sample records for cardiopulmonary bypass increases

  1. Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass

    Duara Rajnish; Misra Manoranjan; Bhuyan Ritwick; Sarma P; Jayakumar Karunakaran


    Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomi...

  2. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Rabie Soliman


    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  3. Cardiopulmonary bypass in pregnancy.

    Pomini, F; Mercogliano, D; Cavalletti, C; Caruso, A; Pomini, P


    The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. Maternal mortality was 2.9%. Embryofetal mortality was 20.2%. Examining only the last 40 patients, maternal and embryofetal mortality were 0.0% and 12.5%, respectively. Embryofetal mortality was 24.0% when hypothermia was used, compared with 0.0% while operating in normothermia. Maternal mortality did not change. The use of hypothermia during cardiopulmonary bypass provoked uterine contractions in several patients. Hypothermia decreases O2 exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation. PMID:8561577

  4. Cardiopulmonary bypass in pregnancy

    Mukul Chandra Kapoor


    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  5. NPC 15669 blocks neutrophil CD18 increase and lung injury during cardiopulmonary bypass in pigs

    J. M. Bator


    Full Text Available During cardiopulmonary bypass (CPB, neutrophils become activated due to contact with extracorporeal surfaces and binding of complement fragments C3a and C5a, leading to extravasation and subsequent tissue damage. In this study, the effects of the leumedin NPC 15669 (N [9H - (2,7 dimethylfluorenyl - 9 - methoxy car bonyl]-L-leucine, a leukocyte recruitment inhibitor, were evaluated in a pig model of CPB. NPC 15669 caused significant inhibition of CPB associated increase in CD18 upregulation, lung tissue myeloperoxidase content, and percentage wet weight compared to controls. Lung histology revealed clear airways and minimal neutrophil infiltration in treated animals vs. significant oedema and cellular infiltration in controls. It is concluded that CPB causes a dramatic increase in neutrophil CD18, and that leumedins are effective in inhibiting neutrophil activation and subsequent tissue injury when administered during CPB.

  6. Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass

    Duara Rajnish


    Full Text Available Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomized into 2 groups: (1 cases where residual pump blood was used and (2 controls where residual pump blood was not used. Patients were monitored for hourly drainage on the day of surgery and the 1 st postoperative day and the requirements of homologous blood and its products. Data were matched regarding change in Hemoglobin, Packed Cell Volume and coagulation parameters till 1st postoperative day. All cases were followed up for three years. Results: There was a marginal reduction in bleeding pattern in the early postoperative period in the cases compared to controls. The requirement of homologous blood and its products were also reduced in the cases. Conclusions: The use of CPB circuit blood is safe in the immediate postoperative period. The requirement of homologous blood transfusion can come down if strict transfusion criteria are maintained.

  7. Mini cardiopulmonary bypass: Anesthetic considerations

    Alsatli, Raed A.


    This review article is going to elaborate on the description, components, and advantages of mini-cardiopulmonary bypass (mini-CPB), with special reference to the anesthetic management and fast track anesthesia with mini-CPB. There are several clinical advantages of mini-CPB like, reduced inflammatory reaction to the pump, reduced need for allogenic blood transfusion and lower incidence of postoperative neurological complications. There are certainly important points that have to be considered...

  8. "Orpheus" cardiopulmonary bypass simulation system.

    Morris, Richard W; Pybus, David A


    In this paper we describe a high-fidelity perfusion simulation system intended for use in the training and continuing education of perfusionists. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator can be positioned on an operating table and physically connected to the circuit of the institutional heart-lung machine. The institutional monitoring system is used to display the arterial and central venous pressures, the ECG and the nasopharyngeal temperature using appropriate connections. The simulator is able to reproduce the full spectrum of normal and abnormal events that may present during the course of cardiopulmonary bypass. The system incorporates a sophisticated blood gas model that accurately predicts the behavior of a modern, hollow-fiber oxygenator. Output from this model is displayed in the manner of an in-line blood gas electrode and is updated every 500 msecs. The perfusionist is able to administer a wide variety of drugs during a simulation session including: vasoconstrictors (metaraminol, epinephrine and phenylephrine), a vasodilator (sodium nitroprusside), chronotropes (epinephrine and atropine), an inotrope (epinephrine) and modifiers of coagulation (heparin and protamine). Each drug has a pharmacokinetic profile based on a three-compartment model plus an effect compartment. The simulation system has potential roles in the skill training of perfusionists, the development of crisis management protocols, the certification and accreditation of perfusionists and the evaluation of new perfusion equipment and/or techniques. PMID:18293807

  9. Hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass

    苏肇伉; 周成斌; 张海波; 祝忠群


    Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P<0.05). The fetal catecholamine and cortisol levels increased significantly (P<0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P<0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.

  10. Brain microvascular function during cardiopulmonary bypass

    Sorensen, H.R.; Husum, B.; Waaben, J.; Andersen, K.; Andersen, L.I.; Gefke, K.; Kaarsen, A.L.; Gjedde, A.


    Emboli in the brain microvasculature may inhibit brain activity during cardiopulmonary bypass. Such hypothetical blockade, if confirmed, may be responsible for the reduction of cerebral metabolic rate for glucose observed in animals subjected to cardiopulmonary bypass. In previous studies of cerebral blood flow during bypass, brain microcirculation was not evaluated. In the present study in animals (pigs), reduction of the number of perfused capillaries was estimated by measurements of the capillary diffusion capacity for hydrophilic tracers of low permeability. Capillary diffusion capacity, cerebral blood flow, and cerebral metabolic rate for glucose were measured simultaneously by the integral method, different tracers being used with different circulation times. In eight animals subjected to normothermic cardiopulmonary bypass, and seven subjected to hypothermic bypass, cerebral blood flow, cerebral metabolic rate for glucose, and capillary diffusion capacity decreased significantly: cerebral blood flow from 63 to 43 ml/100 gm/min in normothermia and to 34 ml/100 gm/min in hypothermia and cerebral metabolic rate for glucose from 43.0 to 23.0 mumol/100 gm/min in normothermia and to 14.1 mumol/100 gm/min in hypothermia. The capillary diffusion capacity declined markedly from 0.15 to 0.03 ml/100 gm/min in normothermia but only to 0.08 ml/100 gm/min in hypothermia. We conclude that the decrease of cerebral metabolic rate for glucose during normothermic cardiopulmonary bypass is caused by interruption of blood flow through a part of the capillary bed, possibly by microemboli, and that cerebral blood flow is an inadequate indicator of capillary blood flow. Further studies must clarify why normal microvascular function appears to be preserved during hypothermic cardiopulmonary bypass.

  11. 21 CFR 870.4250 - Cardiopulmonary bypass temperature controller.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass temperature controller. 870... Cardiopulmonary bypass temperature controller. (a) Identification. A cardiopulmonary bypass temperature controller is a device used to control the temperature of the fluid entering and leaving a heat exchanger....

  12. Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?

    Mahmood, Sarah; Bilal, Haris; Zaman, Mahvash; Tang, Augustine


    A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is a fully heparin bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?’ Altogether more than 792 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of...

  13. Dynamic Cerebral Autoregulation after Cardiopulmonary Bypass

    Christiansen, Claus Behrend; Berg, Ronan M G; Plovsing, Ronni;


    Background Cerebral hemodynamic disturbances in the peri- or postoperative period may contribute to postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). We therefore examined dynamic cerebral autoregulation (d......CA) post-CPB and changes in neurocognitive function in patients that had undergone CABG. Materials and Methods We assessed dCA by transfer function analysis of spontaneous oscillations between arterial blood pressure and middle cerebral artery blood flow velocity measured by transcranial Doppler ultrasound...

  14. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.

    Schmitt, Katharina Rose Luise; Fedarava, Katsiaryna; Justus, Georgia; Redlin, Mathias; Böttcher, Wolfgang; Delmo Walter, Eva Maria; Hetzer, Roland; Berger, Felix; Miera, Oliver


    Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P Perfusion temperature did not influence cytokine release, organ injury, or coagulation. Cardiopulmonary bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care. PMID:26581834

  15. 21 CFR 870.4390 - Cardiopulmonary bypass pump tubing.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass pump tubing. 870.4390... bypass pump tubing. (a) Identification. A cardiopulmonary bypass pump tubing is polymeric tubing which is used in the blood pump head and which is cyclically compressed by the pump to cause the blood to...

  16. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...

  17. A genetically engineered human Kunitz protease inhibitor with increased kallikrein inhibition in an ovine model of cardiopulmonary bypass.

    Ohri, S K; Parratt, R; White, T; Becket, J; Brannan, J J; Hunt, B J; Taylor, K M


    A recombinant human serine protease inhibitor known as Kunitz protease inhibitor (KPI) wild type has functional similarities to the bovine Kunitz inhibitor, aprotinin, and had shown a potential to reduce bleeding in an ovine model of cardiopulmonary bypass (CPB). The aim of this study was to assess KPI-185, a modification of KPI-wild type that differs from KPI-wild type in two amino acid residues and which enhances anti-kallikrein activity in a further double-blind, randomized study in an ovine model of CPB, and to compare with our previous study of KPI-wild type and aprotinin in the same ovine model. Post-operative drain losses and subjective assessment of wound 'dryness' showed no significant differences between KPI-185 and KPI-wild type, despite the significant enhancement of kallikrein inhibition using KPI-185 seen in serial kallikrein inhibition assays. These preliminary findings support the hypothesis that kallikrein inhibition is not the major mechanism by which Kunitz inhibitors such as aprotinin reduce perioperative bleeding. PMID:11419655

  18. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.


    ... bypass oxygenator. (a) Identification. A cardiopulmonary bypass oxygenator is a device used to exchange gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  19. Emergent cardiopulmonary bypass during pectus excavatum repair

    Ryan Craner


    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  20. 21 CFR 870.4420 - Cardiopulmonary bypass cardiotomy return sucker.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass cardiotomy return sucker. 870.4420 Section 870.4420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4420 Cardiopulmonary bypass cardiotomy...

  1. Myocardial edema and compromised left ventricular function attributable to dirofilariasis and cardiopulmonary bypass in dogs.

    Rohn, D A; Davis, K L; Mehlhorn, U; Allen, S J; Laine, G A


    We investigated the relation between left ventricular dysfunction and myocardial edema in dogs with heartworm (Dirofilaria immitis) infection that were undergoing cardiopulmonary bypass. Dogs with and without D immitis were anesthetized by continuous thiopental infusion and were mechanically ventilated. Sonomicrometry crystals were placed on the long and short axes of the left ventricle, and a Millar pressure transducer was placed in the left ventricular chamber. Pressure-volume loops were digitized and continuously recorded. Dogs with and without D immitis were placed on standard hypothermic cardiopulmonary bypass, with 1 hour of aortic cross-clamp. Wet-to-dry weight ratio corrected for residual blood volume was used to quantitate the volume of myocardial edema. Preload recruitable stroke work was used as a preload-independent index of systolic function. Tau, the isovolumic relaxation time constant, was determined to assess diastolic relaxation. Dogs with D immitis had increased baseline myocardial wet-to-dry weight ratio. After cardiopulmonary bypass, myocardial edema increased in all dogs. Acute edema attributable to cardiopulmonary bypass decreased preload recruitable stroke work in all dogs of both groups, and dogs with D immitis could not be weaned from cardiopulmonary bypass. Myocardial edema increased diastolic relaxation times (tau) in dogs with and without D immitis. We conclude that cardiopulmonary bypass and heartworm infection induce myocardial edema. This edema compromises left ventricular systolic and diastolic function making D immitis an important confounding factor in weaning dogs from cardiopulmonary bypass. PMID:7717590

  2. Glycemic control and outcome related to cardiopulmonary bypass.

    Thiessen, Steven; Vanhorebeek, Ilse; Van den Berghe, Greet


    Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. The optimal blood glucose target, whether or not glycemic control should be initiated already intraoperatively, and whether or not perioperative glucose administration affects the impact of glycemic control on ischemia-reperfusion damage remain open questions. Hypoglycemia, the risk of which is increased with glycemic control, is also associated with adverse outcomes. However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population. PMID:26060029

  3. Coronary artery bypass surgery without cardiopulmonary bypass: short- and mid-term results.

    Mishra, Y; Mehta, Y; Kohli, V M; Kohli, V; Mairal, M; Mishra, A; Bapna, R K; Trehan, N


    artery bypass grafting, myocardial perfusion scan showed a step-wise improvement in reversible ischemia. The perfusion index increased from 52 percent at three months to 90 percent at 12 months. We conclude that coronary artery bypass grafting without cardiopulmonary bypass can be done with relatively low mortality, more so in a group of patients in whom cardiopulmonary bypass poses a high risk. Transmyocardial laser revascularisation is a suitable means to provide complete myocardial revascularisation along with coronary artery bypass surgery in patients who have graftable vessels in anterior wall and ungraftable vessels in posterolateral and inferior walls. PMID:9505019

  4. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    Marshall, C


    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  5. Self-priming Hemodynamic Reservoir and Inline Flow Meter for a Cardiopulmonary Bypass Simulation

    Raasch, David; Austin, Jon; Tallman, Richard


    Simulator exercises are used at Midwestern University to augment academic and laboratory training toward consolidating particular skills, increasing situation awareness, and preparing the student for practice within the team environment of an operating room. This paper describes an enhanced cardiopulmonary bypass simulator consisting of a self-priming hemodynamic reservoir that includes an inline flow meter. A typical cardiopulmonary bypass adult perfusion circuit was assembled using a roller...

  6. Alveolar proteinosis lung lavage using partial cardiopulmonary bypass.

    Freedman, A P; Pelias, A; Johnston, R F; Goel, I P; Hakki, H I; Oslick, T; Shinnick, J P


    An adult case of pulmonary alveolar proteinosis presented with an arterial oxygen tension of 27 mmHg (3.6 kPa) while breathing air. Dangerous hypoxaemia during lung lavage was avoided by using partial cardiopulmonary bypass.

  7. Normoxic and Hyperoxic Cardiopulmonary Bypass in Congenital Heart Disease


    Cyanotic congenital heart disease comprises a diverse spectrum of anatomical pathologies. Common to all, however, is chronic hypoxia before these lesions are operated upon when cardiopulmonary bypass is initiated. A range of functional and structural adaptations take place in the chronically hypoxic heart, which, whilst protective in the hypoxic state, are deleterious when the availability of oxygen to the myocardium is suddenly improved. Conventional cardiopulmonary bypass delivers hyperoxic...

  8. Electrical failure during cardiopulmonary bypass: a critical moment.

    Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Ozcelik, Gokhan; Yorgancioglu, Cem


    Electrical failure during cardiopulmonary bypass is a crisis situation for the cardiac surgical team. Fortunately, it has a low incidence with low morbidity and mortality rates. Notwithstanding, institutional preventative and management measures should be taken. Here, we report a case of electrical failure during cardiopulmonary bypass, which was successfully managed during the surgery, allowing the patient to recover uneventfully. These unwanted complications can only be managed by promoting awareness and putting in place strategies against them. PMID:27516788

  9. A simple technique can reduce cardiopulmonary bypass use during lung transplantation

    Marcos N. Samano


    Full Text Available Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.


    S. I. Suskov


    Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications. 

  11. Managing the Inflammatory Response after Cardiopulmonary Bypass : Review of the Studies in Animal Models

    Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho


    OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat

  12. 21 CFR 870.4370 - Roller-type cardiopulmonary bypass blood pump.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Roller-type cardiopulmonary bypass blood pump. 870... Roller-type cardiopulmonary bypass blood pump. (a) Identification. A roller-type cardiopulmonary bypass blood pump is a device that uses a revolving roller mechanism to pump the blood through...

  13. 21 CFR 870.4360 - Nonroller-type cardiopulmonary bypass blood pump.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonroller-type cardiopulmonary bypass blood pump... Nonroller-type cardiopulmonary bypass blood pump. (a) Identification. A nonroller-type cardiopulmonary bypass blood pump is a device that uses a method other than revolving rollers to pump the blood...

  14. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class...

  15. 21 CFR 870.4260 - Cardiopulmonary bypass arterial line blood filter.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass arterial line blood filter... Cardiopulmonary bypass arterial line blood filter. (a) Identification. A cardiopulmonary bypass arterial line blood filter is a device used as part of a gas exchange (oxygenator) system to filter...


    HUANG Hui-min; KONG Xiang; WANG Wei; ZHU De-ming; ZHANG Hai-bo


    Objective To study if using autologous lung as a substitute of oxygenator in cardiopulmonary bypass is better than the conventional cardiopulmonary bypass with artificial oxygenator in pulmonary preservation.Methods Twelve piglets were randomly divided into two groups ( n = 6). The isolated lung perfusion model was established. The experimental animals underwent continuous lung perfusion for about 120 min. While the control animals underwent 90 min lung ischemia followed by 30 min reperfusion. Another 12 piglets were randomly divided into two groups ( n =6). The experimental animals underwent bi-ventricular bypass with autologous lung perfusion.While control animals underwent conventional cardiopulmonary bypass with artificial oxygenator. The bypass time and aortic cross clamping time were 135 min and 60 min respectively for each animal. The lung static compliance ( Cstat), alveolus-artery oxygen difference ( PA-aO2 ), TNF-α, IL-6 and wet to dry lung weight ratio (W/D) were measured. Histological and ultra-structural changes of the lung were also observed after bypass. Results After either isolated lung perfusion or cardiopulmonary bypass, the Cstat decreased, the PA-aO2 increased and the content of TNF-α increased for both groups, but the changes of experimental group were much less than those of control group. The lower W/D ratio and mild pathological changes in experimental group than those in control group were also demonstrated. Conclusion Autologous lung is able to tolerate the nonpalsatile perfusion. It can be used as a substitute to artificial ogygenator in cardiopulmonary bypass to minimize the inflammatory pulmonary injury caused mainly by ischemic reperfusion and interaction of the blood to the non-physiological surface of artificial oxygenator.

  17. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;


    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myo...

  18. Comparative study of the protective effect using hypothermic cardiopulmonary bypass and normothermic cardiopulmonary bypass

    HAN Pei-li; FU Qing-lin; ZHANG Xin-zhong; ZHANG-Jie; QIN Yuan-xu; CUI Yu


    Objective To explore the detrimental influence of normothermic and hypothermic cardiopulmonary by-pass during open - heart surgery on immunity function,cytokines and complements. Methods Forty patients with con-genital or rheumatic heart disease were randomized to receive the two strategies: normothermie CPB (study group) andhypothermic CPB (control group) ,20 cases in each group. Venous blood samples were collected at each time points ofpreoperation, end of CPB, day 1,4,7,14 postoperatively to examine the plasma level of IL - 2, TNF - α, C3, C4, IgG,IgM, IgA, CD3, CD4, CD8. Results IL -2 in both groups decreased significantly at day 1,4, and returned to normal atday 7 postoperatively. IL - 2 in control group was significantly lower than that in study group postoperatively. TNF - α intwo groups was all higher at time points of end of CPB,day 1,4 postoperatively;in study group,it returned to normallevel at day 7 postoperatively, whereas in control group, it was still higher at day 7 postoperatively than that before oper-ation ,and returned to normal at day 14 postoperatively. C3 in study group was significantly lower at time points of endof CPB,day 1,7 postoperatively than that in control group;C3 in both groups was all higher at time points of end ofCPB, day 1,4 postoperatively;in study group, it returned to normal level at day 7 postoperatively, whereas in controlgroup,it was still higher at day 7 postoperatively than that before operation and returned to normal at day 14 postopera-tively. CA in study group at time points of end of CPB, day 1 postoperatively was significantly lower than that in controlgroup;C4 in both groups was all lower at time points of end of CPB, day 1,4 postoperatively than that before operation.The results showed that IgA after operation in both groups was significantly lower than that before operation, and re-turned to normal at day 7 postoperatively;IgA in study group at day 1 postoperatively was higher than that in controlgroup. IgG in

  19. Analysis of circulatory mitochondrial DNA level after cardiac surgery with cardiopulmonary bypass and potential prognostic implications.

    Qin, Chaoyi; Gu, Jun; Qian, Hong; Meng, Wei


    Our research letter found that circulatory mtDNA level increased after the end of CPB and positive correlations between mtDNA and peak CRP level, peak BNP level, and peak PCT level, which revealed the prognostic role of perioperative circulatory mtDNA level in patients who underwent cardiopulmonary bypass. PMID:27316503

  20. Arterial pressure during cardiopulmonary bypass is not associated with acute kidney injury

    Kandler, K; Jensen, M E; Nilsson, J C;


    BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is common and is associated with increased mortality. We wanted to investigate if the arterial pressure or the use of norepinephrine during cardiopulmonary bypass were associated with AKI. METHODS: A retrospective analysis of patients who...

  1. Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery

    Ricardo Antonio G. Barbosa


    Full Text Available PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10 or off-pump coronary artery bypass graft (group, n=10 coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL. Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04. Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01 and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01 half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03, compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

  2. Successful cardiopulmonary bypass in diabetics with anaphylactoid reactions to protamine.

    Walker, W. S.; Reid, K G; Hider, C F; Davidson, I. A.; Boulton, F. E.; Yap, P L


    Two insulin dependent diabetics with previous anaphylactic like (anaphylactoid) reactions to protamine underwent successful cardiopulmonary bypass for coronary artery surgery. Platelet concentrates instead of protamine were used to neutralise their systemic heparinisation. In both cases the anaphylactoid reactions first became apparent after administration of protamine sulphate at the end of cardiac catheterisation. These cases show that adverse reactions to protamine need not be a contraindi...

  3. Effect of Dextrose-Crystalloid Priming Solution on Fluid Requirements and Urine Output During Cardiopulmonary Bypass

    Metz, Samuel; Hacker, Jerriann


    We examined the influence of the addition of dextrose to crystalloid cardiopulmonary bypass priming solution. Ten patients received only lactated Ringer's solution during the perioperative period and as their cardiopulmonary bypass priming solution, while ten others, managed identically in all other respects, received only 5% dextrose in lactated Ringer's solution (D 5LR). During cardiopulmonary bypass, patients who did not receive glucose required more supplementary fluid (20.0 vs 2.2 ml Kg−...

  4. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Alain Moré Duarte


    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.




    Full Text Available BACKGROUND: After cardiac surgery acute kidney injury (AKI is a common and serious condition carrying significant costs and is independently associated with increased morbidity and mortality. During cardiopulmonary bypass (CPB surgery, modifiable factors may contri bute to post - operative AKI. Their prevention might be a potential target for nephroprotection and any other morbidity after cardiac surgery. METHODS AND MATERIAL : The objective of the present study was to identify and determine whether intraoperative hypot ension or any other cofactor are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End - stage renal disease. On basis of this patients were divided into two groups according to rise in serum creatinine >0.3 mg/dl till 72 hrs postoperatively. Group B patients have developed AKI (n=34 and the remaining patients were in Group A. RESULT : In our study we have found that mean arterial pressure during CPB were less in group B patients compare to group A patients which was statistically significant (p<0.001. And in this group ICU stay and mortality rate were also high compare to group A pati ent who had not developed AKI. CONCLUSION: Lower MAP during CPB is associated with development of postoperative renal derangement, leads to increase ICU stay and mortality. Larger studies are required to further support the evidence

  6. A pulsatile pump for cardiopulmonary bypass and its clinical use.

    Sasaki, Y; Kawai, T; Nishiyama, K; Murayama, Y; Toda, S; Wada, T; Kitaura, K; Sato, S; Kadowaki, M; Kanki, Y


    A pulsatile pump driven by a coil spring, which was designed and constructed by us, is described in this report. It consists of two main parts, a disposable blood chamber and a driving section. The blood chamber has two leaflet valves and a piston, which is covered with two bellofram rolling diaphragms and moves into the housing to draw in and eject the blood. The driving section consists of three cams, an electric motor and a coil spring. The ejection force is wholly produced by the compressed coil spring and is transmitted to the piston in the blood chamber by a rod. This pump allows the ejection pressure, the beat rates, and the stroke volume all to be changed independently. The performance of the pump was tested by using a circulation model where the beat rate was adjusted from 30 to 250 bpm. The output subsequently increased from 0.8 l/min to 5.7 l/min and the stroke volume, from 20.4 ml to 36.7 ml. This new pump has been used for clinical cardiopulmonary bypasses in 24 patients of open heart surgery and the pressure traces during perfusion resembled those of the patients' own hearts. PMID:3230723

  7. Perioperative considerations in a sickle cell patient undergoing cardiopulmonary bypass

    Monish S Raut


    Full Text Available An 11-year-old child, a known case of sickle cell anaemia with a history suggestive of sickling crisis in the past was scheduled for surgical pulmonary valvotomy. Pre-operative blood transfusion and hydroxyurea were administered. Pre-operative blood transfusion is indicated in sickle cell disease patients to raise the haematocrit level and lower sickle haemoglobin (HbS levels. Before the start of cardiopulmonary bypass (CPB, exchange transfusion was performed to reduce HbS level and raise adult haemoglobin level. Hypothermia was prevented by employing normothermic CPB.

  8. Lepirudin as an alternative to "heparin allergy" during cardiopulmonary bypass

    Parissis Haralabos


    Full Text Available Abstract A treatment strategy of a difficult and unusual problem is presented. We are reporting a case of a patient who had a documented allergy to heparin and required Cardiac surgery for an ASD closure. The anticoagulation regime used during cardiopulmonary bypass was lepirudin based. This report indicates that r-hirudin provides effective anticoagulation, however unless ECT is monitoring, post operative hemorrhage is encountered. Therefore this case is unique not only because of its rarity but also by the fact that it presents the caveats encountered when ECT is not available.

  9. 21 CFR 870.4270 - Cardiopulmonary bypass cardiotomy suction line blood filter.


    ... blood filter. 870.4270 Section 870.4270 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 870.4270 Cardiopulmonary bypass cardiotomy suction line blood filter. (a) Identification. A cardiopulmonary bypass cardiotomy suction line blood filter is a device used as part of a gas exchange...


    Jun-min Chu; Qing-yu Wu; Jian-ping Xu


    Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (ECTCPA) without cardiopulmonary bypass (CPB).Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (noCPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period.Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appeared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P=0.04) and hospital stay (P= 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P= 0.004) in no-CPB group compared with CPB group.Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.

  11. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Popov Aron-Frederik


    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  12. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Ali Rahdari


    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  13. Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes

    Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Ucar, Halil Ibrahim; Yorgancioglu, Cem; Salman, Nevriye; Utku Unal, Ertekin


    Introduction Cardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia–reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount...

  14. Femoro-femoral cardiopulmonary bypass for the resection of an anterior mediastinal mass

    Chaitali SenDasgupta


    Full Text Available The perioperative management of patients with mediastinal mass is challenging. Complete airway obstruction and cardiovascular collapse may occur during the induction of general anaesthesia, tracheal intubation, and positive pressure ventilation. The intubation of trachea may be difficult or even impossible due to the compressed, tortuous trachea. Positive pressure ventilation may increase pre-existing superior vena cava (SVC obstruction, reducing venous return from the SVC causing cardiovascular collapse and acute cerebral oedema. We are describing here the successful management of a patient with a large anterior mediastinal mass by anaesthetizing the patient through a femoro-femoral cardiopulmonary bypass (fem-fem CPB.

  15. Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery

    Vedel, Anne G; Holmgaard, Frederik; Rasmussen, Lars Simon;


    coronary vessel and/or valve disease and who are undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients are stratified by age and surgical procedure and are randomised 1:1 to either an increased mean arterial pressure (70-80 mmHg) or 'usual practice' (40-50 mmHg) during cardiopulmonary...... caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided by the...... cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. METHODS/DESIGN: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients with...

  16. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Aymen N Naguib


    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  17. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Siminelakis Stavros N


    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  18. Apicoaortic Valve Conduit for a Patient with Aortic Valve Stenosis and Patent Coronary Bypass Grafts Using Cardiopulmonary Bypass.

    Shackelford, Anthony G; Relle, Margaret A; Lombardi, Sarah A


    In adults over 65 years of age, aortic valve stenosis has been found to be present in 2-9% within this group. Furthermore, aortic valve replacements in patients whom have had a previous coronary artery bypass grafting surgery have a mortality rate as high as 18%. A non-conventional effective surgical approach of bypassing the aortic valve by inserting an apicoaortic valve conduit (AVC) connecting the left ventricular apex to the descending thoracic aorta has been previously documented. We describe the case of a successful implantation of an AVC in a 64-year-old Caucasian male using cardiopulmonary bypass. PMID:26834287

  19. Separation of craniopagus Siamese twins using cardiopulmonary bypass and hypothermic circulatory arrest.

    Cameron, D E; Reitz, B A; Carson, B S; Long, D M; Dufresne, C R; Vander Kolk, C A; Maxwell, L G; Tilghman, D M; Nichols, D G; Wetzel, R C


    Occipitally joined craniopagus Siamese twins were separated with the use of cardiopulmonary bypass and hypothermic circulatory arrest. The 7-month-old infants shared a large sagittal venous sinus that precluded conventional neurosurgical approach because of risk of exsanguination and air embolism. After craniotomy and preliminary exposure of the sinus, each twin underwent sternotomy and total cardiopulmonary bypass with deep hypothermia. Hypothermic circulatory arrest allowed safe division and subsequent reconstruction of the sinus remnants. Several unusual problems were encountered, including transfusion of a large blood volume from one extracorporeal circuit to the other through the common venous sinus, deleterious warming of the exposed brain during circulatory arrest, and thrombosis of both pump oxygenators. Both infants survived, although recovery was complicated in each by neurologic injury, cranial wound infection, and hydrocephalus. This case demonstrates the valuable supportive role of cardiopulmonary bypass and hypothermic circulatory arrest in the management of complex surgical problems of otherwise inoperable patients. PMID:2682024

  20. Self-priming hemodynamic reservoir and inline flow meter for a cardiopulmonary bypass simulation.

    Raasch, David; Austin, Jon; Tallman, Richard


    Simulator exercises are used at Midwestern University to augment academic and laboratory training toward consolidating particular skills, increasing situation awareness, and preparing the student for practice within the team environment of an operating room. This paper describes an enhanced cardiopulmonary bypass simulator consisting of a self-priming hemodynamic reservoir that includes an inline flow meter. A typical cardiopulmonary bypass adult perfusion circuit was assembled using a roller pump console and integrated oxygenator/heat exchanger/reservoir and primed with 2 liters of water. For patient simulation, a soft-sided reservoir bag was mounted onto an inclined platform. A 1-liter soft-sided bag was placed just above the reservoir, providing an overflow reservoir. The priming line extended to the head of the mannequin. The arterial, venous, and suction lines extended through the open chest. The primed perfusion circuit was connected to ports on the filled reservoir bag. To test the patient simulation, the arterial pump output was adjusted to flow rates ranging from 1-7 liters per minute, with a complete interruption (to zero flow) between each test run. An inline flow meter was added to the bypass circuit and an analog to digital converter board was used to pass flow data into the computer-based simulation program. The use of an inclined hemodynamic reservoir bag proved to be self-priming and functional without problems over a wide range of flows tested. By including a reservoir with the mannequin, plus processing and displaying real-time flow data using the CPB-Sim simulation program, a higher fidelity and more realistic simulation experience was created. PMID:20648900

  1. Comparative Effects of Angiotensin Receptor BlockadeandACE Inhibition on the Fibrinolytic and Inflammatory Responses to Cardiopulmonary Bypass

    Billings, Frederic T.; Balaguer, Jorge M.; Yu, Chang; Wright, Patricia; Petracek, Michael R.; Byrne, John G; Brown, Nancy J.; Pretorius, Mias


    The effects of angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 receptor blockade (ARB) on fibrinolysis and inflammation following cardiopulmonary bypass (CPB) are uncertain. This study tested the hypothesis that ACE inhibition enhances fibrinolysis and inflammation to greater extent than ARB in patients undergoing CPB.One week to five days prior to surgery, patients were randomized to ramipril 5mg/day,candesartan 16mg/day or placebo.ACE inhibition increased intraopera...

  2. The Effect of Low Tidal Volume Ventilation during Cardiopulmonary Bypass on Postoperative Pulmonary Function

    Gholamreza Safarpour; Mohammad Hosein Bakhshaei; Ahmad Moradi; Afshin Farhanchi; Maryam Davoudi


    Background: Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB). In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics. Methods: This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volum...

  3. Esmolol added in repeated, cold, oxygenated blood cardioplegia improves myocardial function after cardiopulmonary bypass

    Dahle, Geir Olav; Salminen, Pirjo-Riitta; Moen, Christian Arvei; Eliassen, Finn; Jonassen, Anne K.; Haaverstad, Rune; Matre, Knut; Grong, Ketil


    Objective: This study investigated if the β-receptor blocking agent esmolol, added to standard oxygenated blood cardioplegia, improved myocardial function after weaning from bypass. Design: A block-randomized, blinded study. Setting: A university laboratory. Participants: Twenty anesthetized pigs, Norwegian Landrace. Interventions: After cardiopulmonary bypass, cardiac arrest was induced with cold (12°C), oxygenated blood cardioplegia, enriched with either esmolol or vehi...

  4. Microbubbles detection during cardiopulmonary bypass with transoesophageal echocardiography: a case report

    Zanatta, Paolo; Bosco, Enrico; Salandin, Valeria; Salvador, Loris; Valfrè, Carlo; Sorbara, Carlo


    Introduction Microembolic signals are usually detected with transcranial doppler during cardiac surgery. This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass. Case presentation A 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach. His past medical history included an uncontrolled hypertension,...

  5. Is the use of albumin in colloid prime solution of cardiopulmonary bypass circuit justified?

    Boks, RH; van Herwerden, LA; Takkenberg, JJM; van Oeveren, W; Gu, YJ; Wijers, MJ; Bogers, AJJC


    Background. Albumin in the priming solution precoats the surface of the cardiopulmonary bypass circuit, supposedly causing delayed adsorption of fibrinogen and reduced activation and adhesion of platelets. This action may result in lower transoxygenator resistance. Because our institution uses a col

  6. Effect of cardiopulmonary bypass on leukocyte activation : changes in membrane-bound elastase on neutrophils

    Tang, M; Gu, YJ; Wang, WJ; Xu, YP; Chen, CZ


    Background: Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase ( MB

  7. Endotoxin release in cardiac surgery with cardiopulmonary bypass : pathophysiology and possible therapeutic strategies. An update

    Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim


    Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome




    Various clinical trials have shown that hemostasis is improved by the administration of aprotinin during cardiopulmonary bypass. However, this effect has not been proved for those patients treated preoperatively with aspirin. Therefore, a double-blind, placebo-controlled study was conducted to test

  9. The effect of pulsatile cardiopulmonary bypass on lung function in elderly patients

    Engels, Gerwin E.; Dodonov, Mikhail; Rakhorst, Gerhard; van Oeveren, Willem; Milano, Aldo D.; Gu, Y. John; Faggian, Giuseppe


    Purpose: Cardiopulmonary bypass is still a major cause of lung injury and delay in pulmonary recovery after cardiac surgery. Although it has been shown that pulsatile flow induced by intra-aortic balloon pumping is beneficial for preserving lung function, it is not clear if the same beneficial effec

  10. The potential of the novel leukocyte removal filter in cardiopulmonary bypass.

    Fujii, Yutaka


    Cardiopulmonary bypass (CPB) is indispensable for cardiac surgery but leads to systemic inflammatory responses and leukocyte activation, possibly due to blood contact with the surface of the CPB unit, surgical, ischemic reperfusion injury, etc. Systemic inflammatory responses during CPB result in increased morbidity and mortality. Activation of leukocytes is an important part of this process and directly contributes to coagulopathy and hemorrhage. This inflammatory response may contribute to the development of postoperative complications, including myocardial dysfunction, respiratory failure, renal and neurologic dysfunction, altered liver function and ultimately, multiple organ failure. Various pharmacologic and mechanical strategies have been developed to minimize the systemic inflammatory response during CPB. For example, leukocyte removal filters were developed in the 1990s for incorporation into the CPB circuit. However, studies of this approach have yielded conflicting findings. The purpose of this was to review the studies of a novel leukocyte removal filter in patients undergoing CPB. PMID:26613267

  11. Effect of short-acting beta blocker on the cardiac recovery after cardiopulmonary bypass

    Qian Yanning


    Full Text Available Abstract The objective of this study was to investigate the effect of beta blocker on cardiac recovery and rhythm during cardiac surgeries. Sixty surgical rheumatic heart disease patients were received esmolol 1 mg/kg or the same volume of saline prior to removal of the aortic clamp. The incidence of cardiac automatic re-beat, ventricular fibrillation after reperfusion, the heart rate after steady re-beat, vasoactive drug use during weaning from bypass, the posterior parallel time and total bypass time were decreased by esmolol treatment. In conclusion: Esmolol has a positive effect on the cardiac recovery in cardiopulmonary bypass surgeries.

  12. Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

    Meybohm Patrick


    Full Text Available Abstract Background Neurologic deficits after cardiac surgery are common complications. Aim of this prospective observational pilot study was to investigate the incidence of postoperative cognitive deficit (POCD after cardiac surgery, provided that relevant decrease of cerebral oxygen saturation (cSO2 is avoided during cardiopulmonary bypass. Methods cSO2 was measured by near infrared spectroscopy in 35 patients during cardiopulmonary bypass. cSO2 was kept above 80% of baseline and above 55% during anesthesia including cardiopulmonary bypass. POCD was tested by trail making test, digit symbol substitution test, Ray's auditorial verbal learning test, digit span test and verbal fluency test the day before and 5 days after surgery. POCD was defined as a decline in test performance that exceeded - 20% from baseline in two tests or more. Correlation of POCD with lowest cSO2 and cSO2 - threshold were determined explorative. Results POCD was observed in 43% of patients. Lowest cSO2 during cardiopulmonary bypass was significantly correlated with POCD (p = 0.015, r2 = 0.44, without Bonferroni correction. A threshold of 65% for cSO2 was able to predict POCD with a sensitivity of 86.7% and a specificity of 65.0% (p = 0.03, without Bonferroni correction. Conclusions Despite a relevant decrease of cerebral oxygen saturation was avoided in our pilot study during cardiopulmonary bypass, incidence of POCD was comparable to that reported in patients without monitoring. A higher threshold for cSO2 may be needed to reduce the incidence of POCD.

  13. Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass

    Claudia Gissi da Rocha Ferreira


    Full Text Available Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15 and a clonidine group (12, were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

  14. Effect of Low-Dose Dopamine on Renal Function and Electrolyte Extraction During Cardiopulmonary Bypass

    Türker EMRE


    Full Text Available OBJECTIVE: Kidney damage after cardiac surgery can cause acute renal failure, increase the morbidity and mortality, and prolong the hospital stay. Various methods have therefore been used to prevent renal failure. One of the most frequently used drugs for this purpose is low-dose dopamine (2-4 mcg/kg/min but it has various disadvantages in addition to advantages. One disadvantage is the increased urinary excretion of electrolytes. We studied the use low-dose dopamine on renal function in patients who had undergone coronary artery bypass surgery. MATERIAL and METHODS: We included 40 patients who were planned to undergo open heart surgery, had developed kidney damage for any reason before the surgery, and had normal ejection fraction (EF in the study. The data were recorded before and 1, 24, and 48 hours after the operation. RESULTS: When we compared the postoperative 24th hour data, urinary K and Cl were higher in the control group than the dopamine group (p<0.05. Postoperative 24th hour creatinine clearance was higher in the dopamine group than the control group (p<0.05. CONCLUSION: We conclude that the use of low-dose dopamine in cardiopulmonary bypass patients in the postoperative period does not have a positive effect on the renal function and does not affect urinary electrolyte excretion.

  15. Plasma levels of immunosuppressive mediators during cardiopulmonary bypass

    E. Borrelli


    Full Text Available The aim of this study was to evaluate plasma levels of two mediators with immunosuppressive properties, complement fraction C3a (C3a and transforming growth factor-β1 (TGF-β1, during extracorporeal circulation. The proliferation index after phytohaemagglutinin (PHA stimulation of isolated peripheral blood mononuclear cells was also investigated. Sixteen patients undergoing hypothermic (n = 8, group 1 and normothermic (n = 8, group 2 cardiopulmormry bypass (CPB were enrolled in this study. As a control, we evaluated four patients undergoing thoracovascular operations without CPB. Blood samples were collected before CPB but after anaesthesia, every 30 min during CPB, at the end of CPB and 10 min after protamine administration. Both C3a and TGF-β1 increased significantly during CPB and after protamine administration in the hypothermic as well as the normothermic group. In the latter case the increase of C3a and TGF-β1, although more prominent, was not significantl higher than in the former group. Conversely, the proliferation, index of peripheral mononuclear cells had already decreased 30 min after CPB was started and remained depressed throughout the CPB time. These results suggest a possible role of C3a and TGF-β1 in the immunological changes occurring during extracorporeal circulation.

  16. Matrix Metalloproteinase-9 Production following Cardiopulmonary Bypass Was Not Associated with Pulmonary Dysfunction after Cardiac Surgery

    Tso-Chou Lin


    Full Text Available Background. Cardiopulmonary bypass (CPB causes release of matrix metalloproteinase- (MMP- 9, contributing to pulmonary infiltration and dysfunction. The aims were to investigate MMP-9 production and associated perioperative variables and oxygenation following CPB. Methods. Thirty patients undergoing elective cardiac surgery were included. Arterial blood was sampled at 6 sequential points (before anesthesia induction, before CPB and at 2, 4, 6, and 24 h after beginning CPB for plasma MMP-9 concentrations by ELISA. The perioperative laboratory data and variables, including bypass time, PaO2/FiO2, and extubation time, were also recorded. Results. The plasma MMP-9 concentrations significantly elevated at 2–6 h after beginning CPB (P<0.001 and returned to the preanesthesia level at 24 h (P=0.23, with predominant neutrophil counts after surgery (P<0.001. The plasma MMP-9 levels at 4 and 6 h were not correlated with prolonged CPB time and displayed no association with postoperative PaO2/FiO2, regardless of reduced ratio from preoperative 342.9±81.2 to postoperative 207.3±121.3 mmHg (P<0.001. Conclusion. Elective cardiac surgery with CPB induced short-term elevation of plasma MMP-9 concentrations within 24 hours, however, without significant correlation with CPB time and postoperative pulmonary dysfunction, despite predominantly increased neutrophils and reduced oxygenation.

  17. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation

    Hansen, Dominique; Roijackers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; DENDALE, PAUL


    Objective: The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Design: Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory ...

  18. Red Kidney: Kidney Transplant From a Deceased Donor Who Received Massive Blood Transfusion During Cardiopulmonary Bypass.

    Bell, Richard; Hanif, Faisal; Prasad, Padmini; Ahmad, Niaz


    Here, we present a case of a deceased-donor kidney transplant. The brain-dead donor had received a massive blood transfusion during cardiopulmonary bypass, which lead to hemolysis, hemoglobinuria, acute kidney injury, and renal replacement therapy. The kidney appeared red after in situ flush. Postoperatively, the recipient developed delayed graft function. Protocol biopsy during the postoperative period revealed the widespread deposition of heme pigment in the renal tubules. Massive blood transfusion and cardiopulmonary bypass surgery are associated with hemolysis and heme pigment deposition in the renal tubules, which subsequently lead to acute kidney injury. Kidneys from such donors appear red and, while this does not preclude transplant, are likely to develop delayed graft function. PMID:26030717

  19. Effect of Cardiopulmonary Bypass on Regional Antibiotic Penetration into Lung Tissue

    Hutschala, D.; Skhirtladze, K.; Kinstner, C.; Zeitlinger, M.; Wisser, W.; Jaeger, W.; Hoeferl, M.; Müller, M; Tschernko, E.


    The use of cardiopulmonary bypass (CPB) during cardiac surgery causes regional ventilation-perfusion mismatch, contributing to regional disturbances in antibiotic penetration into lung tissue. Ventilation-perfusion mismatch is associated with postoperative pneumonia, a frequent and devastating complication after cardiac surgery. In this prospective clinical animal study, we performed in vivo microdialysis to determine the effect of CPB on regional penetration of levofloxacin (LVX) into lung t...

  20. Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

    Vladimir Pichugin; Nikolay Melnikov; Farkhad Olzhayev; Alexander Medvedev; Sergey Jourko; Alishir Gamzaev; Vladimir Chiginev


    Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB) is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor complian...

  1. Median sternotomy for double lung transplantation with cardiopulmonary bypass in seven consecutive patients

    Kohno, Mitsutomo; Steinbrüchel, Daniel A


    We describe our technique of using median sternotomy to perform double lung transplantations with cardiopulmonary bypass. By sparing the respiratory muscles, median sternotomy is probably less invasive and preserves lung function. Furthermore, it causes less long-term discomfort than intercostal...... thoracotomy. Although exposure of the pleural space is less optimal, abundant pleural adhesions can be dissected, particularly in the left posterior pleural cavity, using pericardial traction stitches, exposing the retrocardiac pleura with minimal manipulation of the heart....

  2. Renal hemodynamics, function, and oxygenation during cardiac surgery performed on cardiopulmonary bypass: a modeling study

    Sgouralis, Ioannis; Evans, Roger G.; Gardiner, Bruce S; Smith, Julian A.; Fry, Brendan C.; Layton, Anita T.


    Abstract Acute kidney injury, a prevalent complication of cardiac surgery performed on cardiopulmonary bypass (CPB), is thought to be driven partly by hypoxic damage in the renal medulla. To determine the causes of medullary hypoxia during CPB, we modeled its impact on renal hemodynamics and function, and thus oxygen delivery and consumption in the renal medulla. The model incorporates autoregulation of renal blood flow and glomerular filtration rate and the utilization of oxygen for tubular ...

  3. Heparin Therapy during Extracorporeal Circulation: Deriving an Optimal Activated Clotting Time during Cardiopulmonary Bypass for Isolated Coronary Artery Bypass Grafting

    Palmer, Kenneth; Ridgway, Tim; Al-Rawi, Omar; Poullis, Michael


    Bull’s seminal work on heparin therapy during cardiopulmonary bypass (CPB) was carried out over 30 years ago and has not been updated in the modern era. No correlation with postoperative blood loss was performed. The optimal activated clotting time (ACT) with regard to blood loss has not been established for patients undergoing CPB. A minimum ACT of 400 is based on the lack of visible formation of clots in the CPB circuit. The effect of heparin dose, sensitivity, metabolism, patient size, ele...

  4. Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass

    N.M.H. Bulow


    Full Text Available Cardiopulmonary bypass (CPB with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72 were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA group of 11 patients (4 females and 7 males. The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL-1, IL-6, IL-10, interferon (INF-γ, tumor necrosis factor (TNF-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001 levels compared with TIVA (two-way ANOVA. In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA. Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001, but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

  5. Significance of adrenomedullin under cardiopulmonary bypass in children during surgery for congenital heart disease.

    Takeuchi M


    Full Text Available To elucidate the effect of adrenomedullin (AM on fluid homeostasis under cardiopulmonary bypass (CPB, we investigated the serial changes in plasma AM and other parameters related to fluid homeostasis in 13 children (average age, 28.2 months with congenital heart disease during cardiac surgery under CPB. Arterial blood and urine samples were collected just after initiation of anesthesia, just before commencement of CPB, 10 min before the end of CPB, 60 min after CPB, and 24 h after operation. Plasma AM levels increased significantly 10 min before the end of CPB and decreased 24 h after operation. Urine volume increased transiently during CPB, which paralleled changes in AM. Simple regression analysis showed that plasma AM level correlated significantly with urinary vasopressin, urine volume, urinary sodium excretion, and plasma osmolarity. Stepwise regression analysis indicated that urine volume was the most significant determinant of plasma AM levels. Percent rise in AM during CPB relative to control period correlated with that of plasma brain natriuretic peptide (r = 0.57, P < 0.01. Our results suggest that AM plays an important role in fluid homeostasis under CPB in cooperation with other hormones involved in fluid homeostasis.

  6. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Alessandro Varrica


    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  7. Theophylline Population Pharmacokinetics and Dosing in Children Following Congenital Heart Surgery With Cardiopulmonary Bypass.

    Frymoyer, Adam; Su, Felice; Grimm, Paul C; Sutherland, Scott M; Axelrod, David M


    Children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) frequently develop acute kidney injury due to renal ischemia. Theophylline, which improves renal perfusion via adenosine receptor inhibition, is a potential targeted therapy. However, children undergoing cardiac surgery and CPB commonly have alterations in drug pharmacokinetics. To help understand optimal aminophylline (salt formulation of theophylline) dosing strategies in this population, a population-based pharmacokinetic model was developed using nonlinear mixed-effects modeling (NONMEM) from 71 children (median age 5 months; 90% range 1 week to 10 years) who underwent cardiac surgery requiring CPB and received aminophylline as part of a previous randomized controlled trial. A 1-compartment model with linear elimination adequately described the pharmacokinetics of theophylline. Weight scaled via allometry was a significant predictor of clearance and volume. In addition, allometric scaled clearance increased with age implemented as a power maturation function. Compared to prior reports in noncardiac children, theophylline clearance was markedly reduced across age. In the final population pharmacokinetic model, optimized empiric dosing regimens were developed via Monte Carlo simulations. Doses 50% to 75% lower than those recommended in noncardiac children were needed to achieve target serum concentrations of 5 to 10 mg/L. PMID:26712558

  8. Hydrodynamic evaluation of aortic cardiopulmonary bypass cannulae using particle image velocimetry.

    McDonald, C I; Bolle, E; Lang, H F; Ribolzi, C; Thomson, B; Tansley, G D; Fraser, J F; Gregory, S D


    The high velocity jet from aortic arterial cannulae used during cardiopulmonary bypass potentially causes a "sandblasting" injury to the aorta, increasing the possibility of embolisation of atheromatous plaque. We investigated a range of commonly available dispersion and non-dispersion cannulae, using particle image velocimetry. The maximum velocity of the exit jet was assessed 20 and 40 mm from the cannula tip at flow rates of 3 and 5 L/min. The dispersion cannulae had lower maximum velocities compared to the non-dispersion cannulae. Dispersion cannulae had fan-shaped exit profiles and maximum velocities ranged from 0.63 to 1.52 m/s when measured at 20 mm and 5 L/min. Non-dispersion cannulae had maximum velocities ranging from 1.52 to 3.06 m/s at 20 mm and 5 L/min, with corresponding narrow velocity profiles. This study highlights the importance of understanding the hydrodynamic performance of these cannulae as it may help in selecting the most appropriate cannula to minimize the risk of thromboembolic events or aortic injury. PMID:25987551

  9. Perioperative risk factors for prolonged mechanical ventilation and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass

    Zahra S Faritous


    Full Text Available Background: Prolonged mechanical ventilation is an important recognized complication occurring during cardiovascular surgery procedures. This study was done to assess the perioperative risk factors related to postoperative pulmonary complications and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass. Methods: It was a retrospective study on 5,497 patients, including 31 patients with prolonged ventilatory support and 5,466 patients without it; from the latter group, 350 patients with normal condition (extubated in 6-8 hours without any complication were selected randomly. Possible perioperative risk factors were compared between the two groups using a binary logistic regression model. Results: Among the 5,497 women undergoing coronary artery bypass graft (CABG, 31 women needed prolonged mechanical ventilation (PMV, and 15 underwent tracheostomy. After logistic regression, 7 factors were determined as being independent perioperative risk factors for PMV. Discussion: Age ≥70 years old, left ventricular ejection fraction (LVEF ≤30%, preexisting respiratory or renal disease, emergency or re-do operation and use of preoperative inotropic agents are the main risk factors determined in this study on women undergoing CABG.

  10. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base.

    Landis, R Clive; Brown, Jeremiah R; Fitzgerald, David; Likosky, Donald S; Shore-Lesserson, Linda; Baker, Robert A; Hammon, John W


    A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture "self-identified" anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the "Outcomes 2010" consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings, leukocyte filtration, complement C5 inhibition, preoperative aspirin, and corticosteroid prophylaxis. Interventions at level B evidence (single RCT) for minimizing inflammation included nitric oxide donors, C1 esterase inhibition, neutrophil elastase inhibition, propofol, propionyl-L-carnitine, and intensive insulin therapy. A secondary analysis revealed that suppression of at least one inflammatory marker was necessary but not sufficient to confer clinical benefit. The most effective interventions were those that targeted multiple inflammatory pathways. These observations are consistent with a "multiple hit" hypothesis, whereby clinically effective suppression of the systemic inflammatory response requires hitting multiple

  11. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    Hargrove, M


    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  12. Oxygenator Exhaust Capnography for Prediction of Arterial Carbon Dioxide Tension During Hypothermic Cardiopulmonary Bypass

    Baraka, Anis; El-Khatib, Mohamad; Muallem, Eva; Jamal, Salim; Haroun-Bizri, Sania; Aouad, Marie


    Continuous monitoring and control of arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is essential. A reliable, accurate, and inexpensive system is not currently available. This study was undertaken to assess whether the continuous monitoring of oxygenator exhaust carbon dioxide tension (PexCO2) can be used to reflect PaCO2 during CPB. A total of 33 patients undergoing CPB for cardiac surgery were included in the study. During normothermia (37°C) and stable hypother...

  13. Emergency management of heat exchanger leak on cardiopulmonary bypass with hypothermia.

    Gukop, P; Tiezzi, A; Mattam, K; Sarsam, M


    Heat exchanger leak on cardiopulmonary bypass is very rare, but serious. The exact incidence is not known. It is an emergency associated with the potential risk of blood contamination, air embolism and haemolysis, difficulty with re-warming, acidosis, subsequent septic shock, multi-organ failure and death. We present a prompt, highly co-ordinated algorithm for the successful management of this important rare complication. There is need for further research to look for safety devices that detect leaks and techniques to reduce bacterial load. It is essential that teams practice oxygenator change-out routines and have a well-established change-out protocol. PMID:25870370

  14. Improved red blood cell survival after cardiac operations with administration of urea during cardiopulmonary bypass

    The plasma hemoglobin and red blood cell survival (half-life of 51Cr) was studied in 48 patients undergoing single valve replacement or coronary artery bypass graft. Urea or placebo was administered during cardiopulmonary bypass in a prospective, randomized, double-blind manner to test the potential effect on mechanical hemolysis. The mean plasma hemoglobin level at the end of extracorporeal circulation was significantly lower in the urea-treated groups (coronary artery bypass 342 mg/L; valve replacement 364 mg/L) than in the control groups (coronary artery bypass 635 mg/L, valve replacement 518 mg/L. The half-life of 51Cr was significantly longer in the urea-treated patients (coronary artery bypass 18 days; valve replacement 16 days) than in the control groups (coronary artery bypass 12.4 days; valve replacement 12.7 days) but still below the normal reference value (29 +/- 4 days). The plasma hemoglobin returned to near normal values (50 mg/L) the day after operation (day 1) and remained low with no differences between control and urea-treated groups. The total blood hemoglobin was followed for 2 weeks after operation and showed significantly less anemia in the urea-treated group. The lowest mean blood hemoglobin level was noted between days 5 and 9-114 (coronary artery bypass) and 107 (valve replacement) gm/L in the urea-treated patients compared to 92.3 gm/L in the control subjects. The reduction in the severity of the anemia led to less transfusion in the urea-treated patients (approximately 0.5 unit/patient) than in the control subjects (approximately 1 unit/patient) between days 3 and 14

  15. The effect of cardiopulmonary bypass in coronary artery bypass surgeries (on-pump versus off-pump) on erectile function and endothelium-derived nitric oxide levels

    Onder Canguven; Selami Albayrak; Ahmet Selimoglu; Muhsin Balaban; Ahmet Sasmazel; Ayse Baysal


    PURPOSE: To investigate the effects of on-pump and off-pump coronary artery bypass grafting (CABG) on the erectile function and endothelium-derived nitric oxide (eNO) levels. MATERIALS AND METHODS: Twenty-eight consecutive patients were randomized into two groups depending on use of cardiopulmonary bypass in CABG surgery. The erectile function was evaluated by using the IIEF-5 questionnaire. The plasma eNO levels were determined at baseline and after reactive hyperemia before and after surger...

  16. Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

    García-Bengochea Jose B


    Full Text Available Abstract Background To evaluate, with different pacing modes, acute changes in left ventricular systolic function, obtained by continuous cardiac output thermodilution in various subsets of patients undergoing cardiopulmonary bypass surgery. Increments of mean arterial pressure and cardiac output were considered the end point. Methods Fifty cases electively submitted to cardiac surgery were analyzed. Isolated valve surgery 62%, coronary revascularization 30% and 8% mixed disease. Left ventricular ejection fraction was preserved in 50%,36% had moderate depression,(EF 36%-50% whereas 14% had severe depression (EF  Results Right atrium-right ventricular pacing, decreased significantly mean arterial pressure and cardiac output (2.3% in the overall population and in the subgroups studied. Right atrium-left ventricle, increased mean arterial pressure and cardiac output in 79% of patients and yielded cardiac output increments of 7.5% (0.40 l/m in the low ejection fraction subgroup and 7.3% (0.43 l/m in the left bundle branch block subset. In atrial fibrillation patients, left ventricular and biventricular pacing produced a significant increase in cardiac output 8.5% (0.39 l/min and 11.6% (0.53 l/min respectively. The dP/dt max increased significantly with both modes (p = 0.021,p = 0.028. Conclusion Right atrial-right ventricular pacing generated adverse hemodynamic effects. Right atrium-left ventricular pacing produced significant CO improvement particularly in cases with depressed ventricular function and left bundle branch block. The greatest increments were observed with left ventricular or biventricular pacing in atrial fibrillation with depressed ejection fraction.

  17. Transfusion-free arterial switch operation in a 1.7-kg premature neonate using a new miniature cardiopulmonary bypass system.

    Huebler, Michael; Redlin, Matthias; Boettcher, Wolfgang; Koster, Andreas; Berger, Felix; Peters, Björn; Hetzer, Roland


    In cardiac surgery, the potentially detrimental effects of transfusions on patient outcome are increasingly appreciated. Therefore, at our institution there are continuing efforts to modify our surgical, perfusion, and blood management strategies with the aim of transfusion-free cardiac surgery even in neonates and small children. Stringent improvement of these strategies, particularly the downsizing of the cardiopulmonary bypass system, have now enabled a transfusion-free arterial switch operation in a 1700-gram prematurely born neonate. PMID:18598328

  18. The Effect of Low Tidal Volume Ventilation during Cardiopulmonary Bypass on Postoperative Pulmonary Function

    Gholamreza Safarpour


    Full Text Available Background: Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB. In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics.Methods: This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volume (TV = 3 ml/kg, respiratory rate (RR = 12/min, fraction of inspiratory oxygen (FIO2= 1.0, positive end expiratory pressure (PEEP = 5 cmH2O] was applied during CPB (group I; and in the other 50 patients (group II, the lungs were open to the atmosphere without ventilation. Measurements were taken preoperatively,after CPB, and before discharge.Results: Post-bypass PaO2 (just after CPB 85 versus75 was higher significantly in group I (P value < 0.05. Decrease in postoperative forced expiratory volume in 1 second (25% versus 30% and forced vital capacity (32% versus 35% was less significant in group I. Also, time to extubation (5 hrs versus 5.5 hrs was shorter in group I.Conclusion: Continued low tidal volume ventilation during CPB improved post-bypass oxygenation and lung mechanics.

  19. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

    Kambiz Alizadeh


    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  20. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization, and intramucosal pH.

    Ohri, S K; Becket, J; Brannan, J; Keogh, B E; Taylor, K M


    Studies documenting rises in endotoxin after cardiopulmonary bypass (CPB) have postulated gut mucosal hypoperfusion. We have investigated alterations in jejunal blood flow by laser Doppler flow measurement, intramucosal pH (pHi) by tonometry, and oxygen utilization in a canine model of hypothermic CPB (n = 11 dogs). After 10 minutes of hypothermic CPB, despite no major reduction in superior mesenteric artery flow, mucosal laser Doppler flow decreased to -38.2% +/- 9.3% of levels obtained before bypass (p = 0.008) and serosal laser Doppler flow, to -47.3% +/- 11.4% (p = 0.006). During the hypothermic phase, mesenteric oxygen consumption fell from 0.18 +/- 0.01 to 0.098 +/- 0.01 (p = 0.005), and mesenteric oxygen delivery fell from 1.97 +/- 0.39 to 1.14 +/- 0.12 (p = 0.05). There was no change in jejunal pHi. During the rewarming phase, there was a substantial increase in mucosal laser Doppler flow, peaking at +69.8% +/- 15.2% (p = 0.03), whereas serosal laser Doppler flow returned to values seen prior to CPB (-16.4% +/- 21.5%; p = 0.25). These changes coincided with a surge in oxygen consumption (0.33 +/- 0.042; p = 0.009), while mesenteric oxygen delivery remained depressed at 1.09 +/- 0.12 (p = 0.04). Jejunal pHi fell from a value of 7.36 +/- 0.04 before CPB to 7.12 +/- 0.07 (p = 0.02), thus indicating mucosal hypoxia. During the rewarming phase of hypothermic CPB, there is a disparity between mesenteric oxygen consumption and oxygen delivery with villus tip ischemia; these findings may explain the pathophysiology of endotoxemia during CPB. PMID:8179384

  1. Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model.

    Rodrigo Sánchez-Véliz

    Full Text Available The impact of cardiac surgery using cardiopulmonary bypass (CPB on the respiratory mucociliary function is unknown. This study evaluated the effects of CPB and interruption of mechanical ventilation on the respiratory mucociliary system.Twenty-two pigs were randomly assigned to the control (n = 10 or CPB group (n = 12. After the induction of anesthesia, a tracheostomy was performed, and tracheal tissue samples were excised (T0 from both groups. All animals underwent thoracotomy. In the CPB group, an aorto-bicaval CPB was installed and maintained for 90 minutes. During the CPB, mechanical ventilation was interrupted, and the tracheal tube was disconnected. A second tracheal tissue sample was obtained 180 minutes after the tracheostomy (T180. Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF and in situ mucociliary transport (MCT were studied in ex vivo tracheal epithelium. Mucus viscosity (MV was assessed using a cone-plate viscometer. Qualitative tracheal histological analysis was performed at T180 tissue samples.CBF decreased in the CPB group (13.1 ± 1.9 Hz vs. 11.1 ± 2.1 Hz, p < 0.05 but not in the control group (13.1 ± 1 Hz vs. 13 ± 2.9 Hz. At T90, viscosity was increased in the CPB group compared to the control (p < 0.05. No significant differences were observed in in situ MCT. Tracheal histology in the CPB group showed areas of ciliated epithelium loss, submucosal edema and infiltration of inflammatory cells.CPB acutely contributed to alterations in tracheal mucocilliary function.

  2. A new model of centrifugal blood pump for cardiopulmonary bypass: design improvement, performance, and hemolysis tests.

    Leme, Juliana; Fonseca, Jeison; Bock, Eduardo; da Silva, Cibele; da Silva, Bruno Utiyama; Dos Santos, Alex Eugênio; Dinkhuysen, Jarbas; Andrade, Aron; Biscegli, José F


    A new model of blood pump for cardiopulmonary bypass (CPB) application has been developed and evaluated in our laboratories. Inside the pump housing is a spiral impeller that is conically shaped and has threads on its surface. Worm gears provide an axial motion of the blood column. Rotational motion of the conical shape generates a centrifugal pumping effect and improves pumping performance. One annular magnet with six poles is inside the impeller, providing magnetic coupling to a brushless direct current motor. In order to study the pumping performance, a mock loop system was assembled. Mock loop was composed of Tygon tubes (Saint-Gobain Corporation, Courbevoie, France), oxygenator, digital flowmeter, pressure monitor, electronic driver, and adjustable clamp for flow control. Experiments were performed on six prototypes with small differences in their design. Each prototype was tested and flow and pressure data were obtained for rotational speed of 1000, 1500, 2000, 2500, and 3000 rpm. Hemolysis was studied using pumps with different internal gap sizes (1.35, 1.45, 1.55, and 1.7 mm). Hemolysis tests simulated CPB application with flow rate of 5 L/min against total pressure head of 350 mm Hg. The results from six prototypes were satisfactory, compared to the results from the literature. However, prototype #6 showed the best results. Best hemolysis results were observed with a gap of 1.45 mm, and showed a normalized index of hemolysis of 0.013 g/100 L. When combined, axial and centrifugal pumping principles produce better hydrodynamic performance without increasing hemolysis. PMID:21595709

  3. Effects of phospholipase D on cardiopulmonary bypass-induced neutrophil priming

    吴明; 卢韵碧; 陈如坤


    activity in LPS +fMLP group was higher than that in other groups.Notably, PLD activity was even nonstatistically lower in 1-butanol + LPS + fMLP group than that in LPS or fMLP group. CPB-stirred neutrophils in LPS + fMLP group released more elastase and MPO than control, LPS, and 1-butanol + LPS + fMLP groups did(P<0.01); however,neither of the release was statistically different from that of fMLP group.Conclusions : Cardiopulmonary bypass enables neutrophil priming accompanied with significant increase in PLD activity. Inhibition of neutrophil PLD activation attenuates its priming and may alleviate CPB-induced systemic inflammatory reaction.

  4. Ulinastatin Protects against Acute Kidney Injury in Infant Piglets Model Undergoing Surgery on Hypothermic Low-Flow Cardiopulmonary Bypass.

    Xiaocou Wang

    Full Text Available Infants are more vulnerable to kidney injuries induced by inflammatory response syndrome and ischemia-reperfusion injury following cardiopulmonary bypass especially with prolonged hypothermic low-flow (HLF. This study aims to evaluate the protective role of ulinastatin, an anti-inflammatory agent, against acute kidney injuries in infant piglets model undergoing surgery on HLF cardiopulmonary bypass.Eighteen general-type infant piglets were randomly separated into the ulinastatin group (Group U, n = 6, the control group (Group C, n = 6, and the sham operation group (Group S, n = 6, and anaesthetized. The groups U and C received following experimental procedure: median thoracotomy, routine CPB and HLF, and finally weaned from CPB. The group S only underwent sham median thoracotomy. Ulinastatin at a dose of 5,000 units/kg body weight and a certain volume of saline were administrated to animals of the groups U and C at the beginning of CPB and at aortic declamping, respectively. Venous blood samples were collected at 3 different time points: after anesthesia induction in all experimental groups, 5 minutes, and 120 minutes after CPB in the Groups U and C. Markers for inflammation and acute kidney injury were tested in the collected plasma. N-acetyl-β-D-glucosaminidase (NAG from urine, markers of oxidative stress injury and TUNEL-positive cells in kidney tissues were also detected.The expressions of plasma inflammatory markers and acute kidney injury markers increased both in Group U and Group C at 5 min and 120 min after CPB. Also, numbers of TUNEL-positive cells and oxidative stress markers in kidney rose in both groups. At the time point of 120-min after CPB, compared with the Group C, some plasma inflammatory and acute kidney injury markers as well as TUNEL-positive cells and oxidative stress markers in kidney were significantly reduced in the Group U. Histologic analyses showed that HLF promoted acute tubular necrosis and dilatation

  5. Augmentation of abdominal organ perfusion during cardiopulmonary bypass with a novel intra-aortic pulsatile catheter pump

    Gu, YJ; De Kroon, T; Elstrodt, JM; van Oeveren, W; Boonstra, PW; Rakhorst, G


    Background: Current pulsatile pumps for cardiopulmonary bypass (CPB) are far from satisfactory because of the poor pulsatility. This study was undertaken to examine the efficiency of a novel pulsatile catheter pump on pulsatility and its effect on abdominal organ perfusion during CPB. Methods: Twelv

  6. Clinical Effectiveness of Centrifugal Pump to Produce Pulsatile Flow During Cardiopulmonary Bypass in Patients Undergoing Cardiac Surgery

    Gu, Y. John; van Oeveren, Willem; Mungroop, Hubert E.; Epema, Anne H.; den Hamer, Inez J.; Keizer, Jorrit J.; Leuvenink, Ron P.; Mariani, Massimo A.; Rakhorst, Gerhard


    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate w

  7. [Treatment of a female patient with sickle-cell anemia during cardiac surgery with cardiopulmonary bypass].

    Díaz-Pache, M V Acedo; Sarrión Bravo, M V; Silva Guisasola, J; Ariño Irujo, J; López Timoneda, F


    A 17-year-old girl with drepanocytic (sickle-cell) anemia who was being treated with hydroxyurea and periodic blood transfusions through a Hickman-type catheter was admitted for periodic episodes of fever. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Massive right atrial thrombosis with pulmonary embolism and bacterial endocarditis were detected by computed tomography. Surgery with a beating heart and cardiopulmonary bypass was undertaken. Drepanocytic anemia in individuals homozygous for hemoglobin S is a rare condition in Spain but we are beginning to see a few cases, in which management during anesthesia will be more complicated. High-risk surgery can be carried out in these patients without adverse events if the anesthesiologist is guided by a complete blood workup and takes precautions during and after surgery to control hydration, oxygenation, temperature, and the acid-base balance. PMID:22046869

  8. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass.

    Hargrove, M


    Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial\\/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.

  9. Low-fidelity simulator for technical connection to the cardiopulmonary bypass.

    Hossien, Abdullrazak


    The technical simulator proposed in this study is an additional low-cost, reusable, reproducible and portable tool to guide trainees at all levels to effectively construct it in order to improve their surgical skills in connection with the cardiopulmonary bypass (CPB) circuit. The simulator is a self-made portable box that can be used for an unrestricted number of procedures. It is supplied with self-made anatomical replicas that have been tested to simulate the flexible property of the real anatomy. The building process is detailed in this study. The connection to the CPB is performed by the usage of this simulator, in which surgical handling was tested. The total cost was calculated in Euros (about 3.5 Euros). PMID:26811507

  10. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Aman Jyoti


    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  11. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass.

    Ševerdija, Ervin E; Vranken, Nousjka P A; Teerenstra, Steven; Ganushchak, Yuri M; Weerwind, Patrick W


    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p partial oxygen pressures changed. Cerebral tissue oximetry effectively identifies changes related to surgical events or vulnerable periods during cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation. PMID:26390677

  12. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass.

    Coleman, E T


    The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol\\/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol\\/L (27.5% increase). Group C was also 5.2 mmol\\/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may

  13. Evolution of membrane oxygenator technology for utilization during pediatric cardiopulmonary bypass

    Melchior RW


    Full Text Available Richard W Melchior,1 Steven W Sutton,2 William Harris,3 Heidi J Dalton4,5 1Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, 2Cardiovascular Support Services, Inc., Dallas, TX, 3Department of Perfusion Services, Ochsner Clinic Foundation, New Orleans, LA, 4Alaskan Native Tribal Health Consortium, Anchorage, AK, 5Department of Child Health, University of Arizona-College of Medicine, Phoenix, AZ, USAAbstract: The development of the membrane oxygenator for pediatric cardiopulmonary bypass has been an incorporation of ideology and technological advancements with contributions by many investigators throughout the past two centuries. With the pursuit of this technological achievement, the ability to care for mankind in the areas of cardiac surgery has been made possible. Heart disease can affect anyone within the general population, but one such segment that it can affect from inception includes children. Currently, congenital heart defects are the most common birth defects nationally and worldwide. A large meta-analysis study from 1930 to 2010 was conducted in review of published medical literature totaling 114 papers with a study population of 24,091,867 live births, and divulged a staggering incidence of congenital heart disease involving 164,396 subjects with diverse cardiac illnesses. The prevalence of these diseases increased from 0.6 per 1,000 live births from 1930–1934 to 9.1 per 1,000 live births after 1995. These data reveal an emphasis on a growing public health issue regarding congenital heart disease. This discovery displays a need for heightened awareness in the scientific and medical industrial community to accelerate investigative research on emerging cardiovascular devices in an effort to confront congenital anomalies. One such device that has evolved over the past several decades is the pediatric membrane oxygenator. The pediatric membrane oxygenator, in conjunction with the heart lung

  14. Platelet function during cardiopulmonary bypass using multiple electrode aggregometry: comparison of centrifugal and roller pumps.

    Kehara, Hiromu; Takano, Tamaki; Ohashi, Noburo; Terasaki, Takamitsu; Amano, Jun


    Blood trauma may be lower with centrifugal pumps (CPs) than with roller pumps (RPs) during cardiopulmonary bypass (CPB), because, unlike RPs, CPs do not compress the tubing, and shear stress is considered lower in CPs than in RPs. However, relative platelet function remains unclear. Using multiple electrode aggregometry (MEA), we compared platelet function with CP and RP. Ten swine underwent CPB for 3 h, with five weaned off using CP and five using RP. Platelet function was measured using MEA, as were hemoglobin concentration and platelet count, before sternotomy, after heparin infusion, 30 min and 3 h after starting CPB, after protamine infusion, and 60 min after stopping CPB. Platelet activation was initiated with adenosine diphosphate (ADP), arachidonic acid (AA), and thrombin receptor-activating protein 6 (TRAP). Fibrinogen, platelet factor 4 (PF4), and β-thromboglobin (β-TG) concentrations were measured before sternotomy and 60 min after stopping CPB. In the CP group and using ADP, aggregation was significantly reduced 30 min (P = 0.019) and 3 h (P = 0.027) after starting CPB, recovering to baseline 60 min after CPB was stopped. In the RP group, aggregation was significantly decreased 30 min (P = 0.007) and 3 h (P = 0.003) after starting CPB and after protamine administration (P = 0.028). With AA, aggregation significantly decreased 30 min after starting CPB in both the CP (P = 0.012) and RP (P = 0.016) groups, slightly increasing 3 h after starting CPB and after protamine infusion, and recovering to baseline 60 min after CPB cessation. With TRAP, aggregation in the CP and RP groups decreased 30 min after starting the pump, although changes were not significant; aggregation gradually recovered after 3 h and returned to baseline 60 min after the pumps were stopped. There were no significant differences at all sampling points of MEA. In both groups, fibrinogen, PF4, and β-TG concentrations were similar 60 min after pump cessation and before sternotomy

  15. A novel, recovery, and reproducible minimally invasive cardiopulmonary bypass model with lung injury in rats

    LI Ling-ke; CHENG Wei; LIU Dong-hai; ZHANG Jing; ZHU Yao-bin; QIAO Chen-hui; ZHANG Yan-bo


    Background Cardiopulmonary bypass (CPB) has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction.Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model.The purpose of this study was to establish a good rat model of CPB to study the pathophysiology of potential complications.Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into a CPB group (n=10)and a control group (n=10).All rats were anaesthetized and mechanically ventilated.The carotid artery and jugular vein were cannulated.The blood was drained from the dght atrium via the right jugular and transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery.Priming consisted of 8 ml of homologous blood and 8 ml of colloid.The surface of the hollow fiber oxygenator was 0.075 m2.CPB was conducted for 60 minutes at a flow rate of 100-120 in the CPB group.Oxygen flow/perfusion flow was 0.8 to 1.0,and the mean arterial pressure remained 60-80 mmHg.Blood gas analysis,hemodynamic investigations,and lung histology were subsequently examined.Results All CPB rats recovered from the operative process without incident.Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements.Mean arterial pressure remained stable.The results of blood gas analysis at different times were within the normal range.Levels of IL-1β and TNF-α were higher in the lung tissue in the CPB group (P <0.005).Histological examination revealed marked increases in interstitial congestion,edema,and inflammation in the CPB group.Conclusion This novel,recovery,and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic

  16. Anti-inflammatory effects of propofol during cardiopulmonary bypass: A pilot study

    A Samir


    Full Text Available Introduction: Propofol has been suggested as a useful adjunct to cardiopulmonary bypass (CPB because of its potential protective effect on the heart mediated by a decrease in ischemia-reperfusion injury and inflammation at clinically relevant concentrations. In view of these potentially protective properties, which modulate many of the deleterious mechanism of inflammation attributable to reperfusion injury and CPB, we sought to determine whether starting a low dose of propofol infusion at the beginning of CPB would decrease inflammation as measured by pro-inflammatory markers. Materials and Methods: We enrolled 24 patients undergoing elective coronary artery bypass graft (CABG. The study group received propofol at rate of 120 mcg/kg/min immediately after starting CPB and was maintained throughout the surgery and for the following 6 hours in the intensive care unit (ICU. The control group received propofol dose of 30-50 mcg/kg/min which was started at the time of chest closure with wires and continued for the next 6 hours in the ICU. Interleukins (IL -6, -8 and -10 and tumor necrosis factor alpha (TNFalpha were assayed. Result: The most significant difference was in the level of IL-6 which had a P value of less than 0.06. Starting a low dose propofol early during the CPB was not associated with significant hemodynamic instability in comparison with the control group. Conclusion: Our study shows that propofol may be suitable as an anti-inflammatory adjunct for patients undergoing CABG.

  17. A case-controlled evaluation of the Medtronic Resting Heart System compared with conventional cardiopulmonary bypass in patients undergoing isolated coronary artery bypass surgery†

    Nozohoor, Shahab; Johnsson, Per; Scicluna, Sara; Wallentin, Per; Andell, Elisabeth; Nilsson, Johan


    The Medtronic Resting Heart System (RHS) is a heparin-coated, closed perfusion circuit. Clinical results indicate less haemodilution and reduced complement activation, when compared with a traditional circuit leading to fewer postoperative blood transfusions. We evaluated the potential clinical benefits, including reduced transfusion requirements, when using the RHS compared with conventional cardiopulmonary bypass (cCPB). The study group (n = 330) consisted of patients undergoing isolated co...

  18. A good resuscitation model of non-transthoracic cardiopulmonary bypass in rats

    AN Yong; XIAO Ying-bin; ZHONG Qian-jin


    Objective:To establish a good recoverable rat model of cardiopulmonary bypass (CPB) to lay the foundation for studying the pathophysiology of CPB.Methods:Twenty adult male Sprague-Dawley rats weighing 480 g um via the right jugular vein and further transferred by a miniaturized roller pump to a hollow fiber oxgenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 6 ml of colloid. The surface of the hollow fiber oxgenator was 0.075 m2. Rats were catheterized and brought in bypass for 120 min at a flow rate of 100-120 ml/kg/min. Oxygen flow/ perfusion flow was 0. 8 to 1. 0, the mean arterial pressure (MAP) kept in 60-80 mmHg. Blood gas analysis, lactate dehydrogenase (LDH), and survival rate were examined subsequently.Results: All CPB rats recovered from the operative process without incident and remained uneventful within one week. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. MAP remained stable. The results of blood gas analysis at different time points were within a normal range. No significant haemolysis could be detected in the given time frame under bypass condition by using LDH.Conclusions: The rat model of CPB can principally simulate the clinical setting of human CPB. The nontransthoracic model is easy to establish and is associated with excellent recovery. This well reproducible model may open the field for various studies on pathophysiological process of CPB and also of systemic ischemia-reperfusion injury in vivo.

  19. Awake cardiopulmonary bypass to prevent hemodynamic collapse and loss of airway in a severely symptomatic patient with a mediastinal mass.

    Said, Sameh M; Telesz, Brian J; Makdisi, George; Quevedo, Fernando J; Suri, Rakesh M; Allen, Mark S; Mauermann, William J


    Management of a large mediastinal mass causing respiratory and hemodynamic compromise represents a major challenge during induction of anesthesia and surgical resection. The hemodynamic changes associated with anesthetic induction and initiation of positive-pressure ventilation can lead to acute hemodynamic collapse or inability to ventilate, or both. Initiation of cardiopulmonary bypass before anesthetic induction represents a safe alternative. We present a 37-year-old woman who underwent successful resection of a large anterior mediastinal mass through sternotomy. Cardiopulmonary bypass was instituted using the right femoral vessels under local analgesia to allow safe anesthetic induction. Her postoperative course was uneventful. This represents an example of a team approach to the management of a complex patient to achieve a successful outcome. PMID:25282247

  20. Partial exchange transfusion in a patient with homozygous sickle cell disease undergoing heart surgery with cardiopulmonary bypass: a case report

    Deyvis Cruz


    In patients with sickle cell anemia, the extracorporeal circulation circuit promotes the polymerization of hemoglobin and sickle cell formation. Exchange transfusion reduces circulating levels of hemoglobin S. We report the management of a child with homozygous sickle cell anemia who required surgical closure of atrial septal defect. Partial intraoperative exchange transfusion was performed that decreased hemoglobin S levels from 89% to 23%. Cardiopulmonary bypass was conducted at normothermi...

  1. Bloodless Pediatric Cardiopulmonary Bypass for a 3.2-kg Patient Whose Parents are of Jehovah’s Witness Faith

    Ratliff, Todd M.; Hodge, Ashley B.; Preston, Thomas J.; Galantowicz, Mark; Naguib, Aymen; Gomez, Daniel


    Patients and parents of Jehovah’s Witness (JW) faith present multiple challenges to a medical team, especially in the neonatal and pediatric population. The medical team must balance honoring the parents’ request of not receiving blood products and fulfilling our commitment as advocates for the child’s wellbeing. A multidisciplinary approach to cardiac surgery must be embraced for bloodless cardiopulmonary bypass (CPB) to be successful. At our institution, we have developed strategies and tec...

  2. Platelet Function in Stored Heparinised Autologous Blood Is Not Superior to in Patient Platelet Function during Routine Cardiopulmonary Bypass

    Gallandat Huet, Rolf C. G.; de Vries, Adrianus J.; Cernak, Vladimir; Lisman, Ton


    Background In cardiac surgery, cardiopulmonary bypass (CPB) and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogeneic) transfusion requirements. In this observational study we assessed whether platelet function is better preserved in ex vivo stored autologous blood compared to platelet function in the patient du...

  3. Acute serum sodium concentration changes in pediatric patients undergoing cardiopulmonary bypass and the association with postoperative outcomes

    Lee, Jeong Jin; Kim, Young-Soon; Jung, Hae Hyuk


    The objective of this study is to investigate the degree of serum sodium changes and its association with patient outcomes in pediatrics undergoing heart surgery with cardiopulmonary bypass (CPB). We reviewed the medical records of 275 pediatric patients who underwent heart surgery with CPB. Prior to CPB, hyponatremia (≤135 mmol/L) was observed in 21 of 275 patients. After initiation of CPB, serum sodium decreased significantly and severe hyponatermia (≤130 mmol/L) subsequently developed in 3...


    耿希刚; 李兆志; 李明; 师桃


    Objective To study the changes and their influence factors involved of zinc, copper, calcium and magnesium in plasma and erythrocytes during cardiopulmonary bypass(CPB). Methods Zinc, copper, calcium and magnesium values in plasma and erythrocytes were measured by atomic absorption spectrophotometer during CPB. Results Zinc and copper levels in plasma were significantly elevated above preinduction level before perfusion, but calcium and magnesium levels did not change significantly; zinc, copper and calcium levels in plasma were significantly below preoperation level during CPB, but magnesium level in plasma was significantly increased above preoperation; zinc level in plasma was increased to preoperation level after CPB and began to decrease again at 8 hours after CPB, copper level in plasma was increased to preoperation level at 20 hours after CPB, calcium in plasma was increased significantly from beginning to 8 hours after CPB, magnesium level in plasma was decreased to preoperation level at 8 hours afterCPB. Concentration of zinc , copper, calcium and magnesium in erythrocytes did not change significantly. Conclusion During CPB, the changes of zinc, copper, calcium and magnesium had relation to hemodilution, operative wound, carrier protein, stress and component of priming solution and cardioplegic solution, but no relation to transfer from plasma erythrocytes. The results indicate that it is beneficial to patient's recovery to supplement zinc, copper, calcium and magnesium properly by different ways during cardiac perioperation.

  5. Establishment of an animal model of non-transthoracic cardiopulmonary bypass in rats

    SHANG Hong-wei; XIAO Ying-bin; LIU Mei; CHEN Lin


    Objective: To establish an animal model of non-transthoracic cardiopulmonary bypass (CPB) in rats. Methods: Ten adult male Sprague-Dawlay rats, weighing 350-500 g, were used in this study. CPB was established in these animals through cannulating the left carotid and right jugular vein for arterial perfusion and venous return. The components of perfusion circuit, especially the miniature oxygenator and cannula, were specially designed and improved. The mean arterial pressure was measured with a blood pressure meter through cannulating the left femoral artery. The hemodynamic and blood gas parameters were also monitored. Results: The rat model of non-transthoracic CPB was established successfully. The hemodynamical parameters were changed within an acceptable region during CPB. The miniature oxygenator was sufficient to meet the standard of satisfactory CPB.Conclusions: The rat model of non-transthoracic CPB established through the carotid and jugular cannulation is feasible, easily operated, safe, reliable, and economic. It is an ideal model for the pathophysiological research of CPB.

  6. A numerical performance assessment of a commercial cardiopulmonary by-pass blood heat exchanger.

    Consolo, Filippo; Fiore, Gianfranco B; Pelosi, Alessandra; Reggiani, Stefano; Redaelli, Alberto


    We developed a numerical model, based on multi-physics computational fluid dynamics (CFD) simulations, to assist the design process of a plastic hollow-fiber bundle blood heat exchanger (BHE) integrated within the INSPIRE(TM), a blood oxygenator (OXY) for cardiopulmonary by-pass procedures, recently released by Sorin Group Italia. In a comparative study, we analyzed five different geometrical design solutions of the BHE module. Quantitative geometrical-dependent parameters providing a comprehensive evaluation of both the hemo- and thermo-dynamics performance of the device were extracted to identify the best-performing prototypical solution. A convenient design configuration was identified, characterized by (i) a uniform blood flow pattern within the fiber bundle, preventing blood flow shunting and the onset of stagnation/recirculation areas and/or high velocity pathways, (ii) an enhanced blood heating efficiency, and (iii) a reduced blood pressure drop. The selected design configuration was then prototyped and tested to experimentally characterize the device performance. Experimental results confirmed numerical predictions, proving the effectiveness of CFD modeling as a reliable tool for in silico identification of suitable working conditions of blood handling medical devices. Notably, the numerical approach limited the need for extensive prototyping, thus reducing the corresponding machinery costs and time-to-market. PMID:25890509

  7. Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

    Marc Licker


    Full Text Available A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

  8. Comportamiento de los pacientesancianosoperados de cirugíacardíaca con circulaciónextracorpórea/ Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Alain Moré Duarte


    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks. Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass. Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014. Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively. Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  9. Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass

    Nigro Neto, Caetano; De Simone, Francesco; Cassarà, Luigi; Dos Santos Silva, Carlos Gustavo; Maranhão Cardoso, Thiago Augusto Almeida; Carcò, Francesco; Zangrillo, Alberto; Landoni, Giovanni


    Background: Recently, evidence of cardio-protection and reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). These findings seem to be enhanced when the volatile agents are used during all the surgical procedure, including the CPB period. Aims: Since the administration of volatile agents through CPB can be beneficial to the patients, we decided to review the use of volatile agents vaporized in the CPB circuit and to summarize some tricks and tips of this technique using our 10-year experience of Brazilian and Italian centers with a large volume of cardiac surgeries. Study Setting: Hospital. Methods: A literature review. Results: During the use of the volatile agents in CPB, it is very important to analyze all gases that come in and go out of the membrane oxygenators. The proper monitoring of inhaled and exhaled fraction of the gas allows not only monitoring of anesthesia level, but also the detection of possible leakage in the circuit. Any volatile agent in the membrane oxygenator is supposed to pollute the operating theater. This is the major reason why proper scavenging systems are always necessary when this technique is used. Conclusion: While waiting for industry upgrades, we recommend that volatile agents should be used during CPB only by skilled perfusionists and physicians with the aim to reduce postoperative morbidity and mortality. PMID:27052063

  10. Effects of Cardiopulmonary Bypass on Mediastinal Drainage and the Use of Blood Products in the Intensive Care Unit in 60- to 80-Year-Old Patients Who Have Undergone Coronary Artery Bypass Grafting

    Fatih Aygün; Mehmet Özülkü; Murat Günday


    ABSTRACT OBJECTIVE: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. METHODS: The present study comprises a total of 174 patients who have undergone coronary artery bypass graf...

  11. Evaluation of a physiologic pulsatile pump system for neonate-infant cardiopulmonary bypass support.

    Undar, A; Masai, T; Inman, R; Beyer, E A; Mueller, M A; McGarry, M C; Frazier, O H; Fraser, C D


    An alternate physiologic pulsatile pump (PPP) system was designed and evaluated to produce sufficient pulsatility during neonate-infant open heart surgery. This hydraulically driven pump system has a unique "dual" pumping chamber mechanism. The first chamber is placed between the venous reservoir and oxygenator and the second chamber between the oxygenator and patient. Each chamber has two unidirectional tricuspid valves. Stroke volume (0.2-10 ml), upstroke rise time (10-350 msec), and pump rate (2-250 beats per minute [bpm]) can be adjusted independently to produce adequate pulsatility. This system has been tested in 3-kg piglets (n = 6), with a pump flow of 150 ml/kg/min, a pump rate of 150 bpm, and a pump ejection time of 110 msec. After initiation of cardiopulmonary bypass (CPB), all animals were subjected to 25 minutes of hypothermia to reduce the rectal temperatures to 18 degrees C, 60 minutes of deep hypothermic circulatory arrest (DHCA), then 10 minutes of cold perfusion with a full pump flow, and 40 minutes of rewarming. During CPB, mean arterial pressures were kept at less than 50 mm Hg. Mean extracorporeal circuit pressure (ECCP), the pressure drop of a 10 French aortic cannula, and the pulse pressure were 67+/-9, 21+/-6, and 16+/-2 mm Hg, respectively. All values are represented as mean+/-SD. No regurgitation or abnormal hemolysis has been detected during these experiments. The oxygenator had no damping effect on the quality of the pulsatility because of the dual chamber pumping mechanism. The ECCP was also significantly lower than any other known pulsatile system. We conclude that this system, with a 10 French aortic cannula and arterial filter, produces adequate pulsatility in 3 kg piglets. PMID:9952008

  12. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

    Iglézias José Carlos Rossini


    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  13. Potent Antioxidative Potential of Propofol during Cardiopulmonary Bypass in the Adult

    ZHANG; Shihai(


    [1]Stewart J R Blackwell W H Crute S L et al.Inhibitionof surgically induced ischemia/reperfusion injury by oxygen free radical scavengers.J Thorac Cardiovasc Surg 1983 86:262[2]Cavarocchi N C England M D Schaff H V et al.Oxygen free radical generation during cardiopulmonary bypass:correlation with complement activation.Circulation 1986 74 (suppl):Ⅲ 130[3]Nakaya H Tohse N Kanno M.Electrophysiological derangements induced by lipid peroxidation in cardiac tissue.Am J Physiol 1987 253:H1089[4]Hess M L Manson N H.Molecular oxygen:Friend and foe.The role of the oxygen free radical system in the cal cium paradox the oxygen paradox and ischemia/reperfusion injury.J Mol Cell Cardiol 1984 16:969[5]Josephson R A Silverman H S Lakatta E G et al.Study of the mechanisms of hydrogen peroxide and hydroxyl free radical-induced cellular injury and calcium overload in cardiac myocytes.J Biol Chem 1991 266:2354[6]Webster N R Nunn J F.Molecular structure of free radicals and their importance in biological reactions.Br J Anaesth 1988 60:98[7]Navapurkar V U Skepper J N Jones J G et al.Propofol preserves the viability of isolated rat hepatocyte suspensions under an oxidant stress.Anesth Analg 1998 87:1152[8]Hryson H M Fulton B R Faulds D.Propofol:an update of its use in anaesthesia and conscious sedation.Drugs 1995 50:513[9]Murphy P G Myers D S Davies M J et al.The antioxidant potential of propofol (2 6-diisopropylphenol).Br J Anaesth 1992 68:613[10]Murphy P G Davies M J Columb M O et al.Effect of propofol and thiopentone on free radical mediated oxidative stress of the erythrocyte.Br J Anaesth 1996 76:536[11]Lohr G W Waller H D.Glucose-6-phosphoate dehydrogenase.In:Bergmeyer H U eds.Methods of Enzymatic Analysis.Vol.3 2end ed.New York:Academic 1974.636-643[12]Bergmeyer H U Gawehn K Grassl M.Enzymes as biochemical reagents.In:Bergmeyer H U.eds.Methods of Enzymatic Analysis.Vol.1 2end ed.New York:Academic 1974.424-522[13]Barbagallo M

  14. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2

    Measurement of 133Xe clearance and effluent cerebral venous blood sampling were used in 38 patients to determine the effects of cardiopulmonary bypass, and of maintaining temperature corrected or noncorrected PaCO2 at 40 mm Hg on regulation of cerebral blood flow (CBF) and flow/metabolism coupling. After induction of anesthesia with diazepam and fentanyl, mean CBF was 25 ml X 100 g-1 X min-1 and cerebral oxygen consumption, 1.67 ml X 100 g-1 X min-1. Cerebral oxygen consumption during nonpulsatile cardiopulmonary bypass at 26 degrees C was reduced to 0.42 ml X 100 g-1 X min-1 in both groups. CBF was reduced to 14-15 ml X 100 g-1 X min-1 in the non-temperature-corrected group (n = 21), was independent of cerebral perfusion pressure over the range of 20-100 mm Hg, but correlated with cerebral oxygen consumption. In the temperature-corrected group (n = 17), CBF varied from 22 to 32 ml X 100 g-1 X min-1, and flow/metabolism coupling was not maintained (i.e., CBF and cerebral oxygen consumption varied independently). However, variation in CBF correlated significantly with cerebral perfusion pressure over the pressure range of 15-95 mm Hg. This study demonstrates a profound reduction in cerebral oxygen consumption during hypothermic nonpulsatile cardiopulmonary bypass. When a non-temperature-corrected PaCO2 of approximately 40 mm Hg was maintained, CBF was lower, and analysis of pooled data suggested that CBF regulation was better preserved, i.e., CBF was independent of pressure changes and dependent upon cerebral oxygen consumption

  15. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO/sub 2/

    Murkin, J.M.; Farrar, J.K.; Tweed, W.A.; McKenzie, F.N.; Guiraudon, G.


    Measurement of /sup 133/Xe clearance and effluent cerebral venous blood sampling were used in 38 patients to determine the effects of cardiopulmonary bypass, and of maintaining temperature corrected or noncorrected PaCO/sub 2/ at 40 mm Hg on regulation of cerebral blood flow (CBF) and flow/metabolism coupling. After induction of anesthesia with diazepam and fentanyl, mean CBF was 25 ml X 100 g-1 X min-1 and cerebral oxygen consumption, 1.67 ml X 100 g-1 X min-1. Cerebral oxygen consumption during nonpulsatile cardiopulmonary bypass at 26 degrees C was reduced to 0.42 ml X 100 g-1 X min-1 in both groups. CBF was reduced to 14-15 ml X 100 g-1 X min-1 in the non-temperature-corrected group (n = 21), was independent of cerebral perfusion pressure over the range of 20-100 mm Hg, but correlated with cerebral oxygen consumption. In the temperature-corrected group (n = 17), CBF varied from 22 to 32 ml X 100 g-1 X min-1, and flow/metabolism coupling was not maintained (i.e., CBF and cerebral oxygen consumption varied independently). However, variation in CBF correlated significantly with cerebral perfusion pressure over the pressure range of 15-95 mm Hg. This study demonstrates a profound reduction in cerebral oxygen consumption during hypothermic nonpulsatile cardiopulmonary bypass. When a non-temperature-corrected PaCO/sub 2/ of approximately 40 mm Hg was maintained, CBF was lower, and analysis of pooled data suggested that CBF regulation was better preserved, i.e., CBF was independent of pressure changes and dependent upon cerebral oxygen consumption.

  16. Effect of utilization of veno-venous bypass vs. cardiopulmonary bypass on complications for high level inferior vena cava tumor thrombectomy and concomitant radical nephrectomy

    Ross M. Simon


    Full Text Available ABSTRACT Purpose: To determine if patients with renal cell carcinoma (RCC with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB over cardiopulmonary bypass (CPB for high level (III/IV inferior vena cava (IVC tumor thrombectomy and concomitant radical nephrectomy. Materials and Methods: From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16 or VVB (n=5. We retrospectively reviewed our study population for complication rates and perioperative characteristics. Results: Our results are reported using the validated Dindo-Clavien Classification system comparing the VVB and CPB cohorts. No significant difference was noted in minor complication rate (60.0% versus 68.7%, P=1.0, major complication rate (40.0% versus 31.3%, P=1.0, or overall complication rate (60.0% versus 62.5%, P=1.0 comparing VVB versus CPB. We also demonstrated a trend towards decreased time on bypass (P=0.09 in the VVB cohort. Conclusion: The use of VVB over CPB provides no decrease in minor, major, or overall complication rate. The use of VVB however, can be employed on an individualized basis with final decision on vascular bypass selection left to the discretion of the surgeon based on specifics of the individual case.

  17. Effect of cardiopulmonary bypass on beta adrenergic receptor-adenylate cyclase system on surfaces of peripheral lymphocytes.

    Luo, A; Tian, Y; Jin, S


    The experimental results showed that the level of CAMP, the ratio of cAPM to cGMP, IL-2R expression and IL-2 production in vitro in lymphocytes immediate and 2 weeks after cardiopulmonary bypass (CPB) were significantly lower than those before anesthetics in the patients undergoing cardiac surgery with CPB. These findings suggested that CPB could cause serious damage to adrenergic beta receptor-adenylate cyclase system on circulating lymphocytes surfaces, which might be one of the mechanisms resulting in immunosuppression after open heart surgery with CPB. PMID:12845765

  18. Innovative Double Bypass Engine for Increased Performance

    Manoharan, Sanjivan

    Engines continue to grow in size to meet the current thrust requirements of the civil aerospace industry. Large engines pose significant transportation problems and require them to be split in order to be shipped. Thus, large amounts of time have been spent in researching methods to increase thrust capabilities while maintaining a reasonable engine size. Unfortunately, much of this research has been focused on increasing the performance and efficiencies of individual components while limited research has been done on innovative engine configurations. This thesis focuses on an innovative engine configuration, the High Double Bypass Engine, aimed at increasing fuel efficiency and thrust while maintaining a competitive fan diameter and engine length. The 1-D analysis was done in Excel and then compared to the results from Numerical Propulsion Simulation System (NPSS) software and were found to be within 4% error. Flow performance characteristics were also determined and validated against their criteria.

  19. Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery.

    McNair, E; Marcoux, J-A; Bally, C; Gamble, J; Thomson, D


    Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery. PMID:25934498

  20. Rapid detection of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass surgery

    Objective: To determine the accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in early detection of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery by comparing with serum creatinine. Study Design: Descriptive study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, AFIP in collaboration with AFIC/ NIHD, Rawalpindi, from April to December 2011. Methodology: Eighty eight patients undergoing CPB surgery in AFIC/NIHD were included by consecutive sampling. Blood samples of subjects for serum creatinine analysis were drawn pre-operatively, 4 h, 24 h and 48 h after CPB surgery. Spot urine samples for NGAL were collected at 4 h after CPB surgery. Urine samples were analyzed on Abbott ARCHITECT i2000SR analyzer whereas serum creatinine samples were measured on Beckman UniCel DxC 600 Synchron Clinical System. Results: Out of 88 patients, 11 (13%) cases developed AKI 4 h postoperatively. Urinary NGAL increased markedly at 4 h postoperatively as compared to serum creatinine which showed rise at 24 - 48 h after cardiac surgery. Analysis of urine NGAL at a cutoff value of 87 ng/ml showed area under the curve of 0.91 [95% confidence interval (CI) 0.83 - 0.96] with sensitivity of 90.9% (95% CI 58.7 - 98.5) and specificity of 98.7% (95% CI 92.9-99.8). There was a positive correlation of 4 h urine NGAL and serum delta creatinine at 48 h, which was statistically significant (rs = 0.33, p = 0.001). Conclusion: The study demonstrated that levels of urine NGAL in patients suffering from AKI increased significantly at 4 h as compared to serum creatinine levels. Urine NGAL is an early predictive biomarker of AKI after CPB. (author)

  1. Comparison of urine with plasma neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after cardiopulmonary bypass surgery

    Objective: To compare the accuracy of urine with plasma neutrophil gelatinase-associated lipocalin (NGAL) in early detection of acute kidney injury (AKI) following cardiopulmonary bypass (CPB) surgery. Study Design: A prospective cohort study. Place and duration of study: Department of Chemical Pathology and Endocrinology, AFIP from December 2011 to July 2012. Patients and Methods: Ninety three adult patients planned for CPB surgery in AFIC/NIHD were consecutively included. Blood for serum creatinine were collected preoperatively, 4, 24 and 48 hours (h) after CPB surgery. Blood and urine samples for NGAL analysis were collected only at 4 h. Serum creatinine, plasma and urine NGAL samples were analyzed on UniCel at the rate DxC 600 (Beckman), TRIAGE meter pro (Biosite) and ARCHITECT i2000SR analyzer (Abbott) respectively. Results: Out of 93 patients undergoing CPB surgery, 12 (13%) developed AKI. AKI patients had significantly higher median interquartile range (IQR) urine NGAL of 180 ng/ml (105-277 ng/ml) as compared to control of 6 ng/ml (2-15 ng/ml) and median plasma NGAL of 170 ng/ml (126-274 ng/ml) as compared to control of 75 ng/ml (61-131 ng/ml). The patients had increased urine vs plasma NGAL area under curve (AUC) ( 0.91 vs 0.70 (p = <0.001)), better sensitivity (91% vs 82%) and specificity (98% vs 65%). Conclusion: Plasma and urine NGAL values increased significantly in AKI patients as compared to serum creatinine values. Urine in comparison to plasma NGAL revealed more sensitivity and specificity in detecting AKI following CPB surgery. (author)

  2. The Role of Aquaporin 1 Activated by cGMP in Myocardial Edema Caused by Cardiopulmonary Bypass in Sheep

    Fang-bao Ding


    Full Text Available Background/Aims: Most cardiac procedures involve the use of cardiopulmonary bypass (CPB, which pumps oxygenated blood to the body while the heart and lungs are isolated. CPB can cause profound alterations V in the homeostasis of physiological fluids, which often results in myocardial edema. In our study, we used sheep CPB model of in vivo and in vitro to assess the relationship between cGMP and AQP1 during CPB. Methods: ODQ, a specific inhibitor of soluble guanylate cyclase (sGC, was used to treat the CPB animals or cardiomyocytes. Left ventricular function of each group was determined by pressure-volume system. Water content of myocardial tissue was assessed by dry-wet weight, and cardiomyocytes water permeability was also calculated. The concentration of cGMP was determined by Radioimmunoassay (RIA. mRNA and protein expression of AQP1 were detected by real-time PCR and western blot, respectively. Results: The relative expression level of AQP1 mRNA and protein at each time point (0, 6, 12, 24 or 48 h after CPB was significantly increased (1.18-fold at 12 h, 1.77-fold at 24 h and 2.18-fold at 48h compared with each sham group, the protein expression of AQP1 also showed a rising trend after CPB. The degree of myocardial edema (75.1% at 12 h, 79.3% at 24 h and 81.0% at 48h increased following the CPB surgery. The mRNA expression level of AQP1 was significantly decreased by 39.7% (pin vitro experiments showed the same changing trends as in vivo. Conclusion: cGMP pathway controls water channels and then affects water intake during CPB through an AQP1-mediated pathway.

  3. Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

    Vladimir Pichugin


    Full Text Available Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP and the “beating heart” in combination with pulmonary artery perfusion (PAP and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients, the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients, the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients, the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level, oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and

  4. A novel, minimally invasive rat model of normothermic cardiopulmonary bypass model without blood priming

    Zhu Yaobin; Liu Donghai; Li Xiaofeng; Liu Aijun; Wang Qiang; Qiao Chenhui; Zhang Jing


    Background Cardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction.Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model.The purpose of this study was to establish a novel,minimally invasive rat model of normothermic CPB model without blood priming.Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into CPB group (n=10) and control group (n=10).All rats were anaesthetized and mechanically ventilated.The carotid artery and jugular vein were cannulated.The blood was drained from the right atrium via the right jugular and further transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery.The volume of the priming solution,composed of 6% HES130/0.4 and 125 IU heparin,was less than 12 ml.The surface of the hollow fiber oxygenator was 0.075 m2.CPB was conducted for 60 minutes at a flow rat of 100-120 ml· kg-1· min-1 in CPB group.Oxygen flow/perfusion flow was 0.8 to 1.0,and the mean arterial pressure remained 60-80 mmHg.Results All CPB processes were successfully achieved.Blood gas analysis and hemodynamic parameters of each time point were in accordance with normal ranges.The vital signs of all rats were stable.Conclusions The establishment of CPB without blood priming in rats can be achieved successfully.The nontransthoracic model should facilitate the investigation of pathophysiological processes concerning CPB-related multiple organ dysfunction and possible protective interventions.This novel,recovery,and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.

  5. Combination of biomarkers for diagnosis of acute kidney injury after cardiopulmonary bypass.

    Prowle, John Richard; Calzavacca, Paolo; Licari, Elisa; Ligabo, E Valentina; Echeverri, Jorge E; Bagshaw, Sean M; Haase-Fielitz, Anja; Haase, Michael; Ostland, Vaughn; Noiri, Eisei; Westerman, Mark; Devarajan, Prasad; Bellomo, Rinaldo


    Novel acute kidney injury (AKI) biomarkers offer promise of earlier diagnosis and risk stratification, but have yet to find widespread clinical application. We measured urinary α and π glutathione S-transferases (α-GST and π-GST), urinary l-type fatty acid-binding protein (l-FABP), urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary hepcidin and serum cystatin c (CysC) before surgery, post-operatively and at 24 h after surgery in 93 high risk patient undergoing cardiopulmonary bypass (CPB) and assessed the ability of these biomarkers alone and in combination to predict RIFLE-R defined AKI in the first 5 post-operative days. Twenty-five patients developed AKI. π-GST (ROCAUC = 0.75), lower urine Hepcidin:Creatine ratio at 24 h (0.77), greater urine NGAL:Cr ratio post-op (0.73) and greater serum CysC at 24 h (0.72) best predicted AKI. Linear combinations with significant improvement in AUC were: Hepcidin:Cr 24 h + post-operative π-GST (AUC = 0.86, p = 0.01), Hepcidin:Cr 24 h + NGAL:Cr post-op (0.84, p = 0.03) and CysC 24 h + post-operative π-GST (0.83, p = 0.03), notably these significant biomarkers combinations all involved a tubular injury and a glomerular filtration biomarker. Despite statistical significance in receiver-operator characteristic (ROC) analysis, when assessed by ability to define patients to two groups at high and low risk of AKI, combinations failed to significantly improve classification of risk compared to the best single biomarkers. In an alternative approach using Classification and Regression Tree (CART) analysis a model involving NGAL:Cr measurement post-op followed by Hepcidin:Cr at 24 h was developed which identified high, intermediate and low risk groups for AKI. Regression tree analysis has the potential produce models with greater clinical utility than single combined scores. PMID:25585949

  6. Changes in phospholipase D activity of leukocytes during human systemic inflammatory response syndrome induced by cardiopulmonary bypass

    吴明; 卢韵碧; 陈如坤; 周汉良


    Objective To investigate the fluctuations in arterial leukocyte phospholipase D (PLD) activity during the perioperative period of open heart surgery under cardiopulmonary bypass (CPB), and the relationship between PLD activity and systemic inflammatory response induced by CPB.Methods Arterial blood was obtained from 26 patients undergoing open heart surgery at 8 different time points during the perioperative period, from which leukocytes were isolated for determination of PLD activity, CD11b expression and myeloperoxidase (MPO) activity. Plasma IL-6, IL-8 and C-reactive protein were also determined. The 26 cases were retrospectively divided into 3 groups according to perfusion time in order to detect the possible influences of CPB on PLD activity and IL-6 and IL-8 levels.Results When the ascending aorta was declamped, average arterial leukocyte PLD activity was 0.305±0.132 nmol choline·min-1·mg-1,5.0 times higher of the pre-CPB value, and remained (5.4 times higher of the pre-CPB level) at 72 hours after CPB. Leukocyte CD11b expression and plasma IL-6 and IL-8 levels increased significantly at the end of CPB, while MPO activity and C-reactive protein concentration reached their peaks at 1 and 24 hours, respectively, after CPB. At the end of CPB, the arterial leukocyte PLD activity of patients whose CPB duration was longer than 90 minutes were 1.82- and 1.74-fold that of the other two groups with CPB lasting between 90 and 60 minutes and less than 60 minutes.Conclusions Arterial leukocyte PLD activity rises significantly in CPB and its elevation is earlier and more persistent than other inflammation-related indicators tested; longer CPB duration leads to higher leukocyte PLD activity at the end of CPB. These results imply that PLD could be a new target for prevention of systemic inflammatory response induced by CPB.

  7. Effect of Ligustrazine hydrochloride on coagulation reaction and inflammation reaction in single valve replacement patients with rheumatic heart disease undergoing cardiopulmonary bypass



    Objective To observe the protection effect of Ligustrazine Hydrochloride(LH)on coagulation reaction and inflammation reaction in single valve replacement patients with rheumatic heart disease undergoing cardiopulmonary bypass(CPB).Methods Totally 40 patients undergoing single valve replacement were recruited in the study and randomly assigned to the two groups,the treatment group

  8. Heparin-coated cardiopulmonary bypass circuits selectively deplete the pattern recognition molecule ficolin-2 of the lectin complement pathway in vivo

    Hein, Estrid; Munthe-Fog, L; Thiara, A S;


    randomized into two groups using different coatings of cardiopulmonary bypass circuits, Phisio® (phosphorylcholine polymer coating) and Bioline® (albumin-heparin coating). Concentrations of MBL, ficolin-1, -2 and -3 and soluble C3a and terminal complement complex (TCC) in plasma samples were measured....... Ficolin-3-mediated complement activation potential was evaluated with C4, C3 and TCC as output. There was no significant difference between the two circuit materials regarding MBL, ficolin-1 and -3. In the Bioline® group the ficolin-2 levels decreased significantly after initiation of surgery (P < 0.......0001) and remained reduced throughout the sampling period. This was not seen for Phisio®-coated circuits. Ficolin-3-mediated complement activation potential was reduced significantly in both groups after start of operation (P < 0.0001), whereas soluble C3a and TCC in the samples were increased (P < 0...


    石践; 邵展社; 李学文; 高宏; 马良龙


    目的:观察低温体外循环心内直视手术中细胞因子的变化,探讨体外循环对其影响。方法:应用ELISA法测定IL-8、TNF-α、IL-10在心脏直视手术围术期的血浆浓度。结果:IL-8、IL-10在体外循环结束后明显高于体外循环前(P<0.05),TNF-α无明显变化。结论:IL-8、IL-10作为重要心炎性介质,参与了缺血再灌注损伤的过程。%Objective:Proinflammatory cytokines,such as tumor-necrosis-factor alpha,interleukin-8,and anti-inflammatory cytokine interleukin-10,may play an important role in patient responses to cardiopulmonary bypass.We sought to define the variety of these cytokines under conditions of hypothermic cardiopulmonary bypass.Methods:Twenty patients were monitored with an arterial catherter.Plasma levels of tumor-necrosis-factor alpha,interleukin-8,and interleukin-10 were measured in peripheral arterial blood before anaesthesia,aortic cannulation,at 5 minutes of CPB,at 10 minutes after aortic declamping,and 4 hours after aortic declamping.Results:Levels of interleukin-8 and interleukin-10 were significantly higher arterial blood after aortic declamping.Tumor necrosis factor-a was not increased markedly.Conclusions:Our data suggest that CPB do caused increase of interleukin-8 and 10,but not tumornecrrosis-factor alpha.

  10. Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery

    Vazquez-Jimenez Jaime F


    Full Text Available Abstract Background A comprehensive evaluation of postoperative arrhythmias following surgery for congenital heart disease by continuous Holter monitoring has not been carried out. We aimed, firstly, to establish the time course of pre- and early postoperative arrhythmias by beat-to-beat analysis following cardiopulmonary bypass and, secondly, to examine which surgical procedures present risk factors for specific arrhythmias. Methods 494 consecutive patients, including 96 neonates, were studied with serial 24-hour Holter electrocardiograms before as well as uninterruptedly during the first 72 hours after surgery and prior to discharge. Results Within 24 hours of surgery 59% of the neonates and 79% of the older children developed arrhythmias. Junctional ectopic tachycardia occurred in 9% of neonates and 5% of non-neonates and ventricular tachycardia in 3% and 15%, respectively. For neonates, male sex and longer cross-clamping time independently increased the risk for arrhythmias (odds ratios 2.83 and 1.96/minute, respectively. Ventricular septal defect repair was a strong risk factor for junctional ectopic tachycardia in neonates and in older children (odds ratios 18.8 and 3.69, respectively. For infants and children, older age (odds ratio 1.01/month and closure of atrial septal defects (odds ratio 2.68 predisposed to arrhythmias of any type. Conclusions We present the largest cohort of neonates, infants and children that has been prospectively studied for the occurrence of arrhythmias after cardiac surgery. Postoperative arrhythmias are a frequent and transient phenomenon after cardiopulmonary bypass, provoked both by mechanical irritation of the conduction system and by humoral factors.

  11. Postoperative ventilatory and circulatory effects of heating after aortocoronary bypass surgery. Extended rewarming during cardiopulmonary bypass and postoperative radiant heat supply.

    Joachimsson, P O; Nyström, S O; Tydén, H


    Twenty-four patients with stable angina pectoris were studied after aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). Twelve patients (radiant heat supply group) were rewarmed during CPB to a nasopharyngeal temperature of at least 38 degrees C and a mean rectal temperature of 34.4 degrees C. Postoperatively they received radiant heat supply from a thermal ceiling. In addition, a heating water mattress was used during the end of the operation and heated, humidified inspired gases were administered intra- and postoperatively. The other 12 patients (combination heat supply group) had the rewarming during CPB extended until the rectal temperature exceeded 36 degrees C, but otherwise received the same treatment as the radiant heat supply group. The combination of extended rewarming during CPB and postoperative radiant heat supply significantly reduced oxygen uptake, carbon dioxide production and the required ventilation volumes during early recovery as compared with the values in the radiant heat supply group. The reduced metabolic demands were accompanied by lower cardiac index and oxygen delivery, which, however, were sufficient for adequate tissue perfusion as judged by the similarity in oxygen extraction and arterial base excess values in the two groups. The metabolic demands and ventilatory requirements were reduced to a level at which safe early extubation is possible. PMID:3498281

  12. Coronary flow and reactivity, but not arrhythmia vulnerability, are affected by cardioplegia during cardiopulmonary bypass in piglets

    Liuba, Petru; Johansson, Sune; Pesonen, Erkki;


    velocity (cPFV) rose significantly after surgery especially in the cardioplegia group (p0.4). There was no difference in systolic myocardial function between groups at any time point.Conclusion: In piglets, CPB with cardioplegia was associated with profound abnormalities in coronary vasomotor tone and......Background: Surgery under cardiopulmonary bypass (CPB) is still associated with significant cardiovascular morbidity in both pediatric and adult patients but the mechanisms are not fully understood. Abnormalities in coronary flow and function have been suggested to play an important role. Prior...... studies suggest protective effects on coronary and myocardial function by short intravenous (i.v.) infusion of cyclosporine A before CPB.Methods: Barrier-bred piglets (10-12 kg, n=20) underwent CPB for 45 min, with or without antegrade administration of cardioplegic solution. Prior to CPB, half of the...

  13. Pulmonary microRNA expression profiling in an immature piglet model of cardiopulmonary bypass-induced acute lung injury.

    Li, Wenlei; Ma, Kai; Zhang, Sen; Zhang, Hao; Liu, Jinping; Wang, Xu; Li, Shoujun


    After surgery performed under cardiopulmonary bypass (CPB), severe lung injury often occurs in infants. MicroRNAs (miRNAs) are potentially involved in diverse pathophysiological processes via regulation of gene expression. The objective of this study was to investigate differentially expressed miRNAs and their potential target genes in immature piglet lungs in response to CPB. Fourteen piglets aged 18.6 ± 0.5 days were equally divided into two groups that underwent sham sternotomy or CPB. The duration of aortic cross-clamping was 2 h, followed by 2 h reperfusion. Lung injury was evaluated by lung function indices, levels of cytokines, and histological changes. We applied miRNA microarray and quantitative real-time polymerase chain reaction (qRT-PCR) analysis to determine miRNA expression. Meanwhile, qRT-PCR and enzyme-linked immunosorbent assay were used for validation of predicted mRNA targets. The deterioration of lung function and histopathological changes revealed the piglets' lungs were greatly impaired due to CPB. The levels of tumor necrosis factor alpha, interleukin 6, and interleukin 10 increased in the lung tissue after CPB. Using miRNA microarray, statistically significant differences were found in the levels of 16 miRNAs in the CPB group. Up-regulation of miR-21 was verified by PCR. We also observed down-regulation in the levels of miR-127, miR-145, and miR-204, which were correlated with increases in the expression of the products of their potential target genes PIK3CG, PTGS2, ACE, and IL6R in the CPB group, suggesting a potential role for miRNA in the regulation of inflammatory response. Our results show that CPB induces severe lung injury and dynamic changes in miRNA expression in piglet lungs. Moreover, the changes in miRNA levels and target gene expression may provide a basis for understanding the pathogenesis of CPB-induced injury to immature lungs. PMID:25347932

  14. Evaluation of Capiox RX25 and Quadrox-i Adult Hollow Fiber Membrane Oxygenators in a Simulated Cardiopulmonary Bypass Circuit.

    Wang, Shigang; Kunselman, Allen R; Ündar, Akif


    The Capiox RX25 and Quadrox-i Adult oxygenators are commonly used in clinical adult cardiopulmonary bypass circuits. This study was designed to test the effectiveness of two adult oxygenators in order to evaluate gaseous microemboli (GME) trapping capability and hemodynamic performance. A simulated adult CPB circuit was used and primed with Ringer's lactate and packed red blood cells (hematocrit 25%). All trials were conducted at flow rates of 2-5 L/min (1 L/min increments) with a closed and open arterial filter purge line at 35°C. The postcannula pressure was maintained at 100 mm Hg. After a 5 cc of bolus air was introduced into the venous line, an Emboli Detection and Classification system was used to detect and classify GME at the preoxygenator, postoxygenator, and precannula sites. At the same time, real-time pressure and flow data were recorded, and hemodynamic energy was calculated using a custom-made data acquisition system and Labview software. Our results showed that the oxygenator pressure drops of Quadrox-i Adult oxygenator were lower than Capiox RX25 at all flow rates. The Quadrox-i Adult oxygenator retained more hemodynamic energy across the oxygenator. Both oxygenators could trap the majority of GME, but Capiox RX25 did better than the Quadrox-i Adult oxygenator. No GME was delivered to the pseudo patient at all flow rates in the Capiox group. The Capiox RX25 venous reservoir could capture more GME at lower flow rates, while the Quadrox-i Adult venous reservoir performed better at higher flow rates. An open arterial filter purge line reduced GME slightly in the Capiox group, but GME increased in the Quadrox group. The Quadrox-i Adult oxygenator is a low-resistance, high-compliance oxygenator. The GME handling ability of Capiox RX25 performed well under our clinical setting. Further optimized design for the venous/cardiotomy reservoir is needed. PMID:27168381

  15. Aprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study.

    Harmon, Dominic C


    PURPOSE: Cognitive deficit after coronary artery bypass surgery (CABG) has a high prevalence and is persistent. Meta-analysis of clinical trials demonstrates a decreased incidence of stroke after CABG when aprotinin is administrated perioperatively. We hypothesized that aprotinin administration would decrease the incidence of cognitive deficit after CABG. METHODS: Thirty-six ASA III-IV patients undergoing elective CABG were included in a prospective, randomized, single-blinded pilot study. Eighteen patients received aprotinin 2 x 10(6) KIU (loading dose), 2 x 10(6) KIU (added to circuit prime) and a continuous infusion of 5 x 10(5) A battery of cognitive tests was administered to patients and spouses (n = 18) the day before surgery, four days and six weeks postoperatively. RESULTS: Four days postoperatively new cognitive deficit (defined by a change in one or more cognitive domains using the Reliable Change Index method) was present in ten (58%) patients in the aprotinin group compared to 17 (94%) in the placebo group [95% confidence interval (CI) 0.10-0.62, P = 0.005); (P = 0.01)]. Six weeks postoperatively, four (23%) patients in the aprotinin group had cognitive deficit compared to ten (55%) in the placebo group (95% CI 0.80-0.16, P = 0.005); (P = 0.05). CONCLUSION: In this prospective pilot study, the incidence of cognitive deficit after CABG and cardiopulmonary bypass is decreased by the administration of high-dose aprotinin.

  16. Cardiopulmonary Bypass and Extracorporeal Life Support for Emergent Intraoperative Thoracic Situations.

    Machuca, Tiago N; Cypel, Marcelo; Keshavjee, Shaf


    Intraoperative thoracic surgical catastrophes may require extracorporeal circulation modes to support the patient while the appropriate repair is made. Teamwork is key and, given the evidence supporting better performance with the use of simulation and surgical-crisis checklists, their use should be encouraged. Anticipation is another important factor because the results of intrathoracic malignancy resection are clearly superior in the setting of planned cardiopulmonary support. In addition, familiarity with the different modes of support that are currently available can direct the decision-making process toward the best option to facilitate resolution of the intraoperative catastrophe with the least related morbidity. PMID:26210928

  17. Lowered threshold for ventricular fibrillation in amiodarone-treated pigs undergoing cardiopulmonary bypass and cardioplegic arrest with St. Thomas' cardioplegic solution

    Gøtzsche, L S; Pedersen, Erik Morre; Paulsen, P K


    The antiarrhythmic agent amiodarone has been suspected of causing reduced cardiac performance after extracorporeal circulation and cardioplegic arrest in patients. This has recently been confirmed in an experimental model where pigs were exposed to cardiopulmonary bypass and cold cardioplegic...... arrest with Bretschneider's solution. Due to the high concentration of the cardio-depressant agent procain in Bretschneider's solution, it could be speculated whether it is the combination of amiodarone and this solution that may be potentially deleterious, rather than amiodarone alone. To investigate...... this, adult pigs (75 +/- 2 kg at surgery) were treated with amiodarone for 30 +/- 2 days (1400 mg/day: n = 8, untreated controls: n = 4, blind experiment), followed by exposure to cardiopulmonary bypass with universal cooling to 28 degrees C and topical cold cardioplegic arrest with St. Thomas...

  18. Linearity analysis and comparison study on the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients

    Chen, Jianing; Gorman, Monique; O’Reilly, Bill; Chen, Yu


    The epoc® blood analysis system (Epocal Inc., Ottawa, Ontario, Canada) is a newly developed in vitro diagnostic hand-held analyzer for testing whole blood samples at point-of-care, which provides blood gas, electrolytes, ionized calcium, glucose, lactate, and hematocrit/calculated hemoglobin rapidly. The analytical performance of the epoc® system was evaluated in a tertiary hospital, see related research article “Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients” [1]. Data presented are the linearity analysis for 9 parameters and the comparison study in 40 cardiopulmonary bypass patients on 3 epoc® meters, Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters. PMID:26937460

  19. Linearity analysis and comparison study on the epoc(®) point-of-care blood analysis system in cardiopulmonary bypass patients.

    Chen, Jianing; Gorman, Monique; O'Reilly, Bill; Chen, Yu


    The epoc(®) blood analysis system (Epocal Inc., Ottawa, Ontario, Canada) is a newly developed in vitro diagnostic hand-held analyzer for testing whole blood samples at point-of-care, which provides blood gas, electrolytes, ionized calcium, glucose, lactate, and hematocrit/calculated hemoglobin rapidly. The analytical performance of the epoc(®) system was evaluated in a tertiary hospital, see related research article "Analytical evaluation of the epoc(®) point-of-care blood analysis system in cardiopulmonary bypass patients" [1]. Data presented are the linearity analysis for 9 parameters and the comparison study in 40 cardiopulmonary bypass patients on 3 epoc(®) meters, Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters. PMID:26937460

  20. Linearity analysis and comparison study on the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients

    Jianing Chen


    Full Text Available The epoc® blood analysis system (Epocal Inc., Ottawa, Ontario, Canada is a newly developed in vitro diagnostic hand-held analyzer for testing whole blood samples at point-of-care, which provides blood gas, electrolytes, ionized calcium, glucose, lactate, and hematocrit/calculated hemoglobin rapidly. The analytical performance of the epoc® system was evaluated in a tertiary hospital, see related research article “Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients” [1]. Data presented are the linearity analysis for 9 parameters and the comparison study in 40 cardiopulmonary bypass patients on 3 epoc® meters, Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters.

  1. Pharmacodynamic and Efficacy Profile of TGN 255, a Novel Direct Thrombin Inhibitor, in Canine Cardiopulmonary Bypass and Simulated Mitral Valve Repair

    Nelson, David A.; Nelson, Katherine T.; Miller, Matthew W.; Dupe, Robert; Chahwala, Suresh B.; Kennedy, Anthony; Chander, Chaman; Fossum, Theresa W.


    Heparin-induced thrombocytopenia can be a life-threatening sequel to conventional use of unfractionated heparin in cardiopulmonary bypass (CPB). This study evaluated the pharmacokinetic/pharmacodynamic (PK/PD) and efficacy profile of a novel direct thrombin inhibitor, TGN 255, during cardiac surgery in dogs. Point-of-care coagulation monitoring was also compared against the plasma concentrations of TRI 50c, the active metabolite of TGN 255. The study was conducted in three phases using 10 ani...

  2. Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels

    Åkerfeldt, Torbjörn; Gunningberg, Lena; Leo Swenne, Christine; Ronquist, Göran; Larsson, Anders


    Background: Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels. Methods: Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA. Results: Serum endostatin was significantly reduced 30 days after surgery i...

  3. CPAP of 10 cmH2O during cardiopulmonary bypass followed by an alveolar recruitment manoeuvre does not improve post-bypass oxygenation compared to a recruitment manoeuvre alone in children.

    Kim, J T; Na, H S; Kim, H S; Kim, C S; Kim, S D


    This randomised controlled study assessed whether continuous positive airway pressure (CPAP) of 10 cmH2O during cardiopulmonary bypass improves post-bypass oxygenation in children compared with no CPAP during bypass. We studied children with a ventricular septal defect. CPAP of 10 cmH2O was applied during bypass in the CPAP group (n=24), whereas the lungs were left deflated in the control group (n=20). In both groups, an alveolar recruitment maneuver was performed by applying positive pressure of 30 to 40 cmH2O for five seconds before weaning from bypass. Postoperative ventilation had the peak inflation pressure set to produce an expired tidal volume of 8 ml/kg with positive end expiratory pressure of 5 cmH2O. Arterial blood gas and haemodynamic measurements were performed at skin incision, five minutes after weaning from bypass, five minutes after chest closure and four hours after arrival in the intensive care unit. In four children CPAP was discontinued because it adversely affected the operating field. There was no difference in demographic characteristics, haemodynamic data, bypass time and operation time. No difference was observed between the groups with respect to pH, PaO2, P(A-a) DO2, PaCO2, and ETCO2 at each time. Variability in the data was greater than expected, leading to a decrease in the expected power of the study. CPAP at 10 cmH2O during bypass was not found to improve the post-bypass oxygenation as compared with leaving the lung deflated during bypass in children undergoing ventricular septal defect repair who had an alveolar recruitment maneuver at the end of bypass. PMID:20369762

  4. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials

    Whitlock, R.P.; Chan, S.; Devereaux, P.J.;


    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...... randomizing 3205 patients. Steroids reduced new onset atrial fibrillation [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59 to 0.87], postoperative bleeding [weighted mean difference (WMD) -99.6 mL, 95% CI -149.8 to -49.3], and duration of ICU stay (WMD -0.23 days, 95% CI -0.40 to -0.07). Length of...... hospital stay was also reduced (WMD -0.59 days, 95% CI -1.17 to -0.02), but this result was less robust. A trend towards reduction in mortality was observed (RR 0.73, 95% CI 0.45 to 1.18). Randomized trials suggest that perioperative steroids have significant clinical benefit in CPB patients by decreasing...

  5. Monitoring cerebral oxygen saturation during cardiopulmonary bypass using near-infrared spectroscopy: the relationships with body temperature and perfusion rate

    Teng, Yichao; Ding, HaiShu; Gong, Qingcheng; Jia, Zaishen; Huang, Lan


    During cardiopulmonary bypass (CPB) because of weak arterial pulsation, near-IR spectroscopy (NIRS) is almost the only available method to monitor cerebral oxygenation noninvasively. Our group develops a NIRS oximeter to monitor regional cerebral oxygenation especially its oxygen saturation (rScO2). To achieve optimal coupling between the sensor and human brain, the distances between the light source and the detectors on it are properly chosen. The oximeter is calibrated by blood gas analysis, and the results indicate that its algorithm is little influenced by either background absorption or overlying tissue. We used it to measure the rScO2 of 15 patients during CPB. It is shown that rScO2 is negatively correlated with body temperature and positively with perfusion rate. There are two critical stages during CPB when rScO2 might be relatively low: one is the low-perfusion-rate stage, the other is the early rewarming stage. During cooling, the changes of total hemoglobin concentration (CtHb) compared with its original value is also monitored. It is shown that CtHb decreases to a small extent, which may mainly reflect cerebral vasoconstriction induced by cooling. All these results indicate that NIRS can be used to monitor cerebral oxygenation to protect cerebral tissue during CPB.

  6. PMEA coating of pump circuit and oxygenator may attenuate the early systemic inflammatory response in cardiopulmonary bypass surgery.

    Ueyama, K; Nishimura, K; Nishina, T; Nakamura, T; Ikeda, T; Komeda, M


    We investigated the effects of coating a cardiopulmonary bypass (CPB) circuit and oxygenator with poly-2-methoxy-ethyl acrylate (PMEA) on the systemic inflammatory response during and after CPB. Thirty patients undergoing elective cardiac surgery were randomized into three groups (each group n = 10): noncoated (group N), heparin coated (group H), and PMEA coated circuit and oxygenator (group X). Bradykinin (BK), complement 3 activation (C3a) and interleukin-6 (IL-6) levels were measured as early phase indicators of inflammatory response, as were maximum C reactive proteins (CRP) and white blood cell (WBC) levels. The alveolar-arterial oxygen gradient (A-a DO2) was measured as a parameter of respiratory function. IL-6 levels after CPB were significantly higher in group N than in groups H and X (p < 0.05). Serum BK and C3a levels showed similar patterns in all groups. A-a DO2 was lower at the end of and 3 hours after CPB in groups H and X than in group N (p < 0.05). Maximum CRP levels were lower in group X than in groups N (p < 0.05). This prospective study suggests that PMEA coated CPB may improve respiratory function and decrease systemic inflammatory response after cardiac surgery, possibly because this circuit is as biocompatible as heparin coated CPB circuit. PMID:15307550

  7. Platelet function in stored heparinised autologous blood is not superior to in patient platelet function during routine cardiopulmonary bypass.

    Rolf C G Gallandat Huet

    Full Text Available BACKGROUND: In cardiac surgery, cardiopulmonary bypass (CPB and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogeneic transfusion requirements. In this observational study we assessed whether platelet function is better preserved in ex vivo stored autologous blood compared to platelet function in the patient during CPB. METHODOLOGY/PRINCIPAL FINDING: We measured platelet aggregation responses pre-CPB, 5 min after the start of CPB, at the end of CPB, and after unfractionated heparin reversal, using multiple electrode aggregometry (Multiplate® with adenosine diphosphate (ADP, thrombin receptor activating peptide (TRAP and ristocetin activated test cells. We compared blood samples taken from the patient with samples taken from 100 ml ex-vivo stored blood, which we took to mimick blood storage during normovolemic haemodilution. Platelet function declined both in ex-vivo stored blood as well as in blood taken from the patient. At the end of CPB there were no differences in platelet aggregation responses between samples from the ex vivo stored blood and the patient. CONCLUSION/SIGNIFICANCE: Ex vivo preservation of autologous blood in unfractionated heparin does not seem to be profitable to preserve platelet function.

  8. The haemodynamic effects of the thromboxane A2 receptor antagonist GR32191B during cardiopulmonary bypass in the dog.

    Mathie, R T; Fleming, J S; Barrow, S E; Arnold, J V; Brannan, J J; Becket, J M; Ritter, J M; Taylor, K M


    This study examined whether treatment with the specific thromboxane (TX) A2 receptor antagonist GR32191B would result in an improvement in peripheral haemodynamics during and after cardiopulmonary bypass (CPB) in anaesthetized dogs compared with animals given either saline (control) or aspirin. Following thoracotomy, heparinization and aortic cannulation, and 35 minutes before CPB, dogs received intravenously either GR32191B (15 micrograms/kg/min), saline (50 ml bolus) or aspirin (225 mg bolus) (n = 6 per group). Cardiac output (dye dilution), femoral artery blood flow (electromagnetic flowmeter), gastrocnemius muscle tissue perfusion (133Xe clearance), retinal blood flow (fluorescein angiography), and thromboxane biosynthesis (urinary excretion rates of TXB2 and the metabolite 2,3-dinor-TXB2) were measured before, during and after a standard 90 minute period of CPB at 2.4 l/min/m2 and 28 degrees C. The aspirin-treated group manifested an eightfold reduction in TXB2 excretion compared with controls, indicating a decrease in TXA2 biosynthesis. There were few haemodynamic differences between the groups, though the aspirin-treated group had better maintained muscle tissue perfusion post-CPB and significantly fewer retinal microcirculatory occlusions than GR32191B-treated animals. We conclude that specific TXA2 receptor antagonism provides no significant improvement in peripheral haemodynamics; rather aspirin provides a modest haemodynamic benefit. PMID:8747897

  9. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass

    Engelman, Richard; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina; Dickinson, Timothy A.; Shore-Lesserson, Linda; Hammon, John W.


    Abstract: To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation. PMID:26543248

  10. Human amniotic mesenchymal stem cells alleviate lung injury induced by ischemia and reperfusion after cardiopulmonary bypass in dogs.

    Qiang, Yong; Liang, Guiyou; Yu, Limei


    Transplantation of mesenchymal stem cells may inhibit pathological immune processes contributing to ischemia/reperfusion (I/R) injury. This study aimed to assess the capacity of human amniotic MSC (hAMSCs) to ameliorate I/R injury in a dog model of cardiopulmonary bypass (CPB). Dissociated hAMSCs were cultured ex vivo, and their immunophenotypes were assessed by flow cytometry and immunohistochemistry. A dog model of CPB was established by surgical blockage of the aorta for 1 h. Dogs either underwent mock surgery (Sham group), CPB (model group), or CPB, followed by femoral injection of 2 × 10(7) hAMSCs (n=6). Anti-human nuclei staining revealed hAMSCs in the lungs 3 h after surgery. Oxygen index (OI) and respiratory index (RI) of arterial blood were measured using a biochemical analyzer. Venous blood TNF-α, IL-8, MMP-9, and IL-10 concentrations were measured by ELISA. Pathological changes in the lung were assessed by light microscopy. Third-generation-cultured hAMSCs expressed high levels of CD29, CD44, CD49D, CD73, and CD166 levels, but low CD34 or CD45 amounts and their cytoplasm contained Vimentin. In CPB model animals, OI was elevated and RI reduced; TNF-α, IL-8, and MMP-9 levels were elevated, and IL-10 levels reduced within 3h (P<0.05), but hAMSC transplantation significantly ameliorated these changes (P<0.05). Pathological changes observed in the hAMSC group were significantly less severe than those in the CPB group. In conclusion, hAMSC transplantation can downregulate proinflammatory factors and reduce MMP-9 levels, whereas upregulating the anti-inflammatory molecule IL-10, thus reducing I/R lung injury in a dog model of CPB. PMID:26927516

  11. Clinical evaluation of the Spiral Pump® after improvements to the original project in patients submitted to cardiac surgeries with cardiopulmonary bypass

    Jarbas Jakson Dinkhuysen; Aron Jose Pazin de Andrade; Juliana Leme; Cibele Silva; Claudia Sanches Medina; Cristiane Célia Pereira; José Francisco Biscegli


    Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males), between 20 to 80 (67±14.4) years old weighing 53 to 102 (71.7±12.6) kg, mostly under myocardial revascularization surgery (34.6%)...

  12. Vascular changes after cardiopulmonary bypass and ischemic cardiac arrest: roles of nitric oxide synthase and cyclooxygenase

    F.W. Sellke


    Full Text Available Cardiac surgery involving ischemic arrest and extracorporeal circulation is often associated with alterations in vascular reactivity and permeability due to changes in the expression and activity of isoforms of nitric oxide synthase and cyclooxygenase. These inflammatory changes may manifest as systemic hypotension, coronary spasm or contraction, myocardial failure, and dysfunction of the lungs, gut, brain and other organs. In addition, endothelial dysfunction may increase the occurrence of late cardiac events such as graft thrombosis and myocardial infarction. These vascular changes may lead to increased mortality and morbidity and markedly lengthen the time of hospitalization and cost of cardiac surgery. Developing a better understanding of the vascular changes operating through nitric oxide synthase and cyclooxygenase may improve the care and help decrease the cost of cardiovascular operations.




    Full Text Available BACKGROUND Postoperative Junctional Ectopic Tachycardia (JET remains one of the most common arrhythmias (8%-20% after paediatric cardiac surgery. JET is associated with hemodynamic instability, longer mechanical ventilation time and longer stays in the Cardiac Intensive Care Unit (ICU. AIM The aim of this study is to evaluate the effect of prophylactic administration of magnesium on the occurrence of postoperative arrhythmias in patients undergoing intracardiac repair for Tetralogy of Fallot and to determine the incidence of hypomagnesaemia in paediatric patients undergoing cardiac surgery who require CPB. METHODS Forty five patients with Tetralogy of Fallot undergoing intracardiac repair were enrolled to receive saline, 25mg/kg and 50mg/kg of Magnesium as three groups intraoperatively. Postoperative ECG monitored for JET and magnesium levels measured. RESULTS Hypomagnesaemia was present in 28% of patients. None of the patients who were administered magnesium developed hypomagnesaemia. The incidence of JET was found to be increased (53.3% in the placebo group as compared to 13.3% and 6.7% in the groups receiving 25 and 50mg/kg of magnesium (p<0.001. Eleven patients having JET 7 (64% had hypomagnesaemia and rest of the 4(36% occurred in patients with normal magnesium levels (p<0.01. The mean mechanical ventilation time and the mean length of ICU stay were both prolonged those with hypomagnesaemia. The mean mechanical ventilation time and length of ICU stay were both prolonged in the patients with JET (p<.001 CONCLUSIONS Hypomagnesemia is one of the factors responsible for JET and in turn with prolonged ICU stay and prolonged mechanical ventilation.

  14. Dopexamine increases internal mammary artery blood flow following coronary artery bypass grafting.

    Flynn, Michael J


    OBJECTIVE: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and beta(2) agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. METHODS: Twenty-six American Society of Anaesthesiology class 2-3 elective coronary artery bypass graft patients who did not require inotropic support on separation from cardiopulmonary bypass (CPB) were studied. According to a randomized allocation patients received either dopexamine (1 microg\\/kg per min) or placebo (saline) by intravenous infusion for 15 min. Immediately prior to and at 5,10 and 15 min of infusion, blood flow through the internal mammary and vein grafts (Transit time flow probes, Transonic Ltd.), heart rate, cardiac index, mean arterial pressure and pulmonary haemodynamics were noted. The data were analysed using multivariate analysis of variance. RESULTS: Low-dose dopexamine (1 microg\\/kg per min) caused a significant increase in mammary graft blood flow compared to placebo at 15 min of infusion (P=0.028, dopexamine group left internal mammary artery (LIMA) flow of 43.3+\\/-14.2 ml\\/min, placebo group LIMA flow at 26.1+\\/-16.3 ml\\/min). Dopexamine recipients demonstrated a non-significant trend to increased saphenous vein graft flow (P=0.059). Increased heart rate was the only haemodynamic change induced by dopexamine (P=0.004, dopexamine group at 85.2+\\/-9.6 beats\\/min and placebo group at 71.1+\\/-7.6 beats\\/min after 15 min of infusion). CONCLUSION: This study demonstrates that administration of dopexamine (1 microg\\/kg per min) was associated with a significant increase in internal mammary artery graft blood flow with mild increase in heart rate being the only haemodynamic change. Low-dose dopexamine may

  15. Anesthetic Effects on Damage of Intestinal Mucosal Barrier Function Caused by Cardiopulmonary Bypass%麻醉药物对体外循环致肠道屏障功能损害作用的影响

    苏日娜(综述); 于建设; 温再和(审校)


    肠道是全身应激反应的重要靶器官,又是全身炎症反应综合征、多器官功能障碍综合征的重要诱因。而临床患者当中手术创伤、应激反应、严重感染、休克、心血管外科手术中体外循环等均可导致肠黏膜屏障功能受损,这些过程最终导致肠屏障通透性增加,继而与脓毒症、全身炎症反应综合征、多器官功能障碍综合征发生有密切关系。在临床实践中证实许多常规麻醉药物预处理对体外循环引起的肠道缺血/再灌注损伤有保护作用,继而减轻肠黏膜损伤。%The gut is an important target organ of the systemic stress response ,and an important cause of the systemic inflammatory response syndrome ( SIRS ) and multiple organ dysfunction syndrome ( MODS ) . Surgical trauma,stress,shock,infection,cardiopulmonary bypass all can lead to impaired intestinal mucosal barrier function.These processes eventually lead to intestinal mucosal permeability increase,which is closely associated with sepsis,SIRS and MODS.In clinical practice it′s confirmed that many conventional anesthetics preconditioning can protect the intestine from ischemia reperfusion injury due to cardiopulmonary bypass and decrease the damage of intestinal mucosa .

  16. A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

    Trethowan Brian A


    Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION, posterior ischaemic optic neuropathy (PION, and central retinal artery occlusion (CRAO. These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass; general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone, alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

  17. Perfil sérico da molécula de adesão intercelular-1 no pós-operatório cardíaco de lactentes submetidos à circulação extracorpórea Intercellular adhesion molecule-1 serum profile in cardiac postoperative period of infants undergoing cardiopulmonary bypass

    Angela Hunsche


    bypass time and aortic cross-clamping time were 87 minutes and 53 minutes. All infants used inotropic drugs. The median values of intubation time and length of stay were 72 hours and 21 days. The patients’ mortality rate was 9.5%. The baseline levels of the molecule were higher than the normal values (P<0.0001. The levels of the molecule significantly decreased at the end of the cardiopulmonary bypass (P<0.001, significantly increasing 8 hours after that period (P<0.005, without reaching baseline values 26 hours after that. Conclusions: the soluble intercellular adhesion molecule-1 baseline serum level is higher than normal in infants presenting congenital cardiac defects. This molecule serum levels vary after cardiopulmonary bypass exposure, presenting a characteristic behavior in these patients.

  18. Study of perioperative extravascular lung water and intrathoracic blood volume in patients undergoing CABG surgery with or without cardiopulmonary bypass

    Samia Ragab El Azab


    Discussion and Conclusion: The clinical advantage of off-pump CABG surgery over standard extracorporeal circulation in regard to lung water content was not found in our study. In conclusion, the presumed superiority of off pump surgery for coronary artery bypass grafting could not be confirmed in our group of patients.

  19. Assessment of team training in management of adverse acute events occurring during cardiopulmonary bypass procedure: a pilot study based on an animal simulation model (Fouilloux, Team training in cardiac surgery)

    FOUILLOUX, Virginie; GSELL, Thibault; Lebel, S.; KREITMANN, B.; Berdah, Stéphane


    Successful cardiac surgery is highly dependent upon effective and efficient teamwork. Practical training and development will further enhance the team ability to react to a series of low-frequency occurring adverse events during cardiopulmonary bypass (CPB). One of our specialized educational programs focuses on training the whole team. This training is based on an original animal simulation model. The objective of this pilot study was to assess our method of training and learning in an attem...

  20. Biocompatibility and pathways of initial complement pathway activation with Phisio- and PMEA-coated cardiopulmonary bypass circuits during open-heart surgery.

    Thiara, A S; Mollnes, T E; Videm, V; Andersen, V Y; Svennevig, K; Kolset, S O; Fiane, A E


    A randomized open-heart surgery study comprising 30 patients was undertaken to compare the biocompatibility of Phisio-(phosphorylcholine) and PMEA-(poly-2-methoxyethyl acrylate) coated cardiopulmonary bypass (CPB) circuits and to assess the initial complement pathway activation during open-heart surgery. Blood samples were obtained at five time points, from the start of surgery to 24 hours postoperatively. The following analyses were performed: haemoglobin, lactate dehydrogenase, leukocyte and platelet counts, myeloperoxidase and neutrophil-activating peptide-2, thrombin-anti-thrombin complexes, syndecan-1 and the complement activation products C1rs-C1-inhibitor complexes, C4bc, C3bc, C3bBbP and the terminal complement complex (TCC). No significant inter-group difference was found in any parameters, except for the concentration of TCC which was moderately lower in the PMEA group at termination of CPB. Complement activation during open-heart surgery was mainly mediated through the alternative pathway. In conclusion, PMEA- and Phisio-coated circuits displayed similar biocompatibility with respect to inflammatory and haemostatic responses during and after open-heart surgery. PMID:21177724

  1. Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler – a systematic review of the literature

    Sanders Stephen P


    Full Text Available Abstract Background Transcranial Doppler Ultrasound (TCD is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV. This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB. Methodology We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring". Discussion Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption. Conclusion In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.

  2. Minimally invasive mitral valve surgery through right mini-thoracotomy: recommendations for good exposure, stable cardiopulmonary bypass, and secure myocardial protection.

    Ito, Toshiaki


    An apparent advantage of minimally invasive mitral surgery through right mini-thoracotomy is cosmetic appearance. Possible advantages of this procedure are a shorter ventilation time, shorter hospital stay, and less blood transfusion. With regard to hard endpoints, such as operative mortality, freedom from reoperation, or cardiac death, this method is reportedly equivalent, but not superior, to the standard median sternotomy technique. However, perfusion-related complications (e.g., stroke, vascular damage, and limb ischemia) tend to occur more frequently in minimally invasive technique than with the standard technique. In addition, valve repair through a small thoracotomy is technically demanding. Therefore, screening out patients who are not appropriate for performing minimally invasive surgery is the first step. Vascular disease and inadequate anatomy can be evaluated with contrast-enhanced computed tomography. Peripheral cannulation should be carefully performed, using transesophageal echocardiography guidance. Preoperative detailed planning of the valve repair process is desirable because every step is time-consuming in minimally invasive surgery. Three-dimensional echocardiography is a powerful tool for this purpose. For satisfactory exposure and detailed observation of the valve, a special left atrial retractor and high-definition endoscope are useful. Valve repair can be performed in minimally invasive surgery as long as cardiopulmonary bypass is stable and bloodless exposure of the valve is obtained. PMID:25840800

  3. Heparin need of the patients with cyanotic congenital heart disease during cardiopulmonary bypass. Comparison of cyanotic, acyanotic, rheumatic and atherosclerotic subjects.

    Babacan, M K; Tasdemir, O; Yakut, C; Zorlutuna, Y; Karagöz, H; Göl, K; Bayazit, K


    Four groups of patients were studied. Group I: Congenital cyanotic heart disease (CCHD), consisting of 24 subjects aged 5 to 28 (1.4); 18 males and 4 females. Group II: Acyanotic congenital heart disease (ACHD), consisting of 34 patients aged 5 to 42 (20.1); 17 males and 17 females. Group III: Rheumatic heart disease (RHD), consisting of 30 patients aged 11-54 (42.4); 9 males and 21 females. Group IV: Atherosclerotic heart disease (AHD), consisting of 35 patients aged 36 to 65 (49.2); 33 males and 2 females. The haematocrit value (Hct) was the highest in the CCHD group. Total amount of heparin (mg/kg) used during cardiopulmonary bypass was 5.4 in CCHD, 4.66 in ACHD, 4.8 in RHD and 4.6 in AHD group. Mean protamine values was 4.02; 4; 4.03; and 4 respectively. Although the difference of Hct value was statistically different between CCHD and RHD group (p less than 0.001), heparin need was not (p less than 0.1). One-way analysis of variance (F test) showed no difference for heparin need between the four groups (F3.119 = 0.64). Prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed a positive correlation (r = 0.36 and r = 0.25) with heparin need in CCHD group but no correlation was found in RHD group. PMID:2745517

  4. Obesity influences propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing cardiopulmonary bypass Influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea

    Valéria Adriana Pereira; Maria José Carvalho Carmona; Célia Etsuco Kobayashi Omosako; José Otávio Costa Auler Júnior; Silvia Regina Cavani Jorge Santos


    Propranolol plasma levels and kinetic disposition may be altered by hypothermic cardiopulmonary bypass (CPB-H). We investigated the potential influence of obesity on propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing CPB-H. Fifteen patients, receiving propranolol perorally pre- (10-40 mg, 2-3 times a day) and post-operatively (10 mg, once a day) were distributed in two groups, based on body mass index (BMI), in obese (n = 9, BMI: mean 29.4 kg/m²) and...

  5. Are There Benefits to a Fresh Whole Blood vs. Packed Red Blood Cell Cardiopulmonary Bypass Prime on Outcomes in Neonatal and Pediatric Cardiac Surgery?

    Valleley, Melinda S.; Buckley, Klayton W.; Hayes, Kylie M.; Fortuna, Randall R.; Geiss, Dale M.; Holt, David W.


    Abstract: Techniques for pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) have significantly improved over the years. The use of fresh whole blood (FWB) and pre-bypass ultrafiltration (PBUF) has been suggested as means for improving perioperative and postoperative outcomes. It is the intent of this study to show that fresh whole blood along with PBUF will result in balanced CPB prime that can offer a reduction in blood product exposures and blood loss along with improving several measured postoperative outcomes. After institutional review board approval, a retrospective review was conducted on 100 patients to analyze the benefits of FWB and PBUF on outcomes in neonatal and pediatric cardiac surgery. Data analysis included preoperative and CPB data, perioperative inotrope and blood product exposure, and postoperative blood loss and blood product exposure measured for up to a 12-hour period in the intensive care unit (ICU). The three groups compared were FWB prime vs. packed red blood cell (PRBC) prime, <5 kg FWB prime vs. <5 kg PRBC prime, and 5+ kg FWB prime and 5+ kg PRBC prime. Cumulative blood product exposures for the FWB prime group found 62% received one blood exposure for the operative and postoperative period (p < .0001). The majority of patients who received a PRBC prime (64%) received three or more cumulative exposures (p < .0003). The <5 kg FWB group also received significantly less cumulative blood exposure, with 64% receiving just one exposure. Comparatively, 85% of the <5 kg PRBC patients received three or more blood product exposures perioperatively and postoperatively (p < .0001). Perioperative inotrope and postoperative blood loss did not differ among the groups. Outcomes for intraoperative death, intraoperative extubation, delayed sternal closure, and mediastinal reexploration were also not statistically different. The results of this study found that FWB leads to significantly less blood exposure, specifically in the <5-kg

  6. Risk factors for the development of SIRS in patients after cardiopulmonary bypass%体外循环术后发生全身性炎症反应综合征的相关危险因素分析

    马燕; 于湘友


    目的 探讨体外循环心脏术后发生全身性炎症反应综合征(SIRS)可能的危险因素.方法 择期行体外循环心脏术后患者83例,年龄6个月至66岁,NYHA I或Ⅱ级,体重7~97 kg.术后24 h内进行SIRS评分,根据SIRS评分,分为2组,SIRS组(S组,SIRS评分≥2分)和非SIRS组(U组,SIRS评分<2分).用logistic回归分析,筛选SIRS发生的危险因素.结果 SIRS发生率为83.13%,体外循环术后发生SIRS的危险因素与动脉血氧分压(PaO2),滞留ICU时间以及术后心率有关(OR=0.518,4.334,3.607,P<0.05).结论 动脉血氧分压(PaO2),滞留ICU时间及心率是体外循环术后发生SIRS可能的危险因素.%Objective To determine the risk factors for the development of systemic inflammatory response syndrome (SIRS) in the patients after cardiopulmonary bypass has been constructed. Methods Eighty three NYHAⅠor Ⅱ patients, aged 6month-66yr, weighting 7~97 kg, undergoing cardiopulmonary bypass, were enrolled in this study. SIRS score was performed during 24 h after the surgery. The patients were divided into 2 groups: SIRS group(S, SIRS score≥2) and non-SIRS group(U, SIRS score<2). The risk factors were identified by logistic regression analysis. Results The incidence of SIRS was 83.13% . Logistic analysis indicated that arterial oxygen pressure (PaO2), retention time, and postoperative heart rate were closely related with the development of SIRS in patients on ICU after cardiopulmonary bypass (OR=0.518,4.334,3.607,P<0.05). Conclusions The arterial oxygen pressure (PaO2), ICU stay, and heart rate after cardiopulmonary bypass has been constructed can be served as the risk factors for the development of SIRS in patients.

  7. The experience of psychological nursing of cardiopulmonary bypass heart operation during perioperative period%体外循环心脏手术围手术期的心理护理体会

    张玉梅; 范春兰; 韩萌萌


    目的:对体外循环心脏手术围术期的心理观察,有前瞻性和针对性的心理护理,从而及时治疗、预防心理行为异常的发生,使患者早日康复。方法通过术前强化系统脱敏、认知行为以及术后相应心理护理。结果45例手术患者无不良事件发生。结论心理护理能有效避免体外循环心脏手术围手术期的病人心理行为异常的发生。%Objective On the psychological observation of cardiopulmonary bypass heart operation during perioperative period,forward-looking and corresponding psychological nursing,and timely treatment,prevent abnormal psychological behavior, so that patients with early rehabilitation.Methods To strengthen the systematic desensitization, cognitive behavior and corresponding psychological nursing after surgery by preoperative.Results 45 cases of operation patients without adverse events.Conclusion Psychological nursing can occur in patients with psychological behavior effectively avoid cardiopulmonary bypass heart operation in perioperative period of abnormal.

  8. Management of anesthesia and cardiopulmonary bypass in a mini-pig model%小型猪体外循环动物模型建立及麻醉管理

    金艳; 陈敏; 金振晓; 郑奇军; 王新利; 赵堃; 崔勤


    AIM: To investigate the establishment and management of anesthesia and cardiopulmonary bypass (CPB) in a mini-pig model. METHODS: Twelve mini-pigs were used in this experiment. After successful anesthesia and tracheal intubation, mediastinotomy was performed to expose the heart and great vessels. CPB was established with cannulations of ascending aorta as well as superior and inferior vena cava. The circuit was composed of a mini-type membrane oxygenator, an arterial filter and a roller pump, which was primed with 250 ml balanced solution. CPB was conducted under moderate hypothermia and hearts were arrested with antegrade blood cardioplegia infusion. Hemodynamic data, arterial and venous oxygen saturation (SaO2, SvO2) , hematocrit (Hct) and blood lactate acid concentrations (Lac) were determined at different time points. RESULTS; The blood was moderately diluted according to Hct values. SaO2 and SvO2 were maintained at the normal range during the CPB period, whereas Lac increased significantly with elapsed CPB time. Mean arterial blood pressure decreased significantly compared with the pre-bypass value and returned to baseline value after CPB disconnection. All hearts were successfully arrested with cardioplegia infusion and spontaneous rhythm restored upon aortic cross-clamping removal. CONCLUSION: CPB is successfully established in this mini-pig model, which can be used for CPB-related in vitro experiments.%[目的]:探讨小型猪体外循环(CPB)实验模型的建立和麻醉管理.[方法]:小型猪12头,全麻诱导插管后,应用全血冷灌[方法]建立中低温阻闭升主动脉的体外循环模型,并于围CPB期进行动、静脉血氧饱和度(SaO2、SvO2)、血细胞比容(Hct)及乳酸水平(Lac)测定,同时监测围CPB期血流动力学变化.[结果]:转流过程中SaO2、SvO2均在正常范围,Lac水平随CPB时间延长,显著升高,Hct在CPB后呈中度稀释,平均血压在CPB后自主循环恢复后经过较短时间恢复到正常范围

  9. The Best Bypass Surgery Trial

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian; Perko, Mario J; Lund, Jens T; Andersen, Lars Willy; Madsen, Jan Kyst; Hughes, Pia; Steinbrüchel, Daniel A


    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have addit...

  10. 体外循环对大鼠脑血管内皮细胞功能的影响%Cerebrovascular endothelial cell injury induced by cardiopulmonary bypass in rats

    陈纲; 贾兵; 刘晔; 闫宪刚; 何春兰; 叶明; 陶麒麟


    Objective Damage to the nervous system remains an inevitable complication for the clinical application of cardiopulmonary bypass(CPB)technique.Experiment studies in animals with cerebral ischemia-reperfusion injury have revealed the association between inflammation and the impaired endothelium-dependent vasodilation in the brain vessels.Few studies have described theeffects of CPB on the vascular endothelial cells of the brain.This study is to investigate functional changes,which occurred in the different CPB modes,of the cerebrovascular endothelial cells and the associations between CPB and inflammatory factors.Methods Twenty-four S.D.rats were equally divided into four groups and underwent normothennic CPB for 120 min(group A),deep hypothermic low flow(DHLF) for 60 min(Group B),deep hypothermic circulatory arrest(DHCA) for 60 min(Group C) and sham group (Group D) respectively via right carotid and jugular cannulation.Blood samples from the internal jugular vein were collected before and after bypass to test the serum levels of nitrogen monoxide (NO) and 1L-6.The middle cerebral artery (MCA) in the right side was harvested for the evaluation of the endothelial cell response to acetylcholine at different concentrations.The protein expression of endothelial NO synthase (eNOS) was determined by Western immunoblotting.The ICAM-1 expression in the cerebral vessels was tested with immunohistochernistry staining.Results Bypass in all of the rats were established and removed successfully.Plasma concentrations of NO were reduced in CPB groups as compared with that in the sham group.Plasma NO levels were lower in group B and C than that in group A[(3.94±0.15) mg/L in group B and (2.93±0.33) mg/L in group C vs.(4.33±0.17) mg/L in group A,P=0.002].Acetylcholine induced a dose-dependent MCA vasodilation in sham group [(24.26 ± 1.90)% increase in diameter],that was attenuated in all CPB groups [(9.60± 1.09)% in group A,(5.97±0.68)% in group B and (5.72±0.67)% in group C

  11. Temperature Inaccuracies During Cardiopulmonary Bypass

    Salah, Mohammad; Sutton, Robin; Tsarovsky, Gary; Djuric, Michael


    Cerebral hyperthermia caused by perfusate temperature greater than 37°C during the rewarming phase of CPB has been linked to postoperative neurologic deficits. The purpose of this study was to determine the accuracy of the coupled temperature measurement system and the CDI 500 arterial temperature sensor. Seventeen patients undergoing CPB were divided into four groups, each with a different temperature probe coupled to the oxygenator. The coupled temperature measurement system and CDI tempera...

  12. Vasopressin reduces cardiac function and augments cardiopulmonary baroreflex resistance increases in man.

    Ebert, T J; Cowley, A W; Skelton, M


    We examined the effects of physiologic infusions of arginine vasopressin (AVP) on cardiovascular hemodynamics and on reflex responses initiated by decreasing cardiopulmonary baroreceptor stimulation (with lower body negative pressure) in 10 healthy, captopril-pretreated young men (19-27 yr). Their responses were compared with those of four volunteers given isosmotic infusion. Heart rate, stroke volume, blood pressure, and forearm blood flow were measured by electrocardiography, impedance card...

  13. Estudo da função simpático-adrenal em crianças submetidas a cirurgia cardíaca com hipotermia de superfície, perfusão limitada e parada circulatória Simpathoadrenal function during cardiac surgery in infants using the technique of surface cooling, limited cardiopulmonary bypass and circulatory arrest

    Richard K Firmin


    Full Text Available Os níveis de catecolamina plasmática foram medidos em 20 crianças (idade média de 6,00 ± 5,86 meses; peso médio 5,3 ± 1,82 kg, durante a correção de defeitos cardíacos congênitos, usando-se a hipotermia de superfície (26ºC, perfusão cardiopulmonar limitada e parada circulatória (15ºC. Adrenalina e noradrenalina plasmática foram dosadas em amostras sangüíneas arteriais seriadas, usando-se a cromatografia. A hipotermia de superfície produziu um significante aumento de ambas as catecolaminas. Durante o resfriamento central, os níveis caíram devido à hemodiluição. Após o período de parada circulatória (23/64 minutos, média de 41,3, ocorreu um aumento das catecolaminas plasmáticas, que persistiu durante o reaquecimento. Após o reaquecimento, as catecolaminas plasmáticas permaneceram elevadas até o final do ato cirúrgico. Nossos resultados mostram que a técnica de hipotermia de superfície, perfusão cardiopulmonar limitada e parada circulatória, sob as nossas condições de anestesia, produziu significante aumento da concentração de adrenalina e noradrenalina plasmática, porém o significado biológico é, ainda, inseguro.Plasma catecholamine levels were measured in 20 infants (mean age 6.0 ± 5.86 months; mean weigh 5.3 ± 1.82 Kg, undergoing correction of congenital heart defects using surface cooling (26ºC, limited cardiopulmonary bypass and circulatory arrest (15ºC. Plasma adrenaline and noradrenaline were assayed in serial arterial blood samples using cromatography and electrochemical techniques. Surface cooling produced a significant rise in adrenaline and noradrenaline: the levels of both catecholamines fell, however, during core-cooling on cardiopulmonary bypass. Following the period of circulatory arrest (23/64 min, mean 41.3 min, there was a further increase in plasma catecholamines, which persisted during rewarming. Following rewarming, plasma catecholamines remained elevated untill the end of the

  14. Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand

    Gurné, Olivier; Chenu, Patrick; Buche, Michel; Louagie, Yves; Eucher, Philippe; Marchandise, Baudouin; Rombaut, E; Blommaert, Dominique; Schroeder, Erwin


    OBJECTIVE—To compare the mechanisms by which arterial and venous grafts increase their flow during pacing induced tachycardia, early and later after coronary bypass surgery.
DESIGN—43 grafts (13 epigastric artery, 15 mammary artery, 15 saphenous vein) evaluated early (9 (3) days (mean (SD)) after bypass surgery were compared with 41 other grafts (15 epigastric, 11 mammary, 15 saphenous vein) evaluated later after surgery (mean 23 months, range 6 to 168 months) by quantitative angiography and ...

  15. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

    Møller, Christian H; Penninga, Luit; Wetterslev, Jørn; Steinbrüchel, Daniel A; Gluud, Christian


    Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear.......Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear....

  16. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

    Møller, Christian H; Steinbrüchel, Daniel A


    Coronary artery bypass grafting (CABG) remains the preferred treatment in patients with complex coronary artery disease. However, whether the procedure should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate....... Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the systemic inflammatory response from extracorporeal circulation is omitted, but no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG as regards the hard outcomes death, stroke or myocardial infarction....... In contrast, off-pump CABG is technically more challenging and may be associated with increased risk of incomplete revascularization. The purpose of the review is to summarize the current literature comparing outcomes of off-pump versus on-pump coronary artery bypass surgery....

  17. Cardiopulmonary Resuscitation (CPR)

    MENU Return to Web version Cardiopulmonary Resuscitation (CPR) Cardiopulmonary Resuscitation (CPR) What is CPR? Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that involves chest compressions and giving ...

  18. The management of cardiopulmonary bypass on the patients of in fective endocarditis%急性重症感染性心内膜炎手术的体外循环管理

    姜建杰; 施丽萍; 邹煜


    目的 探讨急性重症感染性心内膜炎(Infective endocarditis,IE)心脏直视手术的体外循环管理.方法 回顾性分析2005年1月至2010年3月本院43例IE患者体外循环(CPB)下心脏手术的资料.CPB采用中低温、中度血液稀释、中高流量[2.4~3.0L/(min·m2)],7℃~10℃稀释血停搏液顺灌进行心肌保护.术前溶血性贫血39例;肝功能不全10例;肾功能不全12例;外周血管栓塞13例.结果 CPB时间(61.47±17.53)min,阻断时间(47±18.4)min.本组患者术后早期死亡3例,胸部切口感染1例,急性肾功能衰竭1例,消化道出血1例.结论 IE患者术前并发症的评估、体外循环中对症处理,对患者的治疗和恢复至关重要.%Objective To investigate the management of cardiopulmonary bypass (CPB) on the patients of infective endocarditis. Methods To summarize retrospectively the experience of management of cardiopulmonary bypass (CPB) during Open Heart Surgery t for infective endocarditis in 43 cases from 2005.1 to 2010.3. CPB adopted mild hypothermia, moderate hemodilution,high flow[ 2. 4 ~ 3. 0L/( min · m2 ) ]. Cardioplegia with 4℃. cold crystalloid or 7℃ ~ 10℃ 4: 1 ( blood: crystalloid ) Preoperative hemolytic anemia 39 cases; liver dysfunction 10 cases ; renal dysfunction 12 cases. Results The duration of CPB ranged from 43.47to 89. 40 min, and aorta cross - clamp time (ACC) from 29.6to 65.4 min. Three cases died early postoperatively due to thoracic infection of incisional wound; acute renal failure; alimentary tract hemorrhage. Conclusions The key points to success are evaluating the complication accurately,and well treament during the CPB.

  19. 体外循环所致炎性肺损伤机制及保护进展%Study Progress of Lung Injury and Protection and Prevention in Cardiopulmonary Bypass

    杨威; 董啸


    Lung dysfunction is one of the major complications in cardiopulmonary bypass(CPB) cardiac surgery. Mechanisms of lung injury are complex, which is due to systemic inflammatory response syndrome and ischemia-reperfusion injury mainly. Methods of lung protection, aim to reduce systemic inflammatory response syndrome , is helpful to alleviate or avoid ischemic reperfusion injury. This article reviewed the mechanisms of lung injury and methods of lung protection in CPB.%肺损伤是体外循环心内直视手术的主要并发症之一.肺损伤的机制十分复杂,主要是全身炎性反应和缺血/再灌注损伤所致.肺保护的方法多种多样,其目的是降低全身炎性反应,减轻或避免缺血/再灌注损伤.本文探讨体外循环肺损伤的机制和保护进展.

  20. 感染性心内膜炎患者体外循环手术中ACT的监测%Measurement of activated clotting time during cardiopulmonary bypass in patients with infective endocarditis patients

    蒋玲; 喻杰锋


    目的:探讨感染性心内膜炎(infective endocarditis,IE)患者外科治疗时肝素及鱼精蛋白的合理用量.方法:IE患者与风湿性心脏病(rheumatic heart disease,RHD)患者各30例,在体外循环(cardiopulmonary bypass,CPB)期间测定激活全血凝固时间(activated clotting time,ACT),CPB终止后,测ACT拮抗值.结果:转流前IE组肝素用量[(407.2±51.3)U/kg]明显高于RHD组[(350±25)U/kg(P<0.05)],鱼精蛋白用量IE组[(3.00±0.25)mg/kg]亦明显高于RHD组[(2.51±0.26)mg/kg(P<0.05)],鱼精蛋白与肝素之比IE组为0.76±0.23,RHD组为0.74±0.12,二组间无统计学差异(P>0.05).结论:IE病人转流前肝素用量大于400 U/kg,鱼精蛋白用量需增加至3 mg/kg,而鱼精蛋白与肝素之比无明显变化.

  1. Circulação extracorpórea em adultos no século XXI: ciência, arte ou empirismo? Adult cardiopulmonary bypass in the twentieth century: science, art or empiricism?

    André Lupp Mota


    Full Text Available A presente revisão tem por objetivo ressaltar alguns aspectos pouco discutidos da circulação extracorpórea (CEC, levando-se em consideração fisiologia, fisiopatologia e algumas novas tecnologias de perfusão. Assim, alguns aspectos, até certo ponto filosóficos, motivaram a elaboração dessa revisão: a Preservar e atualizar os conhecimentos do cirurgião sobre a CEC, pelo simples fato de manter a sua liderança pedagógica sobre a sua equipe; b Questionar se pacientes idosos e diabéticos pelas suas características individuais, assim como adotado para crianças, talvez merecessem protocolos mais apropriados; c Questionar a reação inflamatória sistêmica causada pela exposição do sangue à superfície não endotelizada do circuito de CEC diante da importância crescente do contato do sangue com a ferida cirúrgica; d Em relação ao tratamento da síndrome vasoplégica, o azul de metileno continua sendo a melhor opção terapêutica, embora, muitas vezes não seja eficiente pela existência de uma "janela terapêutica" embasada na dinâmica da ação da guanilato ciclase (saturação e síntese "de novo" e; finalmente, e Razão da escolha do título, ressaltando que, em seus moldes atuais, a CEC seria conseqüência do empirismo, arte, ou da ciência? A mensagem final vem com a convicção de que tanto o empirismo, a arte e a ciência são muito fortes em se tratando da CEC.The aim of the present review is to highlight some less discussed aspects of the cardiopulmonary bypass (CPB, taking into consideration the physiology, physiopathology, and some new technologies of perfusion. Thus, some points, to a certain extent philosophical, have motivated this revision: a To preserve and update the surgeon knowledge regarding CPB, even to keep his/her pedagogical leadership on his/her surgical team; b To question if elderly and diabetic patients, as a result of their individual characteristics deserve more appropriate protocols similar to

  2. 抑肽酶在体外循环心脏手术中的局部应用%The Topical Use of Aprotinin in Cardiac Surgery with Cardiopulmonary Bypass

    陈亦江; 王晓伟; 陈广明


    Objective To investigate the effects of the topical use of aprotinin an the basisof comprrehensive blood conservations in cardiopulmonary bypass ( CPB). Methods In a prospectiveclinical trial, 20 patients were randomly divided into 2 groups. Control group: placebo was used topical-ly. Aprotinin group: aprotinin was poured into the pericardial cavity before closure of the sternotomy.Before and 24 h after surgery, hemoglobin ( Hb), hematocrit ( Hct), bleeding time (BT), clottingtime (CT) and prothrombin time (PT) were measured. Meanwhile, amounts of the mediastinaldrainage and the hemoglobin loss were observed at 0, 2, 6 and 24 h after operation. The samples fromthe mediastinal drainage were also collected to measure D-Dimer (D-D), tissue type plasminogen activa-tor (t-PA) activity, plasminogen activator inhibitor ( PAI) activity and protein C (PC). ResultsIn Aprotinin group, D-D, t-PA activity and PC were significantly reduced, compared with those in Con-trol group ( P < 0. 05, P<0. 05, P<0. 01). On the contrary, PAI activity was significantly in-creased, compared with that in Control group. Amounts of the mediastinal drainage and the hemoglobinloss were decreased by 43% and 52%, compared with those in Control group. Conclusion Ourresults suggest that the topical use of aprotinin can have better effects an the basis of comprehensive mod-erate blood conservation.%目的:探讨体外循环(CPB)心脏手术中采取综合性血液保护措施的基础上(转流中预充小剂量抑肽酶4~5万kIU/kg,手术失血回输,术后机器余血回输)再局部应用抑肽酶的血液保护效果.方法:体外循环心脏手术病人20例随机分为对照组(C组10例)、局部应用抑肽酶组(A组10例).检测指标:①D-二聚体(D-D)含量、组织型纤溶酶原激活物(t-PA)活性、组织型纤溶酶原激活物抑制剂(PAI)活性、蛋白C(PC)含量;②纵隔心包引流量、血红蛋白丢失.结果:局部用抑肽酶组引流液中D-D含量、t-PA活性

  3. Photorespiratory Bypasses Lead to Increased Growth in Arabidopsis thaliana: Are Predictions Consistent with Experimental Evidence?

    Basler, Georg; Küken, Anika; Fernie, Alisdair R; Nikoloski, Zoran


    Arguably, the biggest challenge of modern plant systems biology lies in predicting the performance of plant species, and crops in particular, upon different intracellular and external perturbations. Recently, an increased growth of Arabidopsis thaliana plants was achieved by introducing two different photorespiratory bypasses via metabolic engineering. Here, we investigate the extent to which these findings match the predictions from constraint-based modeling. To determine the effect of the employed metabolic network model on the predictions, we perform a comparative analysis involving three state-of-the-art metabolic reconstructions of A. thaliana. In addition, we investigate three scenarios with respect to experimental findings on the ratios of the carboxylation and oxygenation reactions of Ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO). We demonstrate that the condition-dependent growth phenotypes of one of the engineered bypasses can be qualitatively reproduced by each reconstruction, particularly upon considering the additional constraints with respect to the ratio of fluxes for the RuBisCO reactions. Moreover, our results lend support for the hypothesis of a reduced photorespiration in the engineered plants, and indicate that specific changes in CO2 exchange as well as in the proxies for co-factor turnover are associated with the predicted growth increase in the engineered plants. We discuss our findings with respect to the structure of the used models, the modeling approaches taken, and the available experimental evidence. Our study sets the ground for investigating other strategies for increase of plant biomass by insertion of synthetic reactions. PMID:27092301

  4. 21 CFR 870.4280 - Cardiopulmonary prebypass filter.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary prebypass filter. 870.4280 Section... prebypass filter. (a) Identification. A cardiopulmonary prebypass filter is a device used during priming of... bypass. The device is not used to filter blood. (b) Classification. Class II (performance standards)....

  5. Feed technology and other methods for increasing the bypass protein for ruminants fed low quality forages

    To make use of crop residues, the protein and energy needs of the ruminant must be met. Inexpensive sources of rumen ammonia (urea or ammonia from ammoniation) cam meet the needs of the rumen microorganisms. The cost of protein supplementation can be reduced by using sources of high bypass protein with the sources of ammonia. Accurate evaluation of protein is necessary. Estimates of the bypass values for protein sources can be made from laboratory analyses or by directly measuring the bypass of a protein source with intestinally fistulated animals. These values are useful as supporting evidence; however, measurement of animal growth or production is the best way to obtain these bypass values. It is essential that proteins be compared below the animal's protein requirement. Otherwise, protein is not the first limiting nutrient and valid comparisons cannot be made. The protein in grain, especially corn and milo, is bypassed to a great extent and, therefore, the grain by-products are high in bypass protein. Heating reduces rumen degradation of proteins and, therefore, the drying of dehydrated alfalfa, blood meal and meat meal causes them to be high bypass protein sources. Hydrolysed feather meal and non-enzymatically browned protein are also good sources of bypass protein. (author). 15 refs, 7 figs, 2 tabs

  6. Effect of Cardiopulmonary Bypass on Gut Mucosal Barrier Function in Patients Undergoing Cardiac-Valve Replacement%体外循环对瓣膜置换术患者肠黏膜屏障功能的影响

    张丽丽; 孙莹杰; 张铁铮


    Objective: To investigate the gut mucosal barrier function during cardiopulmonary bypass (CPB), and the relative mechanisms thereof. Methods: Twenty patients underwent heart valve replacement with cardiopulmonary bypass were enrolled. Blood samples of the jugular vein from 20 CPB patients were drawn following 6 time points, before CPB (T1), 10 min after aortic crossclamp release (T2), immediately at the end of CPB (T3), 2 h after operation(T4), 6 h after operation(T3) and 18 h after operation(T6). The levels of blood intestinal fatty acid binding protein (1-FABP), interleukin(IL)-6, IL-10 and D-lactate were detected. Blood samples were also taken for blood gas analysis and blood glucose detection. Results: Comparing with T, (before CPB), serum concentrations of D-lactate and I-FABP elevated obviously at T2, T3, T4and T5(P < 0.05), and reached its peak value at T5. The serum concentration of I-FABP and D-Lactate were still higher than that at Ti at T6 (P < 0.05). The peak of I-FABP was correlated with peaks of serum glucose and lactate. Conclusion: The gut mucosal barrier function was damaged during CPB, which might be related to the stress response of nervous- endocrine system and immunity system.%目的:探讨围体外循环期瓣膜置换术患者肠黏膜屏障功能的变化及可能机制.方法:选择体外循环(CPB)心脏瓣膜置换术患者20例,按时点采取中心静脉血标本测定血清肠型脂肪酸结合蛋白(I-FABP)、白细胞介素(IL)-6、IL-10及D-乳酸水平,同时行静脉血气分析和血糖监测.结果:与CPB前比较,主动脉开放10 min时,血清D-乳酸和I-FABP值即显著升高;术后2h血浆D-乳酸达峰值,I-FABP维持较高水平;术后6h血浆I-FABP达峰值;术后18h血清D-乳酸和I-FABP值仍高于基础值.术后6h血浆I-FABP峰值与血糖和乳酸峰值呈正相关.结论:围CPB期肠黏膜屏障功能受损.神经-内分泌-免疫系统共同参与的应激反应与肠黏膜屏障功能损伤有关.

  7. The effect of cardiopulmonary bypass during robotic cardiac surgery on pulmonary function%全机器人心脏手术麻醉中体外循环对肺功能的影响

    肖赛松; 高长青; 陈婷婷; 周琪; 李佳春; 王加利; 王瑶; 王刚


    Objective To observe the effects of cardiopulmonary bypass ( CPB ) on pulmonary function under the environment of one - lung ventilation ( OLV ) and carbon dioxide pneumothorax in robotic cardiac surgery. Methods Ninety - eight patients underwent robotic cardiac surgery using the da Vinci system, including 58 on - pump surgeries ( On - pump group, n = 58 ) and 40 off - pump surgeries ( Off- pump group, n =40 ). Mechanical ventilation parameters, airway peak pressure, and arterial blood gas were assessed at the following time points: 20 min after induction of anesthesia with two - lung ventilation ( Tl ), 25 min after OLV ( T2 ), 25 min after termination of CPB with OLV in on - pump group or 25 min after main surgery intervention in off - pump group ( T3 ), and 20 min before surgery finish ( T4 ). Dynamic lung compliance ( Cdyn ), alveolar - arterial PO2 different ( PA_aDO2 ), artery - alveolar P02 ratio ( a/A ) and oxygenation index ( OI) were then calculated. Results No significant differences were observed in pulmonary function parameters between T3 and T2 after operation in off - pump group. But in on - pump group, compared with those in T2, PETCO2 , Ppeak, PaCO2 and PA-aDO2 in T3 were higher whereas SpO2 , Cdyn, PaO2 , OI and a/A were lower ( P 0.05);两组T3时刻组间比较,On-pump组比Off-pump组Ppeak、PaCO2、PA-aDO2高,SpO2、Cdyn、PaO2、OI、a/A低(P<0.01).结论 在机器人心脏手术麻醉中,体外循环将使肺通气功能和换气功能明显降低,耐受OLV的能力下降.

  8. 参附注射液对兔体外循环时胰岛素抵抗的影响%Effect of Shenfu injectio on insulin resistance in rabbits undergoing cardiopulmonary bypass

    童珊珊; 闵苏; 魏珂; 张光新


    目的 探讨参附注射液SFI对兔CPB时胰岛素抵抗的影响.方法 健康成年新西兰大白兔30只,雌雄不拘,体重2.2~2.5 kg,随机分为3组(n=10),假手术组(S组)和CPB组腹腔注射等容量生理盐水,SFI组于CPB前2 d、1 d及麻醉诱导前30 min时腹腔注射SFI 10 ml/kg.于麻醉诱导后5 min(T_1)、主动脉阻断即刻(T_2)、主动脉开放5 min(T_3)、主动脉开放35 min(T_4)和主动脉开放75 min (T_5)时采集动脉血样,测定血糖及胰岛素水平,并计算胰岛素抵抗指数(HOMA-IR).于CPB 150 min时取右后肢股四头肌组织,测定骨骼肌胰岛素受体底物-1(IRS-1)、磷脂酰肌醇3激酶p85亚单位(P13Kp85)、葡萄糖转运蛋白(GLUT)4的表达水平.结果 与T_1时比较,3组T_(2~5)时血糖、胰岛素水平及HOMA-IR均升高(P<0.05);与S组比较,CPB组和SFI组T_(2~5)时血糖、胰岛素水平及HOMA-IR均升高,P13Kp85及GLUT4表达下调(P<0.05);与CPB组比较,SFI组T_(2~5)时血糖水平及HOMA-IR降低,胰岛素水平升高,P13Kp85及GLUT4表达上调(P<0.05).结论 SFI可改善CPB诱导的兔胰岛素抵抗,其机制可能与上调骨骼肌胰岛素信号转导分子的表达有关.%Objective To investigate the effect of Shenfu injectio on insulin resistance in rabbits undergoing cardiopulmonary bypass (CPB) . Methods Thirty New Zealand white rabbits of both sexes weighing 2.2-2.5 kg were randomly divided into 3 groups (n = 10 each): group I sham operation (group S); group Ⅰ CPB and group Ⅰ CPB + Shenfu injectio (group SFI). In group IE (group SFI) Shenfii injectio 10 ml/kg was injected intraperitoneally (IP) once a day for 2 days and at 30 min before anesthesia. In group Ⅱ and Ⅲ the duration between aortic cross-clamping and unclamping was 60 min. MAP was maintained at 50-60 mm Hg during CPB. The plasma glucose and insulin concentrations were measured immediately after induction of anesthesia (T_1), immediately after aortic cross-clamping (T_2) , and at 5, 35 and 75 min

  9. Epicardial ultrasound in coronary artery bypass surgery

    Budde, R.P.J.


    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeo

  10. Outcomes after off-pump coronary bypass surgery

    Dijk, Diederik van


    The complications associated with in coronary artery bypass surgery (CABG) using cardiopulmonary bypass (CPB) have led to a renewed interest in coronary bypass surgery on the beating heart. The primary objective of the Octopus Study was to compare cognitive outcome between patients randomized to off

  11. Epicardial ultrasound in coronary artery bypass surgery

    Budde, R.P.J.


    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeon may face several intraoperative difficulties: 1. Localization of the target coronary artery for bypass grafting. 2. Selection of the optimal anastomotic site on the target coronary artery. 3. Asses...

  12. Tática para cirurgia de correção da coarctação da artéria pulmonar sem uso de circulação extracorpórea Approach for surgical correction of pulmonary artery coarctation without cardiopulmonary bypass

    Denoel Marcelino de Oliveira


    Full Text Available A coarctação de artéria pulmonar é comum em pacientes com atresia pulmonar. A correção tem sido com CEC e no período neonatal, quando influencia o desenvolvimento das artérias pulmonares e o prognóstico. Foram corrigidos três pacientes por esternotomia mediana com atresia pulmonar dependentes do ducto arterioso (PCA sem uso de CEC. O PCA mantinha a saturação durante a confecção do Blalock Taussig na artéria pulmonar contralateral. Arterioplastia foi realizada com sutura de pericárdio autólogo com PDS 7-0 e saturação mantida pelo Blalock. Todos pacientes tiveram boa evolução e alta hospitalar com avaliação de controle demonstrando bom alargamento da área coarctada.Pulmonary artery coarctation often happens in patients with pulmonary atresia. The correction has been usually performed using cardiopulmonary bypass and during the neonatal period, influencing pulmonary artery development and prognosis. Three patients with pulmonary atresia with PDA underwent correction using median sternotomy without cardiopulmonary bypass. The PDA maintained the arterial saturation during Blalock Taussig anastomoses upon the contralateral pulmonary artery. Arterioplasty was performed using an autologous pericardium with 7-0 PDS running suture and saturation was maintained by Blalock shunt. All patients presented good follow-up and where discharged with good enlargment of coarctation area.

  13. 体外循环术对先天性心脏病患儿手术前后神经系统发育障碍的影响%Influence of cardiopulmonary bypass on neurodevelopmental disorder in congenital heart disease children before and after operation



    With the advances of medical management and surgical techniques during cardiopulmonary bypass,children with congenital heart disease are increasingly surviving to adulthood.Research into their neurodevelopmental outcomes in the past 20 years had revealed sobering realizations about the adverse impact on the quality of life of these surgical survivors.A multitude of factors contribute to the incidence and severity of neurodevelopmental abnormalities and can be separated into preoperative,intraoperative,and postoperative events,in addition to genetic contributions and socioeconomic factors.This article highlight some of current understanding of these protean factors.Understanding should lead to modification of current techniques and management strategies,all with the ultimate goal of improving patients' quality of life.%随着临床治疗和外科技术的改善,先天性心脏病患儿体外循环术后早期和长期成活率显著增加.因此,已有越来越多的患儿进入学校学习.在过去20年中,对于这些术后存活患儿神经发育的研究结果证实这些患儿的学习和生活质量受到严重影响.神经发育障碍由多种因素引起,可大致分为术前、术中和术后3类,另有基因及社会经济条件等因素.现着重阐述先天性心脏病患儿体外循环后,导致神经发育异常影响因素的最新研究进展.理解这些才能改善现有技术和治疗方法,最终改善患儿生活质量.

  14. Revascularização do miocárdio sem circulação extracorpória: análise dos resultados em 15 anos de experiência Myocardial revascularization without cardiopulmonary bypass: results of 15 years' experience

    Ênio Buffolo


    Full Text Available A revascularização miocárdica sem circulação extracorpórea agora se constitui numa alternativa de tratamento cirúrgico de cardiopatia isquêmica de interesse crescente. O objetivo deste trabalho é apresentar os resultados obtidos ao longo de 15 anos de experiência ininterrupta. De setembro de 1981 a março de 1996, 1549 pacientes foram operados sem o auxílio do coração-pulmão artificial, o que constitui cerca de 18% do total de pacientes operados no período. As idades variaram de 28 a 86 anos, oscilando em torno de 57 anos, sendo 1126 do sexo masculino e 423 do feminino. O número de pontes variou de 1 a 5, com média de 1,7 pontes/paciente. A técnica não constituiu problema especial para o emprego de enxertos arteriais, sendo as artérias torácicas internas utilizadas em 1140 artérias coronárias. Em 1515 pacientes a via de acesso foi a esternotomia mediana e, em 34, a toracotomia anterior esquerda mínima. A mortalidade operatória global foi de 2,4% (38/1549, sendo a principal causa o mau débito cardíaco em pacientes operados em isquemia aguda, sendo 8 sob auxílio de balão intra-aórtico. Os resultados desta experiência permitem concluir que a revascularização do miocárdio sem circulação extracorpórea é uma excelente alternativa de revascularização para determinado subgrupo de pacientes, oferecendo baixa mortalidade e morbidade pós-operatória, sendo especialmente indicada em pacientes com complicações clínicas pré-existentes e de maior risco operatório.Myocardial revascularization without cardiopulmonary bypass is now a subject of increasing interest. The purpose of this paper is to present the results obtained during 15 years of experience. From September 1981 till March 1996,1549 patients we operated on without the use of cardiopulmonary bypass with an applicability of this alternative around 18% of the total revascularized patients in this period. The ages varied from 28 to 86 years (medium 57 with

  15. Increasing Severity of Aortic Atherosclerosis in Coronary Artery Bypass Grafting Patients Evaluated by Transesophageal Echocardiography

    Denny, John T; Pantin, Enrique; Chiricolo, Antonio; Tse, James; Denny, Julia E.; Mungekar, Sagar S.; Chyu, Darrick; Solina, Alann


    Background Atherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade. Methods Data from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years ...

  16. “Orpheus” Cardiopulmonary Bypass Simulation System

    Morris, Richard W.; Pybus, David A.


    In this paper we describe a high-fidelity perfusion simulation system intended for use in the training and continuing education of perfusionists. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator can be positioned on an operating table and physically connected to the circuit ...

  17. Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke Resultado inicial após revascularização miocárdica: efeito na mortalidade e no acidente cerebrovascular

    Delawer Reber; Marcus Fritz; Alfred Germing; Peter Marks; Axel Laczkovics


    OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated wit...

  18. Innovations in Pedriatic Cradiopulmonary Bypass: a continuous process of quality improvement

    Golab, Hanna


    textabstractCardiopulmonary bypass (CPB) is defined as a technique that temporarily replaces the function of the heart and lungs, maintaining an adequate blood circulation and oxygen content of the body during surgery of the heart and great vessels. The current practice of cardiopulmonary bypass was achieved through the efforts of a numbers of individuals who believed that artificial cardiopulmonary support could replace the body’s own circulatory and respiratory systems. Collaborative effort...

  19. [Cardiopulmonary exercise test in patients with DDD pacemaker: report of two cases with increased exercise capacity by decreased ventricular tracking limit rate setting].

    Asakuma, S; Nakamura, K; Tateishi, J; Terawaki, K; Nishian, K; Tsumoto, S; Komasa, N; Yasutomi, S; Fujitani, K; Iwasaki, T


    We reported 2 patients with complete A-V block with a DDD pacemaker whose exercise capacity was increased by decreased ventricular tracking limit rate setting (VTL) of their pacemakers. Cardiopulmonary exercise test was used for estimating exercise capacity. Case 1: A 15-year-old girl complained of fainting. Her electrocardiogram (ECG) revealed complete A-V block (atrial rates 100/min, ventricular rates 39/min). After implantation of a DDD pacemaker and the VTL setting at 152/min, her bradycardia disappeared, however, she complained of dyspnea after a few minutes' walk. We performed symptom-limited cardiopulmonary exercise test with a motor-driven treadmill. When the pacing rate reached VTL (152/min), ECG suddenly changed to approximately 2:1 pacing (80/min) and the patient complained of dyspnea. Concomitant rapid increases in VE, VCO2 and RQ suggested that dyspnea was caused by the marked change in pacing rates on VTL. With the lowered VTL (110/min), there was no rapid increase in VE, VCO2 and RQ, and dyspnea subsided when the pacing rate reached VTL. At the same time, the peak VO2 and exercise time were increased by 15% and 8%, respectively. Case 2: A 47-year-old man complained of syncope. His ECG revealed complete A-V block (atrial rates 100/min, ventricular rates 33/min). After a DDD pacemaker implantation (VTL: 150/min), he experienced dyspnea while walking up the stairs in his office. Like in Case 1, when the VTL was lowered from 150/min to 110/min, both the peak VO2 and exercise time were increased by 11%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1844429

  20. Increased cardiopulmonary disease risk in a community-based sample with chemical odor intolerance: implications for women's health and health-care utilization.

    Baldwin, C M; Bell, I R


    Chemical intolerance, or reported illness from odors of common environmental chemicals (e.g., car exhaust, pesticides), is emerging as an important environmental and public health-care issue. Epidemiologic methods provide relevant heuristic devices for studies of complex disorders, such as chemical intolerance. The authors examined personal and reported parental cardiopulmonary disease prevalence rates in a community sample of chemically intolerant and control individuals. A county government (Tucson, Arizona) employee and kin subset (N = 181; 113 households) completed standard health questionnaires. Investigators determined chemical intolerance (n = 41/181) from self-reports of individuals who felt "moderately" to "severely" ill from exposure to at least three of five chemicals (i.e., car exhaust, pesticides, paint, new carpet, and perfume) on a Chemical Odor Intolerance Index. The authors chose the control group (n = 57/181) on the basis of self-reports of "never" feeling ill on the Chemical Odor Intolerance Index. The chemically intolerant group, which primarily comprised women (78% versus 51% of controls, p < .05), was significantly more likely to report-and to have sought--medical attention for heart problems, bronchitis, asthma, and pneumonia. Reports of heart problems in the chemically intolerant index cases and the occurrence of heart disease in both of their parents were significant (Fisher's p < .05). The chemically intolerant individuals were also significantly more likely to report maternal histories of chest problems (e.g., inhalant allergens, tuberculosis) than controls. The findings of the study suggested that the chemically intolerant individuals (a preponderance of whom were women [sex-related risk]) were more likely to have (a) reported cardiopulmonary problems (i.e., greater health risk); (b) actively sought medical care for these problems (i.e., increased medical utilization); and (c) reported more parental illnesses-particularly heart disease

  1. Avaliação da aprotinina na redução da resposta inflamatória sistêmica em crianças operadas com circulação extracorpórea Assessment of aprotinin in the reduction of inflammatory systemic response in children undergoing surgery with cardiopulmonary bypass

    Cesar Augusto Ferreira


    Full Text Available OBJETIVO: Avaliar se a aprotinina em altas doses hemostáticas pode reduzir o processo inflamatório após circulação extracorpórea (CEC em crianças. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9 e o outro, Aprotinina (n=10. Neste, o fármaco foi administrado antes e durante a CEC. A resposta inflamatória sistêmica e disfunções hemostática e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To assess if the hemostatic high-dose aprotinin is able to reduce the inflammatory process after cardiopulmonary bypass (CPB in children. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who underwent correction of acyanogenic congenital heart disease with CPB and were divided into two groups: Control (n=9 and Aprotinin (n=10. In the Aprotinin Group the drug was administered before and during CPB and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were assessed through clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, staying in the postoperative ICU and length of hospitalization, or regarding the use of inotropic drugs and renal function. The partial arterial oxygen pressure/ inspired oxygen fraction ratio (PaO2/FiO2 was significantly reduced 24 h after surgery in the Control Group. Blood loss was similar for both groups. Significant leukopenia was observed in the Aprotinin Group during CPB, followed by leukocytosis. Tumor necrosis factor alpha (TNF- α, interleukins (IL

  2. 抑肽酶对体外循环呼吸指数和胸肺顺应性的影响%The influence of aprotinin on respiratory index and lung-thorax compliance during cardiopulmonary bypass

    张兰; 王泉云; 肖红; 廖刃; 刘斌


    Objective To study the projection effect of aprotinin on acute lung injury during cardiopulmonary bypass (CPB). Methods Twenty-eight patients scheduled for cardiac value replacement for the first time were randomized into two groups: control group (14 patients) and aprotinin treatment group (14). Pulmonary thoracic compliance (Cs) and dynamic compliance (Cd) were measured at pre-CPB(T1), 10 minutes after aortic crossclamping (T2), and 10 minutes (T3), 60 minutes (T4) after CPB. Arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide(PaCO2), fractional concentration of oxygen in inspired gas (FiO2), and barometric pressure (PB) were measured at the same time. Then respiratory indexes (RI) were calculated. Results There were no differences in the values of Cs,Cd and RI at T1 between the aprotinin group(52.8±13.49, 42.97±9.06, 0.44±0.1) and the control group (56.43±9.29,45.62±6.92,0.45±0.13) respectively(P>0.05).There was a significant (P<0.05) decrease of Cs and Cd at T2 (33.82±8.83, 28.39±6.04), T3(35.42±11.83,30.6±17.88) and T4(37.96±7.27,32.38±6.52) in the control group as compared with basline values (T1)and the values of the aprotinin group (42.74±9.08,36.83±5.47; 43.38±10.88 , 37.27±10.57; 47.64±12.27, 40.52±9.07) respectively. The RI of the control group at T2 (0.78±0.14), T3(0.69±0.12) was higher than either their baseline(T1) or the values of the aprotinin group (0.53±0.14, 0.51±0.1) at the same measure points (P<0.05). Though there was no difference(P>0.05) between T4(0.63±0.13) and their baseline′s in the control group, the values of the control group were higher than those of the aprotinin group at T4(0.49±0.13)(P<0.05). Conclusion Aprotinin has a protection effect on acute lung injury after CPB.%目的探讨抑肽酶是否减轻体外循环(CPB)所致急性肺损伤。方法 28例首次心脏瓣膜置换术患者随机分为对照组及抑肽酶组,各14例。于CPB前(T1

  3. 重组人脑利钠肽对体外循环心脏瓣膜置换术患者血浆内毒素及全身炎性反应的影响%The effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients with cardiac valve replacement during cardiopulmonary bypass

    林国强; 罗万俊; 李迎秋; 蒋海河


    Objective To observe the effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients undergoing cardiac valve replacement surgery during cardiopulmonary bypass (CPB) and to explore its mechanism.Methods 32 patients with elective heart valve replacement surgery during cardiopulmonary bypass were divided into a control group and a treatment group randomly.The patients of treatment group were recievel rhBN (1.5 μg · kg-1 · min-1 bolus intravenous injection before aortic cross-clamping followed by 0.0075 μg · kg-1 · min-1 for 24 hours),while the patients of control group received the same volume of 0.9% sodium chloride.The plasma levels of endothelin -1 ( ET-1 ),diamine oxidase(DAO),lipopolysaccharide ( LPS),tumor necrosis factor-α (TNF-α) before skin incision ( T1 ),the end of CPB ( T2 ),4 h after the end of CPB ( T3 ),8 h after the end of CPB (T4),24h after the end of CPB (T5) respectively.Results Before skin incision ( T1 ),plasma ET-1,DAO,LPS,TNF-α of two group patients showed no significant difference ( P > 0.05 ) ; At each time point after the end of CPB ( T2,T3,T4,T5 ) Plasma DAO,LPS,TNF-α levels of two groups patients were significantly higher than before skin incision ( T1 ) levels ( P < 0.01 ).There was no significant difference of the plasma levels of ET-1 between T5 and T1 in treatment group patients ( P =0.24).At each time point after the end of CPB ( T2,T3,T4,T5 ),treatment group patients'plasma ET-1,DAO,LPS,TNF-α levels were significantly lower than the control group respectively (P <0.01 ).The increase in blood ET-1 was highly positive correlated with the increase in blood DAO (r=0.51,P <0.01 ).The increase in blood DAO was highly positive correlated with the increase in blood LPS (r =0.77,P < 0.01 ).The increase in blood LPS was significantly positive correlated with the increase in blood TNF-α ( r =0.48,P <0.01 ).Conclusion Recombinant human brain natriuretic

  4. 心理疏导及聆听音乐对体外循环手术患者术前睡眠质量的影响%Effect of psychological counseling and listening to music on sleep quality of the cardiopulmonary bypass patients before surgery

    陈美娇; 林玉琴


    目的 探讨心理疏导及聆听音乐对体外循环手术患者术前睡眠质量的影响.方法 将46例需行体外循环手术的患者按随机数字表法分为干预组和对照组各23例,对照组按体外循环术前常规护理进行护理,包括术前健康教育、呼吸训练、床上大小便训练及生活指导等,干预组在常规护理的基础上进行心理疏导及聆听音乐,分别采用匹兹堡睡眠质量指数问卷(Pittsburgh sleep quality index,PSQI)作为评定工具评价两组患者睡眠质量情况.结果入院时两组患者睡眠质量评分比较(P>0.05),差异无统计学意义;干预组患者经进行心理疏导及聆听音乐后,术前睡眠质量明显改善,两者比较(P<0.01),差异有统计学意义.结论 心理疏导及聆听音乐可提高体外循环手术患者术前的睡眠质量.%Objective To explore the effect of psychological counseling and listening to music on sleep quality of the cardiopulmo nary bypass patients before surgery.Methods A total of 46 patients who required cardiopulmonary bypass surgery were randomly divided into intervention group and control group,each group was 23 cases.The patients in control group were received routine care according to cardiopulmonary bypass surgery,including preoperative health education,breathing training,toilet training on bed,living guidance and so on.The patients in intervention group were received psychological guidance and listening to music on the basis of routine care.The sleep quality of all patients was evaluated by Pittsburgh sleep quality index.Results Compared with the scores of sleep quality of the two groups'patients in admitting (P > 0.05 ),the difference was not significant; the preoperative sleep quality was significant improved after intervention in intervention group,the difference was significant ( P < 0.01 ).Conclusions Psychological counseling and listening to music can improve the sleep quality of cardiopulmonary bypass patients

  5. Long-term closed chest partial and total cardiopulmonary bypass by peripheral cannulation for severe right and/or left ventricular failure, including ventricular fibrillation. The use of a percutaneous spring in the pulmonary artery position to decompress the left heart.

    Kolobow, T; Rossi, F; Borelli, M; Foti, G


    The authors report that total cardiopulmonary bypass (CPBP) for severe heart failure can be safely maintained for several days through peripheral cannulation alone. In two healthy sheep under general anesthesia, the authors cannulated the right external jugular vein and the right subclavian artery. A special spring was attached to a 7F Swan-Ganz catheter and positioned at the level of the pulmonary artery (PA) valve, rendering it partially incompetent. The extracorporeal circuit included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator set at 25 beats/min. Ventricular fibrillation was induced with 110 VAC. Extracorporeal blood flow was raised to 100-120 ml/kg min. Mechanical pulmonary ventilation was changed to 5% CO2 in room air. During bypass, the wedge pressure (WP) averaged 9-13 mmHg, PA pressure 7-13 mmHg, and central venous pressure 1-9 mmHg. After 38 and 48 hr respectively the hearts were defibrillated with DC shock. There was total heart failure with no ejection from right or left. We continued with TCPBP. The right heart recovered after 1 and 3 hr respectively. After 7 and 5 hr, respectively, there was some aortic ejection. By 11 and 4 hr, respectively, the sheep were off bypass and on room air, with return to baseline cardiac function. Throughout the recovery the WP averaged 4-8 mmHg. At autopsy, all hearts were soft and normal in appearance. Histologic examination of the lungs and the heart was unremarkable. The authors conclude that the PA spring readily decompressed the LV. Ventilating lungs with 5% CO2 in air during CPBP sustained excellent lung function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3196550

  6. Estudo da função pulmonar em pacientes submetidos a revascularização do miocárdio sem circulação extracorpórea com derivação intraluminal Pulmonary function study in patients who underwent myocardial revascularization without cardiopulmonary bypass with an intraluminal shunt

    Ana Maria Rocha Pinto


    Full Text Available As alterações da função pulmonar nos pacientes submetidos a cirurgias com auxílio da Circulação Extracorpórea (CEC têm sido relatadas na literatura. O objetivo do presente estudo foi analisar a função pulmonar de um grupo de pacientes submetidos a cirurgia de revascularização do miocárdio sem o uso da CEC. Foram estudados de maneira prospectiva 23 pacientes portadores de insuficiência coronariana e submetidos a cirurgia de revascularização do miocárdio sem CEC. A idade variou de 36 a 69 anos, sendo 16 pacientes do sexo masculino e sete do sexo feminino. A avaliação da função pulmonar foi feita através de espirometria e prova alvéolo-respiratória, realizadas no período pré-operatório, no quarto dia (PO4 e no décimo dia (PO10> pós-operatório. A análise dos dados revelou redução da Capacidade Vital (CV em 37,84% (pPulmonary complications are a major cause of postoperative morbidity and mortality in those patients undergoing operations utilizing cardiopulmonary bypass. The purpose of this study was to evaluate the pulmonary function after myocardial revascularization without cardiopulmonary bypass using a intraluminal shunt. Twenty-three patients with coronary disease were submitted to surgery by this technique and pulmonary function testing was conducted consecutively. The surgeries were performed via a median sternotomy with a reversed saphenous vein and/or an internal mammary artery graft. The age ranged from 36 to 69 years (mean 56,3 years. The group was comprised by 16 men and seven women. The pulmonary function tests consisted of spirometric investigations and blood gases measurements with evaluation of intrapulmonary shunt degree, both analyzed during the preoperative period, at the 4th (PO4 and at the 10th (PO10 postoperative day. In spirometry were determinated the vital capacity (VC, forced vital capacity (FVC, forced expiratory volume at one second (FEV, forced expiratory flow over middle half of FVC (FEF

  7. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    Im, Hyeongwoo; Min, Jeong Jin; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan


    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopa...

  8. Outcomes after off-pump coronary bypass surgery

    van Dijk, Diederik


    The complications associated with in coronary artery bypass surgery (CABG) using cardiopulmonary bypass (CPB) have led to a renewed interest in coronary bypass surgery on the beating heart. The primary objective of the Octopus Study was to compare cognitive outcome between patients randomized to off-pump or on-pump CABG. In chapter 2, the literature suggesting that CABG may impair cognitive function is systematically reviewed and chapter 3 describes in detail the rationale and design of the O...

  9. Monitoring Renal Microcirculation Perfusion Alteration with Contrast-enhanced Ultrasound during Cardiopulmonary Bypass%超声造影监测儿童及婴幼儿体外循环下肾脏微循环灌注的初探

    钟晓绯; 朱达; 卢强; 刘斌; 彭玉兰


    目的 探讨采用超声微泡造影方法监测儿童及婴幼儿体外循环下肾脏微循环灌注的改变.方法 建立体外循环30 min后,采用实时谐波超声造影技术获取肾脏超声微血管造影图像,分析肾脏不同区域灌注时间-强度(TIC)曲线,获取相关定量参数,包括上升支斜率(A)、曲线下面积(AUC)、曲线峰值强度绝对值(DPI)、达峰时间(TTP),比较不同采集时间点、不同区域灌注相关参数差异.结果 体外循环期间肾脏各个区域(髓质锥体、深层皮质及浅层皮质区域)灌注参数相对于体外循环前均降低或延长(P<0.05).结论 体外循环对儿童肾脏灌注产生明显的影响,其表现为全肾灌注降低及局部灌注性差异,以髓质区域的灌注降低最为明显.超声微泡造影技术能够清晰地显示体外循环期间肾脏微循环灌注功能状态的改变.%Objective To investigate the monitoring of renal microcirculation perfusion alteration with contrast-enhanced ultrasound (CEU) during cardiopulmonary bypass (CPB).Methods Renal microcirculation perfusion before and during CPB was assessed by CEU.Time-intensity curve (TIC) were derived from three region of interest (ROD using QLAB post-analysis software.Parameters such as TIC curve wash in slope (A),area under curve (AUC),peak intensity (DPI) as well as time to peak intensity (TTP) were then calculated.Results Contrast-enhanced ultrasound showed a significant reduction (or elongation) of perfusion parameter (A,AUC,DPI,TTP) in all three regions (superficial cortex,deep cortex and medulla) during cardiopulmonary bypass in comparison with normal cardiac cycle.Conclusion Cardiopulmonary bypass (CPB) has a dramatic impact on renal microcirculation in pediatric patients which manifest as global reduction in renal perfusion as well as significant region perfusion difference.Contrast-enhanced ultrasound (CEU) could detect the renal microcirculation alteration during CPB.

  10. Evaluation of optimal goal of glucose control and the effect on ventricular function in patients undergoing heart surgery with cardiopulmonary bypass%体外循环心脏手术围手术期血糖控制目标及其对心功能影响的探讨

    李静; 穆心苇; 章淬; 施乾坤


    目的 研究不同血糖控制目标对体外循环心脏手术患者围手术期心功能的影响,探讨心脏手术围手术期合理的血糖目标.方法 选择体外循环心脏手术患者584例,随机分为三组:从手术开始直至术后24 h目标血糖控制于4.4~6.1 mmol/L(即80~110 mg/dl,A组)、7.2~8.3 mmol/L(即130~150 mg/dl,B组)和血糖控制于10.0~11.1 mmol/L的对照组(即180~200 mg/dl,RT组),记录各组患者血糖控制情况,观察对比各组血流动力学指标以及围手术期左心室收缩功能、新发心律失常以及低血糖发生情况.结果 围手术期A组、B组相对于RT组血流动力学更加平稳(P<0.001),左心室收缩功能优于RT组(P<0.001),A组低血糖发生明显高于B组及RT组(P<0.05).结论 心脏手术围手术期强化胰岛素治疗将血糖控制在4.4~6.1 mmol/L、7.2~8.3 mmol/L均有利于术后心脏收缩功能的恢复,但将血控制于≤8.3 mmol/L较≤6.1 mmol/L更加安全.%Objective To investigate the influence on ventricular function of different levels of glucose control in patients undergoing heart surgery with cardiopulmonary bypass, therefore to assess the optimal glucose control goal. Methods A total of 584 patients undergoing heart surgery with cardiopulmonary bypass were randomly divided into three groups according to the target glucose control levels from surgery beginning to postoperative 24 hours:Group A,blood glucose maintained between 4. 4-6. 1 mmol/L( 80-110 mg/dl ), Group B,7. 2-8. 3 mmol/L (130-150 mg/dl ) and routine treatment group, 10.0-11.1 mmol/L ( 180-200 mg/dl). The blood glucose, haemodynamics indexes, perioperative left ventricle systolic function, new arrhythmia and hypoglycemia were observed. Results Group A and Group B hold a more stable haemodynamics compared with routine treatment group ( P<0.001 ),and perioperative left ventricle systolic function of Group A and Group B were better than that of routine treatment group( P <0. 001 ),no

  11. The increase of plasminogen activator inhibitor activity is associated with graft occlusion in patients undergoing aorto-coronary bypass surgery

    Rifon, J. (José); Paramo, J. A.; Panizo, C. (Carlos); R. Montes; Rocha, E


    Early graft occlusion is a common complication in patients undergoing aorto-coronary bypass surgery. Both mechanical and haemostatic factors play a role in the pathogenesis of thrombotic occlusion. Several studies have demonstrated a relationship between fibrinolytic activity and venous or arterial thrombosis. We undertook this study to evaluate the possible contribution of the fibrinolytic system to postoperative occlusion in patients undergoing aorto-coronary bypass graft (CABG). A venous o...

  12. Successful Management of Membrane Oxygenator Failure during Cardiopulmonary Bypass—The Importance of Safety Algorithm and Simulation Drills

    Soo, Alan; Booth, Karen; Parissis, Haralabos


    With a high risk to time ratio, the advent of cardiopulmonary bypass has facilitated greater advances in technical procedures in cardiac surgery. This, however, has not come without its own complication risk and previous near misses have been reported with regard to various technical aspects of the cardiopulmonary bypass circuit. We present a case of a failed membrane oxygenator and discuss the real-life aspects to managing this complication without added risk to the patient.

  13. Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats.

    Biegler, Jessica M; Freet, Christopher S; Horvath, Nelli; Rogers, Ann M; Hajnal, Andras


    Roux-en-Y gastric bypass (RYGB) surgery is a commonly performed and very effective method to achieve significant, long-term weight loss. Opioid analgesics are primarily used to manage postoperative pain as fewer alternative medication options are available for bariatric surgery patients than for the general population. Recent clinical studies support a greater risk for substance use following bariatric surgery, including an increased use of opioid medications. The present study is the first to study morphine self-administration in a rat model of RYGB. High fat diet-induced obese (HFD-DIO) rats underwent RYGB (n=14) or sham-surgery with ad libitum HFD (SHAM, n=14) or a restricted amount that resulted in weight matched to the RYGB cohort (SHAM-WM, n=8). An additional normal-diet (ND, n=7), intact (no surgery) group of rats was included. Two months after the surgeries, rats were fitted with jugular catheters and trained on a fixed ratio-2 lick task to obtain morphine intravenously. Both morphine-seeking (number of licks on an empty spout to obtain morphine infusion) and consumption (number of infusion) were significantly greater in RYGB than any control group beginning on day 3 and reached a two-fold increase over a period of two weeks. These findings demonstrate that RYGB increases motivation for taking morphine and that this effect is independent of weight loss. Further research is warranted to reveal the underlying mechanisms and to determine whether increased morphine use represents a risk for opioid addiction following RYGB. Identifying risk factors preoperatively could help with personalized postoperative care to prevent opioid abuse and addiction. PMID:26304761

  14. Retrograde autologous priming in cardiopulmonary bypass in adult patients: effects on blood transfusion and hemodilution Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos: efeitos sobre a hemodiluição e transfusão de sangue

    Ricardo Vieira Reges


    Full Text Available INTRODUCTION: Retrograde autologous priming (RAP is a cardiopulmonary bypass (CPB method, at low cost. Previous studies have shown that this method reduces hemodilution and blood transfusions needs through increased intra-operative hematocrit. OBJECTIVE: To evaluate RAP method, in relation to standard CPB (crystalloid priming, in adult patients. METHODS: Sixty-two patients were randomly allocated to two groups: 1 Group RAP (n = 27 of patients operated using the RAP and; 2 Control group of patients operated using CPB standard crystalloid method (n = 35. The RAP was performed by draining crystalloid prime from the arterial and venous lines, before CPB, into a collect recycling bag. The main parameters analyzed were: 1 CPB hemodynamic data; 2 Hematocrit and hemoglobin values; 3 The need for blood transfusions. RESULTS: It was observed statistically significant fewer transfusions during surgery and reduced CPB hemodilution using RAP. The CPB hemodynamic values were similar, observing a tendency to use lower CPB flows in the RAP group patients. CONCLUSION: This investigation was designed to be a small-scale pilot study to evaluate the effects of RAP, which were demonstrated concerning the CPB hemodilution and blood transfusions.INTRODUÇÃO: Perfusato autólogo retrógrado (PAR é uma técnica de circulação extracorpórea (CEC com baixos custos. Estudos anteriores demonstraram que esta técnica reduz a hemodiluição e a necessidade de transfusões de sangue por meio do aumento do hematócrito intraoperatório. OBJETIVO: Avaliar técnica de PAR em relação à CEC técnica padrão (perfusato cristaloide em pacientes adultos. MÉTODOS: Sessenta e dois pacientes foram aleatoriamente alocados em dois grupos: 1 Grupo PAR (n = 27, constituído por pacientes operados utilizando a técnica de PAR e; 2 Grupo Controle, constituído por pacientes operados utilizando técnica padrão de CEC com cristaloides (n = 35. A PAR foi realizada drenando-se o perfusato

  15. Out-of-hospital cardiopulmonary arrest due to penetrating cardiac injury treated by percutaneous cardiopulmonary support in the emergency room: report of a case.

    Kurimoto, Yoshihiko; Kano, Hitoshi; Yama, Naoya; Nara, Satoshi; Hase, Mamoru; Asai, Yasufumi


    Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients. PMID:17342366

  16. Roux-en-Y gastric bypass alleviates hypertension and is associated with an increase in mid-regional pro-atrial natriuretic peptide in morbid obese patients

    Bonfils, Peter K; Taskiran, Mustafa; Damgaard, Morten;


    OBJECTIVE: To examine 24-h blood pressure (24BP), systemic haemodynamics and the effect of sodium intake on 24BP in obese patients before and after gastric bypass surgery [laparoscopic Roux-en-Y gastric bypass (LRYGB)], and to determine whether weight loss from LRYGB might be related to an increase...... effect of high versus low sodium intake on 24BP was evaluated before and 12 months after LRYGB. RESULTS: Six weeks after LRYGB, the average weight loss was 20 kg, with a further 21 kg weight loss 1 year after surgery. In hypertensive patients, 24BP was significantly reduced at 6 weeks, but not 1 year...... prior to surgery in hypertensive patients and increased by 77% 1 year after the operation. In normotensive patients, preoperative concentrations were normal and increased only by 6%. High sodium intake induced plasma volume expansion, increased stroke volume and cardiac output, but no significant change...

  17. Cardiopulmonary resuscitation update.

    Lipley, Nick


    THE ROYAL College of Nursing (RCN), Resuscitation Council (UK) and British Medical Association (BMA) have issued a new edition of their guidance on when to attempt cardiopulmonary resuscitation (CPR). PMID:25369953

  18. Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia Temperatura y alteraciones en el equilibrio ácido-base de pacientes sometidos a cirugía cardíaca con circulación extracorpórea, bajo normotermia e hipotermia Temperature and acid-base balance in coronary bypass grafting with cardiopulmonary bypass, under hypothermia and normothermia

    Hugo Leonardo de Moura Luz


    operados sobre hipotermia, sugiriendo que el transporte de oxígeno para la periferia no fue adecuado durante el período de observación propuesto. La disminución de la temperatura, aun cuando discreta, parece no haber conferido el grado de protección celular esperada al flujo sanguíneo de la CEC.BACKGROUND AND OBJECTIVES: Cardiopulmonary bypass (CPB is related to several changes in normal physiology. The multiple causes of these changes interact and are a potential risk for postoperative organic dysfunction. This study aimed at investigating changes in acid-base and metabolic balance during cardiopulmonary bypass with hypothermia and at comparing them to those observed in patients submitted to normothermal cardiopulmonary bypass. METHODS: Participated in this study 30 adult patients of both genders, aged 41 to 78 years, scheduled for coronary bypass grafting with CPB, under normothermia or hypothermia. The following parameters were evaluated: hemoglobin and blood gases concentration, pH, bicarbonate, base excess, anion gap, lactate ion, tissue oxygenation parameters and flow and systemic vascular resistance. RESULTS: There were no statistically significant differences in arterial pH, arterial bicarbonate, Na+ and Cl- plasma concentrations, anion gap, carbon dioxide partial pressure and arterial oxygen content between Normothermia and Hypothermia Groups. A time-effect was observed for all variables except for base excess and anion gap. Base excess and K+ concentration were lower in the hypothermia group. Serum lactate increased in both groups when comparing time before CPB to after CPB, with higher levels in the hypothermia group. CONCLUSIONS: Mild hypothermia does not seem to substantially change acid-base balance as compared to normal temperature during CPB. Plasma lactate, however, has significantly increased in patients under hypothermia, suggesting inadequate oxygen transport to periphery during the proposed observation period. Low temperature, although mild, does

  19. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

    Levy Adrian R


    Full Text Available Abstract Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients for patients treated within the recommended time and 1.5% (70 among 4641 for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96. There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11. Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.

  20. Impact of Obesity on Cardiopulmonary Disease.

    Chandler, Marjorie L


    Although there are known detrimental effects of obesity on the heart and lungs, few data exist showing obesity as risk factor for cardiopulmonary disorders in dogs and cats. It is probable that increased abdominal fat is detrimental as it is in humans, and there is evidence of negative effects of increased intrathoracic fat. As well as physical effects of fat, increased inflammatory mediators and neurohormonal effects of obesity likely contribute to cardiopulmonary disorders. Weight loss in overweight individuals improves cardiac parameters and exercise tolerance. Obesity in patients with obstructive airway disorders is recognized to increase disease severity. PMID:27264052

  1. Cardiopulmonary adaptation to weightlessness

    Prisk, G. K.; Guy, H. J.; Elliott, A. R.; West, J. B.


    The lung is profoundly affected by gravity. The absence of gravity (microgravity) removes the mechanical stresses acting on the lung paranchyma itself, resulting in a reduction in the deformation of the lung due to its own weight, and consequently altering the distribution of fresh gas ventilation within the lung. There are also changes in the mechanical forces acting on the rib cage and abdomen, which alters the manner in which the lung expands. The other way in which microgravity affects the lung is through the removal of the gravitationally induced hydrostatic gradients in vascular pressures, both within the lung itself, and within the entire body. The abolition of a pressure gradient within the pulmonary circulation would be expected to result in a greater degree of uniformity of blood flow within the lung, while the removal of the hydrostatic gradient within the body should result in an increase in venous return and intra-thoracic blood volume, with attendant changes in cardiac output, stroke volume, and pulmonary diffusing capacity. During the 9 day flight of Spacelab Life Sciences-1 (SLS-1) we collected pulmonary function test data on the crew of the mission. We compared the results obtained in microgravity with those obtained on the ground in both the standing and supine positions, preflight and in the week immediately following the mission. A number of the tests in the package were aimed at studying the anticipated changes in cardiopulmonary function, and we report those in this communication.

  2. 儿童非紫绀型先心病体外循环术后急性肾损伤相关危险因素分析%Risk factors for acute kidney injury after cardiopulmonary bypass operation in children with non cyanotic congenital heart disease

    温昱鹏; 常诚; 王仲伦; 郑捷


    目的 探讨儿童非紫绀型先天性心脏病体外循环(CPB)心脏手术后急性肾损伤(AKI)的发病情况及相关危险因素.方法 回顾性分析2012年5月—2014年5月行CPB心脏手术的患儿150例,根据术后是否发生AKI分为AKI组29例和非AKI组121例.收集患儿性别、年龄、基础血肌酐值等相关临床资料,比较2组间临床指标的差异,并采用多因素Logistic回归分析AKI发生的相关危险因素.结果 全组无死亡,组间比较分析显示年龄、肺炎和(或)心衰史、基础血肌酐值、基础尿酸值、体质量、CPB时间、主动脉阻断时间、术后输血量、机械通气时间及低血压差异有统计学意义.Logistic回归分析显示,年龄(≤1岁)、肺炎和(或)心衰史、CPB时间(>40 min)、主动脉阻断时间(>30 min)是CPB术后发生AKI的危险因素.结论 选择儿童手术的最佳年龄、积极预防术前并发症、缩短CPB和主动脉阻断时间对预防AKI的发生有重要作用.%Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after cardiopulmonary bypass(CRB) in children with non cyanotic congenital heart disease. Methods A total of 150 children who underwent cardiopulmonary bypass operation from 2012 May to 2014 May were analyzed retrospectively. The patients were divided into two groups:AKI group (n=29) and non AKI group (n=121). Clinical data were collected and compared between two groups, including gender, age and baseline serum creatinine level. Multivariate Logistic regression analysis was used to evaluate the risk factors for AKI after operation. Results There was no death in the 150 cases. Comparison between groups, there were significant differences in age, history of heart failure and (or)pneumonia, baseline serum creatinine level, baseline uric acid, body mass, CPB) time, aortic clamping time, mechanical ventilation time, postoperative transfusion and hypotension. Multivariate Logistic regression analysis

  3. 不同年龄发绀型先心病患儿围体外循环期凝血功能的比较%Changes in blood coagulation during cardiopulmonary bypass in children of different ages with cyanotic congenital heart disease

    陈煜; 黄延辉; 白洁


    Objective To investigate the changes in blood coagulation during cardiopulmonary bypass (CPB) in children of different ages undergoing open heart surgery for cyanotic congenital heart disease.Methods Sixty children with cyanotic congenital heart disease undergoing open heart surgery under CPB were divided into 3 age groups: Group A(age≤12 mort, n=25), Group B (12mon<age≤24 mon, n= 17) and Group C (24 mon< age<4 yr, n=18). Venous blood samples were taken immediately after induction of anesthesia(T1) and at 10 min after protamine administration (T2)for determination of activated coagulation time (SonACT), clot rate and platelet function (PF) using Sonoclot coagulation and platelet function analyzer-type DP2951 (Sieuco Co., USA).Results There was significant difference in SonACT, clot rate and PF at T1 among the 3 groups: the SonACT was significantly shorter in Groups B and C than in Group A, the clot rate was significantly higher in Group B than in Group C, and the PF was significantly lower in Group C than in Group A. At T2 , the SonACT was significantly prolonged in all 3 groups, the clot rate was significantly decreased in Groups A and B, and the PF was significantly decreased in Group A.Conclusion There are significant differences in blood coagulation and PF among the 3 different age groups of children with cyanotic congenital heart disease after induction of anesthesia and CPB has different effects on their blood coagulation and PF.

  4. Cardiopulmonary discipline science plan


    Life sciences research in the cardiopulmonary discipline must identify possible consequences of space flight on the cardiopulmonary system, understand the mechanisms of these effects, and develop effective and operationally practical countermeasures to protect crewmembers inflight and upon return to a gravitational environment. The long-range goal of the NASA Cardiopulmonary Discipline Research Program is to foster research to better understand the acute and long-term cardiovascular and pulmonary adaptation to space and to develop physiological countermeasures to ensure crew health in space and on return to Earth. The purpose of this Discipline Plan is to provide a conceptual strategy for NASA's Life Sciences Division research and development activities in the comprehensive area of cardiopulmonary sciences. It covers the significant research areas critical to NASA's programmatic requirements for the Extended-Duration Orbiter, Space Station Freedom, and exploration mission science activities. These science activities include ground-based and flight; basic, applied, and operational; and animal and human research and development. This document summarizes the current status of the program, outlines available knowledge, establishes goals and objectives, identifies science priorities, and defines critical questions in the subdiscipline areas of both cardiovascular and pulmonary function. It contains a general plan that will be used by both NASA Headquarters Program Offices and the field centers to review and plan basic, applied, and operational (intramural and extramural) research and development activities in this area.

  5. The effect of monosialotetrahexosylganglioside on cardiopulmonary bypass-associated brain injury and extrallular signal regulated protein kinase signaling pathway%单唾液酸神经节苷脂对大鼠体外循环脑损伤及细胞外信号调节激酶信号通路的影响

    王洪乾; 姚国泉; 孙莹杰; 张铁铮


    目的 探讨单唾液酸神经节苷脂(monosialotetrahexosylganglioside,GM-1)对大鼠体外循环(cardiopulmonarybypass,CPB)脑损伤及细胞外信号调节激酶(extrallular signal regulated protein kinase,ERK1/2)信号通路的影响. 方法 成年雄性SD大鼠27只,体重350 g~450 g,采用随机数字表法将其随机分成3组(每组9只):空白对照组(阴性对照组,S组)、CPB对照组(阳性对照组,B组)、GM-1干预组(实验组,C组).采用右颈静脉腔房引流、右颈动脉灌注建立大鼠体外循环模型.S组不建模型,穿刺后进行机械通气60 min,B组和C组进行CPB 60 min,其中C组转流液中加入GM-1(20 mg/kg),B组给予相同体积的生理盐水.于转流前(T0)、CPB转流即刻(T1)、CPB 15 min(T2)、CPB 45 min(B)、CPB结束后1 h(T4)时记录平均动脉压(mean artery pressure,MAP)及血气分析指标.CPB结束和S组机械通气后3h时断头取脑组织标本,透射电镜观察皮质超微结构变化;原位细胞凋亡检测法[terminal dexynucleotidyl transferase(TdT)-mediated dUTP nick end labeling,TUNEL]标记皮质神经元凋亡数;免疫组化和免疫印迹(Western-blot)法检测ERK1/2蛋白的表达. 结果 B组和C组转流中平均动脉压、心率、血气、红细胞比容比较,差异无统计学意义;与S组比较,B组和C组皮质神经元损伤严重,凋亡的神经细胞数目分别增加220%和147%,ERK1/2蛋白活性分别升高65%和41%(P<0.05);与B组比较,C组皮质神经元损伤明显减轻,凋亡的神经细胞数目减少24%,ERK1/2蛋白活性降低15%(P<0.05). 结论 GM-1对体外循环脑损伤有保护作用,其机制可能与抑制ERK1/2信号通路减少神经细胞凋亡有关.%Objective To investigate the effect of monosialotetrahexosylganglioside (GM-1) on cardiopulmonary bypass (CPB)-associated brain injury and extrallular signal regulated protein kinase (ERK1/2) signaling pathway.Methods Twenty-seven adult male SD rats weighing 350 g-450 g were randomly

  6. Nitrite exhaled breath condensate study in patients undergoing cardiopulmonary bypass cardiac surgery Estudo do nitrito do condensado do exalado pulmonar em pacientes submetidos à cirurgia cardíaca com CEC

    Viviane dos Santos Augusto


    Full Text Available BACKGROUND: There is a relative lack of studies on postoperative changes in nitrite (NO2 - concentrations, a marker of injury, following cardiac surgery. In this context, investigations on how exhaled NO concentrations vary in the postoperative period of cardiac surgery will certainly contribute to new clinical findings. OBJECTIVE: The objective of this study was to compare the EBC NO levels in both the pre and postoperative (24 hours periods of cardiac surgery. METHODS: Twenty - eight individuals were divided into three groups: 1 control, 2 coronary artery bypass grafting, and 3 valve surgery. The nitrite (NO2 - levels were measured by chemiluminescence in blood samples and exhaled breath condensate (EBC. Data were analyzed by the Mann - Whitney and Wilcoxon tests. RESULTS: 1 Preoperatively, the EBC NO2 - levels from groups 2 and 3 patients were higher than control individuals; 2 The postoperative (24 hours NO2 - levels in the EBC from group 3 patients were lower compared with preoperative values; 3 The NO2 - levels in the plasma from group 2 patients were lower in the preoperative compared with the postoperative (24h values and; 4 Preoperatively, there was no difference between groups 2 and 3 in terms of plasma NO2 - concentrations. CONCLUSION: These data suggest that NO measurement in EBC is feasible in cardiac surgery patients.INTRODUÇÃO: Estudos mostrando alterações das concentrações de nitrito (NO2 - exalado, com biomarcador de lesão, são raros em pacientes submetidos à cirurgia cardíaca. Nesse contexto, o seu estudo no pré e pós - operatório de cirurgias cardíacas poderá contribuir para novos dados clínicos. OBJETIVO: O objetivo foi comparar os níveis de nitrito (NO2 - do condensado do exalado pulmonar (CEP no pré e pós - operatório de cirurgia cardíaca com circulação extracorpórea. MÉTODOS: Vinte e oito indivíduos foram alocados em três grupos: 1 controle, 2 revascularização do miocárdio e 3 corre

  7. Early chest tube removal after coronary artery bypass graft surgery

    Mohsen Mirmohammad-Sadeghi


    Full Text Available Background: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. Aim: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. Material and Methods: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107 chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200, chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. Results: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001 which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047. The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016. The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. Conclusion: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn′t increase the risk of creation of plural effusion and pericardial effusion.

  8. Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery

    Kadan, Murat; Erol, Gokhan; Savas Oz, Bilgehan; Arslan, Mehmet


    Summary Background We aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery. Methods Fifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients...

  9. Cost Performance and Efficacy of Off-pump Coronary Artery Bypass Grafting

    Nomura, Fumikazu; Mukai, Shogo; Tamura, Kentaro; Shimazutsu, Kazufumi; Okuma, Kazuhide; Ihara, Katsuhiko


    Off-pump coronary artery bypass grafting (Off-Pump CABG) may provide an alternative form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in high-risk patients. To clarify the efficacy and cost performance of Off- Pump CABG, we studied the postoperative course of Off-Pump CABG and compared it to On- pump coronary artery bypass grafting (On-Pump CABG). From Aug. 1998 to Feb. 2002, twenty-eight patients who had preoperative complicatio...

  10. Aprotinina preserva plaquetas em crianças com cardiopatia congênita acianogênica operadas com circulação extracorpórea? Does aprotinin preserve platelets in children with acyanogenic congenital heart disease undergone surgery with cardiopulmonary bypass?

    Cesar Augusto Ferreira


    Full Text Available OBJETIVO: Avaliação dos efeitos hemostáticos e plaquetários em crianças submetidas a correção de cardiopatias congênitas acianogênicas com circulação extracorpórea que receberam aprotinina. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas a correção de cardiopatia congênita acianogênica, com circulação extracorpórea (CEC e divididas em dois grupos, um denominado Controle (n=9 e o outro, Aprotinina (n=10. Neste, a droga foi administrada antes e durante a CEC. A disfunção hemostática foi analisada por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB and were divided into two groups: Control (n=9 and Aprotinin (n=10. In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug presented no benefit regarding time of mechanical pulmonary ventilation, stay in the postoperative intensive care unit and hospital, or regarding the use of inotropic drugs and renal function. Platelet concentration was preserved with the use of Aprotinin, whereas thrombocytopenia occurred in the Control Group since the initiation of CPB. Blood loss was similar for both groups. There were no complications with the use of Aprotinin. CONCLUSION: Aprotinin quantitatively preserved the blood platelets in children with