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Sample records for cardiopulmonary bypass

  1. Cardiopulmonary bypass in pregnancy.

    Science.gov (United States)

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

    1996-01-01

    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

  2. Thrombin during cardiopulmonary bypass.

    Science.gov (United States)

    Edmunds, L Henry; Colman, Robert W

    2006-12-01

    Cardiopulmonary bypass (CPB) ignites a massive defense reaction that stimulates all blood cells and five plasma protein systems to produce a myriad of vasoactive and cytotoxic substances, cell-signaling molecules, and upregulated cellular receptors. Thrombin is the key enzyme in the thrombotic portion of the defense reaction and is only partially suppressed by heparin. During CPB, thrombin is produced by both extrinsic and intrinsic coagulation pathways and activated platelets. The routine use of a cell saver and the eventual introduction of direct thrombin inhibitors now offer the possibility of completely suppressing thrombin production and fibrinolysis during cardiac surgery with CPB. PMID:17126170

  3. Cardiopulmonary bypass in pregnancy

    Directory of Open Access Journals (Sweden)

    Mukul Chandra Kapoor

    2014-01-01

    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.

  4. Hyperamylasemia following cardiopulmonary bypass.

    Science.gov (United States)

    Chang, H; Chung, Y T; Wu, G J; Hwang, F Y; Chen, K T; Peng, W L; Hung, C R

    1992-01-01

    In order to study the occurrence of postbypass hyperamylasemia, 75 patients undergoing cardiopulmonary bypass (CPB) were studied from March 1989 to January 1990. There were 49 males and 26 females. Among them, 27 had congenital heart disease, 30 had valvular disease, and 18 had coronary artery disease. There were 27 patients with at least one elevated serum amylase sample after operation. Thus, the overall incidence of hyperamylasemia was 36%. As compared with the preoperative data (1.3%), there was a statistically significant difference in the occurrence of hyperamylasemia (p less than 0.05). Three patients had overt clinical pancreatitis postoperatively. There was no positive correlation between the serum amylase level and the occurrence of pancreatitis (p greater than 0.05). Forty-two cases had a significant elevation of the amylase creatinine clearance ratio (ACCR) after CPB. However, there was no significant difference between the groups with pulsatile and nonpulsatile CPB (p greater than 0.05). Three patients (4%) died in our series. The causes of death were heart failure in two and fulminant pancreatitis associated with low cardiac output in one. Although our experience in dealing with pancreatitis improved survival, mortality was still high (33.3%) in our series. Nevertheless, there was no apparent correlation between mortality and postbypass hyperamylasemia (p greater than 0.05). Logistic regression analysis was used to analyze the risk factors of the occurrence of hyperamylasemia, and the analysis revealed that patients with coronary artery disease were susceptible to postbypass hyperamylasemia. Our studies indicate that the use of total serum amylase or ACCR to monitor for the occurrence of pancreatitis in postbypass patients is inadequate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1377742

  5. Mini cardiopulmonary bypass: Anesthetic considerations

    OpenAIRE

    Alsatli, Raed A.

    2012-01-01

    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...

  6. Dynamic Cerebral Autoregulation after Cardiopulmonary Bypass

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...

  7. Cardiopulmonary Bypass and Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Mustafa Zakkar

    2015-01-01

    Full Text Available The development of the cardiopulmonary bypass (CPB revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.

  8. "Orpheus" cardiopulmonary bypass simulation system.

    Science.gov (United States)

    Morris, Richard W; Pybus, David A

    2007-12-01

    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. 21 CFR 870.4250 - Cardiopulmonary bypass temperature controller.

    Science.gov (United States)

    2010-04-01

    ... 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....

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

    OpenAIRE

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

    2012-01-01

    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...

  11. Factor V Leiden and Cardiopulmonary Bypass

    OpenAIRE

    Uppal, Victor; Rosin, Mark; Marcoux, Jo-Anne; Olson, Marnie; Bezaire, Jennifer; Dalshaug, Gregory

    2015-01-01

    We present a case of a patient with factor V Leiden with an antithrombin III activity of 67% who received a successful aortic valve replacement supported by cardiopulmonary bypass (CPB). A safe level of anticoagulation was achieved by monitoring activated clotting time (ACT) and heparin concentration ensuring adequate anticoagulation throughout the procedure. Results from ACT, heparin dose response, heparin protamine titration, and thrombelastography are given. Factor V Leiden patients can be...

  12. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 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...

  13. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    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.

  14. 21 CFR 870.4420 - Cardiopulmonary bypass cardiotomy return sucker.

    Science.gov (United States)

    2010-04-01

    ... 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...

  15. Factor V Leiden and Cardiopulmonary Bypass

    Science.gov (United States)

    Uppal, Victor; Rosin, Mark; Marcoux, Jo-Anne; Olson, Marnie; Bezaire, Jennifer; Dalshaug, Gregory

    2015-01-01

    Abstract: We present a case of a patient with factor V Leiden with an antithrombin III activity of 67% who received a successful aortic valve replacement supported by cardiopulmonary bypass (CPB). A safe level of anticoagulation was achieved by monitoring activated clotting time (ACT) and heparin concentration ensuring adequate anticoagulation throughout the procedure. Results from ACT, heparin dose response, heparin protamine titration, and thrombelastography are given. Factor V Leiden patients can be safely anti-coagulated using heparin for CPB procedures when monitored with ACT, heparin protamine titration, and thrombelastography. Postoperative chest tube losses were 360 mL, less than half our institutional average. Anticoagulation for the pre-and post-operative phase is also discussed. PMID:26834284

  16. Alveolar proteinosis lung lavage using partial cardiopulmonary bypass.

    OpenAIRE

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

    1981-01-01

    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.

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

    Science.gov (United States)

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

    2016-06-01

    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

  18. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Science.gov (United States)

    2010-04-01

    ... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter,...

  19. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

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

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 周成斌; 张海波; 祝忠群

    2003-01-01

    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.

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  2. 21 CFR 870.4370 - Roller-type cardiopulmonary bypass blood pump.

    Science.gov (United States)

    2010-04-01

    ... 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...

  3. 21 CFR 870.4360 - Nonroller-type cardiopulmonary bypass blood pump.

    Science.gov (United States)

    2010-04-01

    ... 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...

  4. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.

    Science.gov (United States)

    2010-04-01

    ... 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...

  5. The influence of biomaterials on inflammatory responses to cardiopulmonary bypass.

    Science.gov (United States)

    Courtney, J M; Matata, B M; Yin, H Q; Esposito, A; Mahiout, A; Taggart, D P; Lowe, G D

    1996-05-01

    The nature of cardiopulmonary bypass and the complexity of the inflammatory response make the detection and interpretation of a biomaterial influence difficult. However, if mediation of the inflammatory response is considered to be an appropriate clinical goal, alteration to the biomaterial influence merits further investigation.

  6. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass oxygenator. 870.4350 Section 870.4350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  7. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    NARCIS (Netherlands)

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G

    2006-01-01

    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using u

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...

  9. Glycemic control and outcome related to cardiopulmonary bypass.

    Science.gov (United States)

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

    2015-06-01

    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

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

    OpenAIRE

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

    1984-01-01

    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...

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

    Science.gov (United States)

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

    1997-01-01

    From March 1994 to April 1997, 433 patients had undergone coronary artery bypass grafting without cardiopulmonary bypass in our institute. Sixty-eight patients had various organ dysfunctions and/or aortic atheroma or calcification and were regarded as high risk for cardiopulmonary bypass. In 277 patients surgery was performed through midline sternotomy, while in 156 minithoracotomy approach was used. In 361 patients single coronary artery bypass grafting was done, and in 72 two-coronary arteries were bypassed. In 63 patients who had graftable vessels in anterior wall and diffusely diseased ungraftable vessels in posterolateral and/or inferior wall, transmyocardial laser revascularisation was also done along with coronary artery bypass grafting to achieve complete myocardial revascularisation. Nine patients in this series were also subjected to simultaneous carotid endarterectomy along with myocardial revascularisation. In two patients complementary percutaneous transluminal coronary angioplasty of left circumflex coronary artery was done five days after minithoracotomy and left internal mammary artery to left anterior descending coronary artery bypass grafting. Forty-two cases were extubated in operating room. Average blood loss was 260 ml. Six patients were reexplored for postoperative bleeding. Seven patients had perioperative myocardial infarction. One developed neurological complication. Hospital mortality was 2.3 percent (10/433 cases) and four deaths were due to malignant ventricular arrhythmias. Nine patients developed chest wound complications. Average hospital stay after operation was six days, 423 patients were discharged from hospital and all of them were asymptomatic. During three years follow-up (range 3 to 38 months) there were three known cardiac deaths. Ninety percent (391) patients reported to the follow-up clinic and 91 percent of them were angina-free. In patients who were subjected to transmyocardial laser revascularisation along with coronary

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Parissis Haralabos

    2011-04-01

    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.

  14. CLINICAL ADVANTAGES OF TOTAL CAVOPULMONARY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Popov Aron-Frederik

    2010-11-01

    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.

  16. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    Science.gov (United States)

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F

    1992-06-01

    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

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

    Science.gov (United States)

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

    1995-02-01

    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

  18. Antioxidative effect of propofol during cardiopulmonary bypass in adults

    Institute of Scientific and Technical Information of China (English)

    Shi-hai ZHANG; Shou-yong WANG; Shang-long YAO

    2004-01-01

    AIM: To investigate the antioxidative potential of propofol (an intravenous anesthetic with a chemical structure similar to phenol-based free radical scavengers such as vitamin E) during cardiopulmonary bypass (CPB). METHODS:Thirty adult patients referred for elective cardiac procedure with CPB were included and randomly allocated to a nously for anesthesia maintenance, whereas those allocated to the control group received fentanyl 10 μg/kg intravenously and inhaled enflurane (1%-1.5 %). Blood samples were collected at 7 time points: before the start of CPB,at 30 and 60 min of CPB, at the conclusion of CPB, 10 min after the administration of protamine, and 12 and 24 h after the cessation of CPB. Plasma levels of free F2-isoprostanes (sensitive markers of free radicals production)and complement C5a were determined by mass-spectrometric assay and enzyme immunoassay, respectively. Neutrophil adhesion to endothelial cells was observed at x200 magnification under a light microscope. RESULTS:Levels of F2-isoprostanes, complement C5a and neutrophil adhesion rate increased significantly during and after CPB in both groups. There were significantly higher levels of F2-isoprostanes, C5a, and more neutrophils adhering to endothelial cells in the control group than those in the propofol group, respectively. CONCLUSION: Cardiopulmonary bypass is associated with a great production of damaging free radicals. Propofol may be beneficial both as an anesthetic and as a potent free radical scavenger in patients presenting pathologies associated with free radical reactions during CPB.

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

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    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.

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

    NARCIS (Netherlands)

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.

    2015-01-01

    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 t

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

    OpenAIRE

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

    2013-01-01

    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...

  2. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    Science.gov (United States)

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano

    2016-01-01

    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  3. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    Institute of Scientific and Technical Information of China (English)

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li

    2011-01-01

    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

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

    OpenAIRE

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

    2008-01-01

    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...

  5. Does heparin pretreatment affect the haemostatic system during and after cardiopulmonary bypass?

    NARCIS (Netherlands)

    Brinks, H.J.; Weerwind, P.W.; Bogdan, S.; Verbruggen, H.W.; Brouwer, M.H.J.

    2001-01-01

    In this clinical pilot study, the influence of heparin pretreatment on the haemostatic system during and after cardiopulmonary bypass (CPB) was investigated. Thirteen patients scheduled for elective coronary artery bypass grafting (CABG) were divided into two groups: heparin pretreated (HP, n = 6) a

  6. The impact of heparin-coated circuits on hemodynamics during and after cardiopulmonary bypass

    NARCIS (Netherlands)

    de Vroege, R; Huybregts, R; van Oeveren, W; van Klarenbosch, J; Linley, G; Mutlu, J; Jansen, E; Hack, E; Eijsman, L; Wildevuur, C

    2005-01-01

    This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused

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

    Science.gov (United States)

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

    1988-09-01

    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

  8. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  9. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Science.gov (United States)

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M

    1981-08-01

    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

  10. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Science.gov (United States)

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M

    1981-08-01

    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB. PMID:6166815

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

    Directory of Open Access Journals (Sweden)

    Marcos N. Samano

    2016-04-01

    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.

  12. THE BASIC LAWS AND FEATURES OF CYTOKINE DYNAMICS IN PROCESS AND EARLY TERMS AFTER CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    S. I. Suskov

    2011-01-01

    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. 

  13. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Siminelakis Stavros N

    2010-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    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

  15. Optimal perfusion during cardiopulmonary bypass: an evidence-based approach.

    Science.gov (United States)

    Murphy, Glenn S; Hessel, Eugene A; Groom, Robert C

    2009-05-01

    In this review, we summarize the best available evidence to guide the conduct of adult cardiopulmonary bypass (CPB) to achieve "optimal" perfusion. At the present time, there is considerable controversy relating to appropriate management of physiologic variables during CPB. Low-risk patients tolerate mean arterial blood pressures of 50-60 mm Hg without apparent complications, although limited data suggest that higher-risk patients may benefit from mean arterial blood pressures >70 mm Hg. The optimal hematocrit on CPB has not been defined, with large data-based investigations demonstrating that both severe hemodilution and transfusion of packed red blood cells increase the risk of adverse postoperative outcomes. Oxygen delivery is determined by the pump flow rate and the arterial oxygen content and organ injury may be prevented during more severe hemodilutional anemia by increasing pump flow rates. Furthermore, the optimal temperature during CPB likely varies with physiologic goals, and recent data suggest that aggressive rewarming practices may contribute to neurologic injury. The design of components of the CPB circuit may also influence tissue perfusion and outcomes. Although there are theoretical advantages to centrifugal blood pumps over roller pumps, it has been difficult to demonstrate that the use of centrifugal pumps improves clinical outcomes. Heparin coating of the CPB circuit may attenuate inflammatory and coagulation pathways, but has not been clearly demonstrated to reduce major morbidity and mortality. Similarly, no distinct clinical benefits have been observed when open venous reservoirs have been compared to closed systems. In conclusion, there are currently limited data upon which to confidently make strong recommendations regarding how to conduct optimal CPB. There is a critical need for randomized trials assessing clinically significant outcomes, particularly in high-risk patients. PMID:19372313

  16. EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect (VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group ( P < 0. 01 ). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group ( P < 0. 05),especially at 6, 9, and 15h after CPB ( P < 0. 01 ). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB ( P <0. 05). There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

  17. CARDIOPULMONARY BYPASS WITH AUTOLOGOUS LUNG AS SUBSTITUTE FOR ARTIFICIAL OXYGENATOR ATTENUATES INFLAMMATORY RESPONSIVE INSPIRATORY DYSFUNCTION

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

    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.

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

    OpenAIRE

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

    2010-01-01

    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...

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

    OpenAIRE

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

    2015-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ricardo Antonio G. Barbosa

    2009-03-01

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

    Science.gov (United States)

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

    2016-01-01

    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

  3. Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

    DEFF Research Database (Denmark)

    Thomassen, Sisse Anette; Larsson, A; Andreasen, Jan Jesper;

    Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior...... not improve cerebral and systemic oxygenation compared to a blood flow based on BSA....

  4. APROTININ PRESERVES HEMOSTASIS IN ASPIRIN-TREATED PATIENTS UNDERGOING CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    TABUCHI, N; HUET, RCG; STURK, A; EIJSMAN, L; WILDEVUUR, CRH

    1994-01-01

    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

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

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

    NARCIS (Netherlands)

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

    2001-01-01

    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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

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

    NARCIS (Netherlands)

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

    2004-01-01

    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

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

    NARCIS (Netherlands)

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

    2011-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Qian Yanning

    2011-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    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.

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

    OpenAIRE

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

    2016-01-01

    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 ...

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

    Science.gov (United States)

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

    2016-06-01

    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

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

    OpenAIRE

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

    2013-01-01

    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...

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

    OpenAIRE

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

    2014-01-01

    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...

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

    DEFF Research Database (Denmark)

    Kohno, Mitsutomo; Steinbrüchel, Daniel A

    2012-01-01

    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....

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

    OpenAIRE

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

    2015-01-01

    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 ...

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

    OpenAIRE

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

    2012-01-01

    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...

  19. Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Temucin Noyan Ogus

    2010-01-01

    Full Text Available Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

  20. Eelvated postoperative renal clearance of amylase without pancreatitis after cardiopulmonary bypass.

    Science.gov (United States)

    Traverso, L W; Ferrari, B T; Buckberg, G D; Tompkins, R K

    1977-03-01

    Two postoperative cardiopulmonary bypass patients who had pancreatitis within a two week period provided the impetus for pursuing this study. Amylase-creatinine clearance ratios (ACCR) were measured in a series of ten thoracic surgery patients: six coronary artery bypass patients with cardiopulmonary bypass (cardiac group), and four exploratory thoracotomy patients (pulmonary group). These ratios were obtained in the preoperative, recovery room, and postoperative periods. Comparisons were made among the following data: clinical history, pre- and postoperative medications, intraoperative vital signs, drugs, and anesthetics. The preoperative mean ACCR was 3.34 per cent. All cardiac patients had a significantly elevated ACCR in the recovery room with a mean of 17.36 per cent (p less than 0.05). The ACCR had returned to preoperative levels by the second postoperative day in five of six cases. There were no elevated ACCR levels in the pulmonary group. All patients were asymptomatic for pancreatitis. The intraoperative course of the cardiac patients involved four common factors, besides cardiopulmonary bypass, which were not present in the pulmonary group. These similarities included transfusion of citrated fresh whole blood activated by calcium chloride, hypotension treated with ephedrine, administration of mannitol, and intraoperative morphine analgesia. The mechanisms of increased amylase secretion by calcium chloride or ephedrine administration and transient sphincter of Oddi constriction by morphine or the alpha-adrenergic response of ephedrine are considered with the theoretical implications toward pancreatitis. The background and significance of the ACCR are also analyzed, especially in association with the osmotic diuresis of mannitol and a subsequent low urine creatinine level. PMID:848659

  1. Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ozyazıcıoglu Ahmet

    2008-07-01

    Full Text Available Abstract Background In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications. Methods 140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2. Results INR (International Normalized Ratio, urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001. In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001. Conclusion HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.

  2. TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND FIBRIN MONOMERS SYNERGISTICALLY CAUSE PLATELET DYSFUNCTION DURING RETRANSFUSION OF SHED BLOOD AFTER CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    DEHAAN, J; SCHONBERGER, J; HAAN, J; VANOEVEREN, W; EIJGELAAR, A

    1993-01-01

    Reduced hemostasis and bleeding tendency after cardiopulmonary bypass results from platelet dysfunction induced by the bypass procedure. The causes of this acquired platelet dysfunction are still subject to discussion, although, recently, greater emphasis has been placed on an overstimulated fibrino

  3. Plasma levels of immunosuppressive mediators during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    E. Borrelli

    1996-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Zahra S Faritous

    2011-01-01

    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.

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

    Science.gov (United States)

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

    2014-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Duara Rajnish

    2008-01-01

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

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    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.

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

    Directory of Open Access Journals (Sweden)

    Chaitali SenDasgupta

    2010-01-01

    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.

  9. Emergent cardiopulmonary bypass for a 180 kilogram patient: support with a single oxygenator.

    Science.gov (United States)

    Hunter, Kyler T; Lopez, Angela R; Yun, Kwok L

    2013-09-01

    As obesity increases in prevalence, so will cases in which patients present at the boundaries of care. We report the support of a class III obese man, having a body mass index of 60.8 kg/m2 and in acute renal failure, with a single Trillium-coated Affinity NT Hollow Fiber oxygenator in cardiopulmonary bypass for an emergent aortic valve replacement secondary to infective endocarditis. A maximum oxygen delivery of 807.51 mL of oxygen per minute is reported for this oxygenator in this case report.

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

    OpenAIRE

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

    2005-01-01

    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...

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

    Science.gov (United States)

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

    2015-11-01

    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

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

    OpenAIRE

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

    2011-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Gholamreza Safarpour

    2010-08-01

    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.

  14. Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass: the role of hemodilution.

    Science.gov (United States)

    Koning, Nick J; de Lange, Fellery; Vonk, Alexander B A; Ahmed, Yunus; van den Brom, Charissa E; Bogaards, Sylvia; van Meurs, Matijs; Jongman, Rianne M; Schalkwijk, Casper G; Begieneman, Mark P V; Niessen, Hans W; Baufreton, Christophe; Boer, Christa

    2016-03-01

    Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue injury in a rat model. Male Wistar rats (375-425 g) were anesthetized, prepared for cremaster muscle intravital microscopy, and subjected to CPB (n = 9), hemodilution alone (n = 9), or a sham procedure (n = 6). Microcirculatory recordings were performed at multiple time points and analyzed for perfusion characteristics. Kidney and lung tissue were investigated for mRNA expression for genes regulating inflammation and endothelial adhesion molecule expression. Renal injury was assessed with immunohistochemistry. Hematocrit levels dropped to 0.24 ± 0.03 l/l and 0.22 ± 0.02 l/l after onset of hemodilution with or without CPB. Microcirculatory perfusion remained unaltered in sham rats. Hemodilution alone induced a 13% decrease in perfused capillaries, after which recovery was observed. Onset of CPB reduced the perfused capillaries by 40% (9.2 ± 0.9 to 5.5 ± 1.5 perfused capillaries per microscope field; P perfusion, which cannot fully explain impaired microcirculation following cardiopulmonary bypass. CPB led to increased renal injury and endothelial adhesion molecule expression in the kidney and lung compared with hemodilution. Our findings suggest that microcirculatory impairment during CPB may play a role in the development of kidney injury.

  15. Protective Effect of Heparin-coated Circuits on the Platelets during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张凯伦; 胡志伟; 杨运海; 黄如清; 范慧敏; 孙宗全

    2003-01-01

    To observe the protective effect of heparin-coated circuits (HCC) on the platelet function during cardiopulmonary bypass (CPB). 23 patients with heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group (n= 15) and heparin-coated circuits in the HCC group (n = 8). Platelet count, α-granule membrane protein-140 (GMP-140) concentrations were determined before CPB, at 60 min of CPB, 30 and 60 min after protamine administration, first 12 h after CPB, respectively. At end of CPB the arterial filters in the circuits were observed by electron microscopy. The amount of first 12-h postoperative blood loss was measured. There was significant reduction in platelet loss during and after CPB in the HCC group in contrast to the control group during CPB (P<0.05). During the first 12 h, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218±61 ml, vs. 332±118 ml, P<0.05). Electron microscopy showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules were occasionally seen, without adherent cells or only few adherent cells on their surfaces, whereas several cellular and fibrous components were found to adhere to the surfaces of the filter meshes in the control group. This study indicates that heparin-coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.

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

    Directory of Open Access Journals (Sweden)

    Kambiz Alizadeh

    2014-02-01

    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.

  17. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    LI Jian-an; LIU Ying-long; LIU Jin-ping; LI Xiao-feng

    2010-01-01

    Background Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a novel adjunctive method, which can minimize the lung ischemic-reperfusion injury and inflammatory response. This study evaluated the protective effect of pulmonary perfusion with hypothermic HTK solution in corrections of congenital heart defects with pulmonary hypertension.Methods Between June 2009 and December 2009, 24 consecutive infants with congenital heart defects and pulmonary hypertension were randomly divided into perfused group (n=12) and control group (n=12). Oxygen index, alveolar-arterial O2gradient, serum levels of malondialchehyche (MDA), interleukin (IL)-6, -8, -10, soluble intercellular adhesion molecule-1(slCAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.Results Oxygenation values were better preserved in the perfused group than in the control group. The serum levels of IL-6 increased immediately after CPB in both groups and returned to baseline at 48 hours after CPB, but it was restored faster and earlier in the perfused group. The serum levels of IL-8, slCAM-1, and MDA remained at baseline at each point after CPB in the perfused group and elevated significantly immediately after CPB in the control group, except for sICAM-1.The serum level of IL-10 increased immediately after CPB and decreased to baseline at 48 hours after CPB in both groups, but the IL-10 level in the perfused group was significantly higher than in the control group at 12 hours after CPB.The serum P-selectin levels in the control group immediately after CPB were significantly higher than prebypass levels.Moreover, there were no significant differences in postoperative clinical characters, except for the intubated time.Conclusion In infants with congenital heart defects, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass could ameliorate lung function and reduce the inflammatory response.

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

    Science.gov (United States)

    Raasch, David; Austin, Jon; Tallman, Richard

    2010-06-01

    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

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

    NARCIS (Netherlands)

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

    2005-01-01

    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

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

    NARCIS (Netherlands)

    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

    2011-01-01

    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

  1. In vitro effect of hemodilution on activated clotting time and high-dose thrombin time during cardiopulmonary bypass

    NARCIS (Netherlands)

    Huyzen, RJ; vanOeveren, W; Wei, FY; Stellingwerf, P; Boonstra, PW; Gu, YJ

    1996-01-01

    Background. Extreme dilution of clotting factors, as may occur during pediatric or neonatal cardiopulmonary bypass, often leads to inadequate monitoring of anticoagulation with activated dotting time (ACT). In this study we postulate that the high-dose thrombin time (HiTT) is less influenced by extr

  2. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass

    Science.gov (United States)

    Soller, Babs R.; Idwasi, Patrick O.; Balaguer, Jorge; Levin, Steven; Simsir, Sinan A.; Vander Salm, Thomas J.; Collette, Helen; Heard, Stephen O.

    2003-01-01

    OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and

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

    Directory of Open Access Journals (Sweden)

    J. M. Bator

    1993-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Aman Jyoti

    2014-01-01

    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.

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

    Science.gov (United States)

    Hossien, Abdullrazak

    2016-01-01

    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

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

    Science.gov (United States)

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

    2015-03-01

    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

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

    Science.gov (United States)

    Fujii, Yutaka

    2016-01-01

    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

  8. Superior Cardiac Function Via Anaplerotic Pyruvate in the Immature Swine Heart After Cardiopulmonary Bypass and Reperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Olson, Aaron; Hyyti, Outi M.; Cohen, Gordon A.; Ning, Xue-Han; Sadilek, Martin; Isern, Nancy G.; Portman, Michael A.

    2008-12-01

    Pyruvate produces inotropic responses in the adult reperfused heart. Pyruvate oxidation and anaplerotic entry into the citric acid cycle (CAC) via carboxylation are linked to stimulation of contractile function. The goals of this study were to determine if these metabolic pathways operate and are maintained in the developing myocardium after reperfusion. Immature male swine (age 10-18 days) were subjected to cardiopulmonary bypass (CPB). Intracoronary infusion of [2]-13C-pyruvate (to achieve a final concentration of 8 mM) was given for 35 minutes starting either during weaning (Group I), after discontinuation (Group II) or without (Control) CPB. Hemodynamic data was collected. 13C NMR spectroscopy was used to determine the fraction of pyruvate entering the CAC via pyruvate carboxylation (PC) to total CAC entry (PC plus decarboxlyation via pyruvate dehydrogenase). Liquid chromatography-mass spectrometry was used to determine total glutamate enrichment.

  9. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas;

    2016-01-01

    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... starting CPB and longitudinally in a mixed-effects model (MEM). Secondary outcomes were tracheal intubation time, serious adverse events, mortality, days alive outside the intensive care unit (ICU) and outside the hospital. RESULTS: 21 hours after starting CPB patients receiving pulmonary artery perfusion...... with normothermic oxygenated blood had a higher oxygenation index compared with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to 1.83; p=0.04). The blood group had also a higher oxygenation index both longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69; p=0.007) compared...

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

    LENUS (Irish Health Repository)

    Hargrove, M

    2008-07-01

    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.

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

    Science.gov (United States)

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

    2015-03-01

    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 retractor (p cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation.

  12. A novel rat model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming

    Institute of Scientific and Technical Information of China (English)

    Zhang Weihua; Zhang Yanbo; Liu Donghai; Zhu Yaobin; Qiao Chenhui; Wang Jiaxiang; Xu Yulin

    2014-01-01

    Background Large animal cardiopulmonary bypass (CPB) models are expensive,and prevent assessment of neurocognitive function,and difficulties with long-term recovery.The purpose of this study was to establish a novel rat model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming.Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomized to CPB with deep hypothermic circulatory arrest (DHCA) and control groups,with 10 rats each.The experimental protocols,including blood and crystalloid fluid administration,anesthesia,orotracheal intubation,ventilation,cannulation,and heparinization were identical in both groups.After inducing cardiac arrest,the circuit was turned off and rats were left in a DHCA state for 15 minutes.Rats were rewarmed to 34℃ to 35℃ over a period of 36 to 42 minutes using CPB-assisted rewarming,a heating blanket,and a heating lamp along with administration of 0.1 mEq of sodium bicarbonate and 0.14 mEq of calcium chloride.The remaining priming volume was reinfused and animals were weaned from CPB.Results All CPB with DHCA processes were successfully achieved.Blood gas analysis and hemodynamic parameters were in the normal range.The vital signs of all rats were stable.Conclusions Our CPB circuit has several novel features,including a small priming volume,active cooling/rewarming processes,vacuum-assisted venous drainage,peripheral cannulation without thoracotomy or stemotomy,and an accurate means of monitoring peripheral tissue oxygenation.

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

    Directory of Open Access Journals (Sweden)

    Claudia Gissi da Rocha Ferreira

    2014-12-01

    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. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    Science.gov (United States)

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  15. The use of VEPs for CNS monitoring during continuous cardiopulmonary bypass and circulatory arrest.

    Science.gov (United States)

    Keenan, N K; Taylor, M J; Coles, J G; Prieur, B J; Burrows, F A

    1987-07-01

    Cerebral function was monitored with the use of visual evoked potentials (VEPs) in 16 infants (mean age 9.9 +/- 4.3 months) during surgery for congenital cardiac anomalies. While hypothermia was employed in all patients, half (8) remained on continuous cardiopulmonary bypass (CCB) while the rest were cooled to lower temperatures before the induction of circulatory stasis and venous exsanguination (CA), i.e., profound hypothermic circulatory arrest (PHCA). VEPs were recorded before, during and after surgical intervention. Latency changes occurred in both the N100 and P145 components of the VEP as a function of systemic temperature during cooling in both groups. Differences in the VEPs were found between the two groups post-operatively, with the most interesting result being a greater increase in P145 latency in the CA group after rewarming. To the extent that VEPs reflect neurological status, our findings suggested that CCB was associated with less perturbation in acute neurological status than PHCA, and shorter arrest times and lower temperatures during CA were associated with the most favourable post-operative VEPs. Hence, intraoperative monitoring of VEPs appeared to be useful as an objective measure of the short-term effects of various cardiopulmonary procedures on neurophysiological function.

  16. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard;

    2009-01-01

    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross......-clamping. It has been hypothesized that when coronary artery by-pass grafting is performed without the use of CPB, the rate of serious complications is reduced. METHODS/DESIGN: The trial is designed as an open, randomized, controlled, clinical trial with blinded assessment of end-points. Patients at or above 70...... years of age, referred for surgical myocardial revascularisation, are included and randomised to receive coronary artery by-pass grafting either with or without the use of CPB and aortic cross-clamping. Follow-up is performed by clinical, biochemical, electrocardiographic, and angiographic data...

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

    Directory of Open Access Journals (Sweden)

    Tso-Chou Lin

    2015-01-01

    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.

  18. Prognosis of hospital survivors after salvage from cardiopulmonary bypass with centrifugal cardiac assist.

    Science.gov (United States)

    Curtis, J J; Walls, J T; Schmaltz, R A; Boley, T; Landreneau, R; Nawarawong, W

    1990-01-01

    Since October 1986, 6 hospital survivors who were salvaged from cardiopulmonary bypass (CPB) with the Sarns centrifugal pump were observed. Centrifugal assist was employed only after failure to wean with usual resuscitative measures, including multiple high dose inotropes and intraaortic balloon pumping. There were five men and one woman, 46-59 years of age (mean 61 years). All patients had undergone coronary artery bypass grafting, with two patients having had concomitant left ventricular aneurysmectomy and two aortic valve replacement. Five patients had left ventricular assist only and one had biventricular assist. Duration of assist ranged from 26 to 72 hr (mean 48 hr). Complications were ubiquitous, and the resultant prolonged hospitalization was resource intensive. All hospital survivors remain alive and are in New York Heart Association functional Class II, with an average follow-up of 24 months, (6-41 months). Compared with preoperative values, current left ventricular function is improved in 2 patients, has deteriorated in 3, and is unchanged in 1. Thus, the Sarns centrifugal pump will allow salvage of some patients who otherwise are not weanable from CPB. Survivors can expect a reasonable functional capacity as reflected by this experience.

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

    Directory of Open Access Journals (Sweden)

    A Samir

    2015-01-01

    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.

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

    OpenAIRE

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

    2012-01-01

    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...

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

    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.

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

    Science.gov (United States)

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

    2014-10-01

    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

  3. The relationship between oxygenator exhaust P(CO2) and arterial P(CO2) during hypothermic cardiopulmonary bypass.

    Science.gov (United States)

    Graham, J M; Gibbs, N M; Weightman, W M; Sheminant, M R

    2005-08-01

    During cardiopulmonary bypass the partial pressure of carbon dioxide in oxygenator arterial blood (P(a)CO2) can be estimated from the partial pressure of gas exhausting from the oxygenator (P(E)CO2). Our hypothesis is that P(E)CO2 may be used to estimate P(a)CO2 with limits of agreement within 7 mmHg above and below the bias. (This is the reported relationship between arterial and end-tidal carbon dioxide during positive pressure ventilation in supine patients.) During hypothermic (28-32 degrees C) cardiopulmonary bypass using a Terumo Capiox SX membrane oxygenator, 80 oxygenator arterial blood samples were collected from 32 patients during cooling, stable hypothermia, and rewarming as per our usual clinical care. The P(a)CO2 of oxygenator arterial blood at actual patient blood temperature was estimated by temperature correction of the oxygenator arterial blood sample measured in the laboratory at 37 degrees C. P(E)CO2 was measured by connecting a capnograph end-to-side to the oxygenator exhaust outlet. We used an alpha-stat approach to cardiopulmonary bypass management. The mean difference between P(E)CO2 and P(a)CO2 was 0.6 mmHg, with limits of agreement (+/-2 SD) between -5 to +6 mmHg. P(E)CO2 tended to underestimate P(a)CO2 at low arterial temperatures, and overestimate at high arterial temperatures. We have demonstrated that P(E)CO2 can be used to estimate P(a)CO2 during hypothermic cardiopulmonary bypass using a Terumo Capiox SX oxygenator with a degree of accuracy similar to that associated with the use of end-tidal carbon dioxide measurement during positive pressure ventilation in anaesthetized, supine patients. PMID:16119486

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

    OpenAIRE

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

    2015-01-01

    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...

  5. Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before, during, and after Cardiopulmonary Bypass

    OpenAIRE

    DiVincenti, Louis; Westcott, Robin; Lee, Candice

    2014-01-01

    Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veteri...

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

    OpenAIRE

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

    2012-01-01

    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...

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

    OpenAIRE

    Deyvis Cruz

    2012-01-01

    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...

  8. Blood hibernation: a novel strategy to inhibit systemic inflammation and coagulation induced by cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    ZHOU Jing; WU Xiao-dong; LIN Ke; Raphael C. Lui; AN Qi; TAO Kai-yu; DU Lei; LIU Jin

    2010-01-01

    Background Inflammation and coagulation are two intimately cross-linked defense mechanisms of most, if not all organisms to injuries. During cardiopulmonary bypass (CPB), these two process-is are activated and interact with each other through several common pathways, which may result in subsequent organ dysfunction. In the present study, we hypothesized that the addition of nitric oxide, prostaglandin E1 (PGE1), and aprotinin to the systemic circulation, hereby referred to as blood hibernation, would attenuate the inflammation and coagulation induced by CPB. Methods Thirty adult mongrel dogs were equally divided into five groups, anesthetized and placed on hypothermic CPB (32 C). Each group received respectively the following treatments: (1) inhalation of 40 ppm nitric oxide; (2) intravenous infusion of 20 ng·kg-1·min-1 of PGE1; (3) 80 000 kallikrein inhibitor units (KIU)/kg of aprotinin; (4) the combination of all three agents (blood hibernation group); and (5) no treatment (control group) during CPB. Activation of leukocyte, platelet, endothelial cell, and formation of thrombin were assessed after CPB.Results As compared with the other four groups, leukocyte counts were higher, while plasma elastase, interleukin-8, CD11b mRNA expression, myeloperoxidase activities and lung tissue leukocyte counts were lower in the blood hibernation group (P<0.05 versus other four groups after CPB). Plasma prothrombin fragment (PTF)1+2, and platelet activation factors were lower, while platelet counts were higher in the blood hibernation group (P<0.05 versus other four groups at 6 and 12 hours after CPB). Electron microscopy showed endothelial pseudopods protrusion, with cell adherence in all four groups except the blood hibernation group where endothelial cells remained intact.Conclusion Blood hibernation, effected by the addition of nitric oxide, PGE1 and aprotinin to the circulating blood during extra-corporeal circulation, was observed to attenuate the inflammation and

  9. Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass

    Science.gov (United States)

    Tsakiridis, Kosmas; Vretzkakis, Giorgos; Mikroulis, Dimitris; Mpakas, Andreas; Kesisis, Georgios; Arikas, Stamatis; Kolettas, Alexandros; Moschos, Giorgios; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Tsiouda, Theodora; Siminelakis, Stavros; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Background The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. Materials and methods Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline. Results Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung’s inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical

  10. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine

    2011-06-15

    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  11. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass.

    Science.gov (United States)

    Boldt, J; Knothe, C; Zickmann, B; Andres, P; Dapper, F; Hempelmann, G

    1993-06-01

    The influence of four different kinds of intravascular volume replacement on platelet function was investigated in 60 patients undergoing elective aortocoronary bypass grafting using cardiopulmonary bypass (CPB). In a randomized sequence, high-molecular weight hydroxyethyl starch solution (HMW-HES, mean molecular weight [Mw] 450,000 d), low-molecular weight HES (LMW-HES, Mw 200,000 d), 3.5% gelatin or 5% albumin were infused preoperatively to double reduced filling pressure (pulmonary capillary wedge pressure [PCWP] inductors: ADP, epinephrine, collagen). Maximum aggregation, maximum gradient of aggregation, and platelet volume were measured before, during, and after CPB until the first postoperative day. HMW-HES 840 +/- 90 mL, LMW 850 +/- 100 mL, gelatin 950 +/- 110 mL, and albumin 810 +/- 100 mL were given preoperatively. Maximum platelet aggregation (ranging from -23% to -44% relative from baseline value) and maximum gradient of platelet aggregation (ranging from -26% to -45% relative from baseline values) were reduced only in the HMW-HES patients. After CPB, aggregometry also was impaired most markedly in these patients. The other volume groups showed less reduction in platelet aggregation and were similar to the untreated control. On the first postoperative day, aggregation variables had returned almost to baseline in all patients. Platelet volume was the same among the groups within the investigation period. Postbypass blood loss was highest in the HMW-HES group (890 +/- 180 mL). There was significant (P < 0.04) correlation in this group between blood loss and change in platelet aggregation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7684579

  12. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery.

    Science.gov (United States)

    Carmona, M J C; Malbouisson, L M S; Pereira, V A; Bertoline, M A; Omosako, C E K; Le Bihan, K B; Auler Jr, J O C; Santos, S R C J

    2005-05-01

    The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 +/- 8 years, mean weight 75.4 +/- 11.9 kg and mean body surface area 1.83 +/- 0.19 m(2)), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min(-1) kg(-1) (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  13. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Carmona M.J.C.

    2005-01-01

    Full Text Available The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB, resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m², receiving propranolol before surgery (80-240 mg a day and postoperatively (10 mg a day. Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9 to 10.6 h (95% CI = 8.2-14.7; P < 0.01 and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3 to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05, while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6 vs 10.7 ml min-1 kg-1 (95% CI = 7.7-26.6; NS after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

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

    Science.gov (United States)

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

    2016-05-01

    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. The Effect of Repeat Cardiopulmonary bypass on Epicardial Microflow and Graft Flow during Intra-operative Heart Failure

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective The relationship between graft blood flow, epicardial microflow,mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure.Methods These parameters were done to evaluate the use of repeated cardiopulmonary bypass supportfor the intraoperative heart failure following aorto-coronary bypass surgery. Included in this study were10 patients with a mean age of 7 0 and unstable angina undergoing coronary bypass grafting and suffer-ing from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressureand blood cell filterability were measured. Resluts During heart failure, the mean arterial pressurefell by 41 % ( P < 0. 01 ), graft flow by 67 % ( P < 0. 01 ) and epicardialmicro flow by 64 % ( P <0. 01 ). After 1 5 to 56 min of assisted cardiopulmonary bypass support, the epicardial mioroflow andgraft flow were partially restored, while red cell and white cell filterability was reduced by 31% and644 % respectively ( P < 0. 01 ). There were significant correlations between graft flow, epicardial mi-croflow, blooxd cell filterability and cardiopulmonary bypass time. All patients recovered and were dis-charged from the hospital. Conclusion It is concluded that the use of temporary assisted CPB sup-port to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores themean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. TheCPB support seemed to be suitable for about 60 rain probably because of increasing disturbance to theblood cell filterability, graft flow and the epicardial microcirculation.

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    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.

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

    Science.gov (United States)

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

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Marc Licker

    2012-01-01

    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.

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

    Science.gov (United States)

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

    2016-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    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.

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Takeuchi M

    2001-08-01

    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.

  3. Cardiopulmonary bypass induced microcirculatory injury of the small bowel in rats

    Institute of Scientific and Technical Information of China (English)

    Guo-Hua Dong; Chang-Tian Wang; Yun Li; Biao Xu; Jian-Jun Qian; Hai-Wei Wu; Hua Jing

    2009-01-01

    AIM: To investigate microvascular injury quantitatively in the small bowel with respect to cardiopulmonary bypass (CPB) and related mechanisms.METHODS: In 10 male SD rats, normothermic CPB was established and continued with a flow rate of 100-150 mL/kg per minute for 60 min, while another 10 sham-operated animals served as controls. An approximate 10-cm loop of the terminal ileum was exteriorized for observation by means of intravital fluorescence microscopy. The small bowel microcirculatory network including arterioles, capillaries, and collecting venules was observed prior to CPB, CPB 30 min, CPB 60 min, post-CPB 60 min and post-CPB 120 min. The intestinal capillary perfusion, microvascular permeability and leukocyte adherence were also measured.RESULTS: The systemic hemodynamics remained stable throughout the experiment in both groups. In CPB animals, significant arteriolar vasoconstriction, blood velocity reduction and functional capillary density diminution were found. As concomitances, exaggerated albumin extravasation and increased leukocyte accumulation were also noted. These changes were more pronounced and there were no signs of restitution at the end of the observation period.CONCLUSION: CPB induces significant microcirculatoryinjury of the small bowel in rats. The major underlying mechanisms are blood flow redistribution and generalized inflammatory response associated with CPB.

  4. A pulsatile cardiopulmonary bypass system that prevents negative pressure at the membrane oxygenator.

    Science.gov (United States)

    Komoda, T; Maeta, H; Imawaki, S; Shiraishi, Y; Arioka, I; Fukunaga, S; Tanaka, S; Nasu, N

    1993-01-01

    Negative pressure is a problem in pulsatile cardiopulmonary bypass (CPB). To avoid this, the authors designed a pulsatile CPB system containing a Sarns centrifugal pump (CP) and a Univox membrane oxygenator, in which the inertial flow is not obstructed by the CP. In both an in vitro study and a clinical study, negative pressure was not observed in the arterial line of the CPB circuit when this system was used. When a roller pump (RP) was used, however, instead of a CP, negative pressure did occur. In a clinical study using this system, mean pulse pressure was 36 mmHg and hemolysis, expressed as the rate of rise in plasma free hemoglobin from 10 to 70 min of CPB, was 26.2 mg/dl/hr, which did not exceed that seen with a pulsatile CPB using an RP instead of a CP. The hemolysis seen in the study caused no clinical problems. Thus, pulsatile CPB using a CP and Univox membrane oxygenator should be considered for clinical use to prevent the occurrence of negative pressure.

  5. Pyruvate effects on red blood cells during in vitro cardiopulmonary bypass with dogs' blood.

    Science.gov (United States)

    Gou, DaMing; Tan, HongJing; Cai, HuiJun; Zhou, FangQiang

    2012-11-01

    To investigate the effects of pyruvate (Pyr) on adenosine triphosphate (ATP), endothelial nitric oxide synthase (eNOS), and nitric oxide (NO) in red blood cells (RBCs) during the cardiopulmonary bypass procedure (CPB), blood, 500 mL, was collected from each of 10 healthy dogs (weight 12-18 kg). The blood was divided into two parts (250 mL each) and randomly assigned into the control group (Group C, n = 10) or the Pyr group (Group P, n = 10). The blood was commingled with an equal volume of 0.9% NaCl and pyruvated isotonic solution (Pyr 50 mM) in the extracorporeal circuit in the two groups, respectively. The CPB procedure was fixed at 120 min, and the transferring flow was 4 L/min. Contents of ATP in RBCs, eNOS activities, and NO productions in plasma were measured before CPB and during CPB at 30, 60, 90, and 120 min in both groups. The ATP level, eNOS activity, and NO production were not different prior to CPB between the two groups. A decline of ATP levels was shown in both groups but remained significantly higher in Group P than in Group C at the same time points during in vitro CPB (P dogs' RBCs in the ATP level, eNOS activity, and NO production, in vitro, but Pyr effectively protected RBCs in these functions during CPB. Pyr would be clinically protective for RBCs during CPB.

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

    Science.gov (United States)

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

    2015-06-01

    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. Plasma macrophage colony-stimulating factor levels during cardiopulmonary bypass with extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Y. Denizot

    1996-01-01

    Full Text Available Leukocytosis and thrombocytopenia occur during cardiopulmonary bypass (CPB with extracorporeal circulation (ECC. Elevated circulating concentrations of macrophage colony-stimulating factor (M-CSF are reported during thrombocytopenia and leukopenia of different origins. We have assessed M-CSF concentrations in 40 patients undergoing CPB with ECC. Plasma M-CSF concentrations were stable during ECC and increased at the 6th (7.3 ± 0.7 IU/μg protein and 24th (8.6 ± 0.8 IU/μg protein postoperative hour compared with pre-ECC values (4.9 ± 0.5 IU/μg protein. A deep thrombocytopenia was found during ECC and until the 24th postoperative hour. A drop of leukocyte counts was found during ECC followed by an increase after ECC weaning. While no correlation was found between M-CSF concentrations and the leukocyte counts, M-CSF values were positively correlated with platelet counts only before and during ECC. Thus, M-CSF is not implicated in the thrombocytopenia and the leukopenia generated during CPB with ECC. However the elevated levels of M-CSFa few hours after the end of ECC might play a role in the inflammatory process often observed after CPB.

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

    Science.gov (United States)

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

    2016-05-01

    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 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.

  9. 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

    OpenAIRE

    Fatih Aygün; Mehmet Özülkü; Murat Günday

    2015-01-01

    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...

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

    Institute of Scientific and Technical Information of China (English)

    吴明; 卢韵碧; 陈如坤

    2004-01-01

    Objective: To investigate the relationship between phospholipase D (PLD) activation and neutrophil priming induced by cardiopulmonary bypass (CPB), and try to clarify whether CPB-induced systemic inflammatory response can be attenuated by inhibiting neutrophilic PLD activation.Methods: Neutrophils were isolated from arterial blood of 8 patients undergoing valve replacement before operation and 30 min after initiation of CPB respectively.Both the preoperative and CPB-stirred neutrophils were subdivided into 5 groups by receiving different experimental interventions: ( 1 ) bacterial lipopolysaccharide ( LPS, 10 ng. Mi-1 ),( 2 ) N-formylmethionylphenylalanine( fMLP, 1 μmol · L - 1 ), ( 3 ) LPS + fMLP, ( 4) 1-butanol(0.5%) + LPS + fMLP, (5) vehicle. Elastase and myeloperoxidase (MPO) release was measured for the parameters of neutrophil activation, neutrophil PLD activity was determined by quantitation of choline produced from the stable product of phosphatidylcholine catalyzed by PLD.Results : ( 1 ) Preoperative neutrophils treated with LPS + fMLP presented significantly higher PLD activity (13.48 ± 2.61 nmol choline · h-1 · mg-1) and released more elastase and MPO than cells treated with vehicle( PLD activity 3.70 ± 0.49 nmol choline · h - 1 · mg - 1, P <0.01), LPS (P < 0.01) and fMLP respectively. In 1-butanol + LPS + fMLP group, PLD activity of preoperative neutrophils was lower than that in LPS + fMLP group (P <0.01 ), besides the release of elastase and MPO decreased sharply below both LPS + fMLP and fMLP groups (P <0.01). In LPS group, PLD activity was higher (P <0.01), while elastase and MPO release did not differ from control. fMLP group presented PLD activity, elastase and MPO release higher than control (P < 0.01 ); nevertheless,lower than LPS + fMLP group (P <0.01).(2) CPB-stirred neutrophils presented prominent PLD activity increment, and even the control level was 3.59-fold of the pre-operative control ( P < 0.01 ). PLD

  11. Cardiopulmonary Bypass Down-Regulates NOD Signaling and Inflammatory Response in Children with Congenital Heart Disease

    Science.gov (United States)

    Li, Yi Ping; Huang, Shungen; Zhou, Huiting; Xie, Yi; Pan, Jian; Li, Yanhong; Wang, Jiang Huai; Wang, Jian

    2016-01-01

    In the present study, we aimed to examine the impact of cardiopulmonary bypass (CPB) on expression and function of NOD1 and NOD2 in children with congenital heart disease (CHD), in an attempt to clarify whether NOD1 and NOD2 signaling is involved in the modulation of host innate immunity against postoperative infection in pediatric CHD patients. Peripheral blood samples were collected from pediatric CHD patients at five different time points: before CPB, immediately after CPB, and 1, 3, and 7 days after CPB. Real-time PCR, Western blot, and ELISA were performed to measure the expression of NOD1 and NOD2, their downstream signaling pathways, and inflammatory cytokines at various time points. Proinflammatory cytokine IL-6 and TNF-α levels in response to stimulation with either the NOD1 agonist Tri-DAP or the NOD2 agonist MDP were significantly reduced after CPB compared with those before CPB, which is consistent with a suppressed inflammatory response postoperatively. The expression of phosphorylated RIP2 and activation of the downstream signaling pathways NF-κB p65 and MAPK p38 upon Tri-DAP or MDP stimulation in PBMCs were substantially inhibited after CPB. The mRNA level of NOD1 and protein levels of NOD1 and NOD2 were also markedly decreased after CPB. Our results demonstrated that NOD-mediated signaling pathways were substantially inhibited after CPB, which correlates with the suppressed inflammatory response and may account, at least in part, for the increased risk of postoperative infection in pediatric CHD patients. PMID:27622570

  12. Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass.

    Science.gov (United States)

    Song, L O U; Yinglong, L I U; Jinping, L I U

    2007-09-01

    The abnormal conditions to which blood is subjected during cardiopulmonary bypass (CPB) trigger an activation of the inflammatory response and cause pulmonary dysfunction. It has been suggested that high-volume, zero-balanced ultrafiltration (ZBUF) facilitates clearance of inflammatory mediators and improves post-operative pulmonary function. Procalcitonin, a newly discovered inflammatory mediator, has been found to be increased after CPB and has been proven to be an appropriate parameter for predicting pulmonary dysfunction secondary to CPB. The aim of this study was to investigate the effects of zero-balanced ultrafiltration (ZBUF) on procalcitonin (PCT) and respiratory function of infants with Tetralogy of Fallot (TOF) after CPB. Twenty infants with TOF undergoing open-heart total surgical correction were randomly assigned to two groups. The trial group was given ZBUF (50 ml/kg) and conventional ultrafiltration (CUF), while the control group was given CUF only. Plasma PCT and pulmonary function were monitored and compared between the two groups before the operation (T1), before rewarming (T2), at the end of the operation (T3), and at 12 h, 24 h and 48 h after the operation (T4-T6). PCT was decreased in the trial group between 12 h and 48 h post-operatively, but the differences did not reach statistical significance. The trial group's pulmonary compliance was higher at 12 h post-operatively (p 0.05). Intubation time was shorter in the trial group (P < 0.01). A positive correlation was found between peak PCT concentration and intubation time. ZBUF appeared to improve ventilation and shorten intubation time. The improved respiratory function may be due to the lower plasma PCT. PMID:18416220

  13. In vivo evaluation of centrifugal blood pump for cardiopulmonary bypass-Spiral Pump.

    Science.gov (United States)

    da Silva, Cibele; da Silva, Bruno Utiyama; Leme, Juliana; Uebelhart, Beatriz; Dinkhuysen, Jarbas; Biscegli, José F; Andrade, Aron; Zavaglia, Cecília

    2013-11-01

    The Spiral Pump (SP), a centrifugal blood pump for cardiopulmonary bypass (CPB), has been developed at the Dante Pazzanese Institute of Cardiology/Adib Jatene Foundation laboratories, with support from Sintegra Company (Pompeia, Brazil). The SP is a disposable pump with an internal rotor-a conically shaped fuse with double entrance threads. This rotor is supported by two ball bearings, attached to a stainless steel shaft fixed to the housing base. Worm gears provide axial motion to the blood column, and the rotational motion of the conically shaped impeller generates a centrifugal pumping effect, improving pump efficiency without increasing hemolysis. In vitro tests were performed to evaluate the SP's hydrodynamic performance, and in vivo experiments were performed to evaluate hemodynamic impact during usual CPB. A commercially available centrifugal blood pump was used as reference. In vivo experiments were conducted in six male pigs weighing between 60 and 90 kg, placed on CPB for 6 h each. Blood samples were collected just before CPB (T0) and after every hour of CPB (T1-T6) for hemolysis determination and laboratory tests (hematological and biochemical). Values of blood pressure, mean flow, pump rotational speed, and corporeal temperature were recorded. Also, ergonomic conditions were recorded: presence of noise, difficulty in removing air bubbles, trouble in installing the pump in the drive module (console), and difficulties in mounting the CPB circuit. Comparing the laboratory and hemolysis results for the SP with those of the reference pump, we can conclude that there is no significant difference between the two devices. In addition, reports made by medical staff and perfusionists described a close similarity between the two devices. During in vivo experiments, the SP maintained blood flow and pressure at physiological levels, consistent with those applied in cardiac surgery with CPB, without presenting any malfunction. Also, the SP needed lower rotational

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

    Science.gov (United States)

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

    2011-05-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Iglézias José Carlos Rossini

    2003-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    1999-01-01

    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

  18. Effects of preoperatively selected gut decontamination on cardiopulmonary bypass-induced endotoxemia

    Institute of Scientific and Technical Information of China (English)

    YU Jiang; XIAO Ying-bin; WANG Xian-yuan

    2007-01-01

    Objective: To evaluate the influence of preoperatively selected gut decontamination (SGD) on intestinally derived endotoxemia(ETM) in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulmonary bypass(CPB) .Methods: Thirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i.e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 mg garlicin and 20% Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levels of endotoxin, D-lactate, TNF-α and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded. Results: Aerobic gram-negative bacilli (AGNB) ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group (P<0.05). The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB (P<0.05). Endotoxin levels of patients in both groups elevated significantly after CPB (P<0.05), and endotoxin levels of the patients in SGD group decreased significantly at points of CPB end (P<0.01) and 24 h after CPB (P<0.05) compared with those in control group. The levels of TNF-α and complement 3 were similar in both groups as well as clinical and biochemical markers. Conclusions: CPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.

  19. Thrombography reveals thrombin generation potential continues to deteriorate following cardiopulmonary bypass surgery despite adequate hemostasis.

    Science.gov (United States)

    Wong, Raymond K; Sleep, Joseph R; Visner, Allison J; Raasch, David J; Lanza, Louis A; DeValeria, Patrick A; Torloni, Antonio S; Arabia, Francisco A

    2011-03-01

    The intrinsic and extrinsic activation pathways of the hemostatic system converge when prothrombin is converted to thrombin. The ability to generate an adequate thrombin burst is the most central aspect of the coagulation cascade. The thrombin-generating potential in patients following cardiopulmonary bypass (CPB) may be indicative of their hemostatic status. In this report, thrombography, a unique technique for directly measuring the potential of patients' blood samples to generate adequate thrombin bursts, is used to characterize the coagulopathic profile in post-CPB patients. Post-CPB hemostasis is typically achieved with protamine reversal of heparin anticoagulation and occasionally supplemented with blood product component transfusions. In this pilot study, platelet poor plasma samples were derived from 11 primary cardiac surgery patients at five time points: prior to CPB, immediately post-protamine, upon arrival to the intensive care unit (ICU), 3 hours post-ICU admission, and 24 hours after ICU arrival. Thrombography revealed that the Endogenous Thrombin Potential (ETP) was not different between [Baseline] and [PostProtamine] but proceeded to deteriorate in the immediate postoperative period. At the [3HourPostICU] time point, the ETP was significantly lower than the [Baseline] values, 1233 +/- 591 versus 595 +/- 379 nM.min (mean +/- SD; n=9, p coagulation testing results, and blood loss volumes are also presented. Despite adequate hemostasis, thrombography reveals an underlying coagulopathic process that could put some cardiac surgical patients at risk for postoperative bleeding. Thrombography is a novel technique that could be developed into a useful tool for perfusionists and physicians to identify coagulopathies and optimize blood management following CPB. PMID:21449230

  20. [Use of Organon, a synthetic heparinoid, in two cardiopulmonary bypass procedures in the same patient sensitive to heparin].

    Science.gov (United States)

    Pineau, E; Le Bret, E; Folliguet, T; Saint Maurice, O S; Carbognani, D; Laborde, F

    2001-02-01

    We report the case of a patient who underwent two cardiopulmonary bypass (CPB) procedures with Orgaran because of heparin-induced thrombocytopenia. A 38 years-old man with ischemic mitral insufficiency was operated for coronary artery bypass and valvular replacement. The CPB was carried out with heparin. Heparin-induced thrombocytopenia occured and was proven immunologically. Two months later, a new valvular replacement was performed because of paravalvular leak due to endocarditis. The Orgaran-CPB protocol was as follows: 5,000 units before cardiopulmonary bypass, 5,000 units in the priming volume, anti-Xa level between 0.9 and 1.1 units/mL, with injection of 1,500 units if necessary, no administration of protamine. One month later, a new valvular replacement was necessary and performed with the same protocol using Orgaran. No bleeding or thrombotic complication occurred. Orgaran is a safe and reliable anti-thrombotic substitute if anti-Xa activity is closely monitored.

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

    Institute of Scientific and Technical Information of China (English)

    ZHANG; Shihai(

    2001-01-01

    [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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-09-01

    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.

  3. Use of danaparoid sodium (Orgaran) as an alternative to heparin sodium during cardiopulmonary bypass: a clinical evaluation of six cases.

    Science.gov (United States)

    Fernandes, P; Mayer, R; MacDonald, J L; Cleland, A G; Hay-McKay, C

    2000-11-01

    Heparin-induced thrombocytopenia (HIT) has become more prevalent in today's cardiac setting and has resulted in the need for alternative anticoagulant therapies. Danaparoid sodium, one alternative to heparin, has been used in six cardiopulmonary bypass procedures in this hospital. This clinical experience has resulted in the progressive refinement of a protocol for the 'safe' clinical use of danaparoid sodium. Although there were six positive outcomes with the use of danaparoid sodium, alternatives must be explored in order to find the optimal anticoagulant for the treatment of HIT. PMID:11131218

  4. Effect of Cardiopulmonary Bypass on Beta Adrenergic ReceptorAdenylate Cyclase System on Surfaces of Peripheral Lymphocytes

    Institute of Scientific and Technical Information of China (English)

    LUO Ailin; TIAN Yuke; JIN Shiao

    2000-01-01

    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.

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

    Science.gov (United States)

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

    2016-04-01

    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

  6. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

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    Sambhunath Das

    2015-01-01

    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

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

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    Vladimir Pichugin

    2014-12-01

    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

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

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    Melchior RW

    2016-06-01

    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

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

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    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

    2015-04-01

    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

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

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

    2014-11-01

    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

  11. [Hematologic and endocrinologic effects of pulsatile cardiopulmonary bypass using a centrifugal pump].

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    Komoda, T; Maeta, H; Imawaki, S; Shiraishi, Y; Tanaka, S

    1992-06-01

    The effects of pulsatile and nonpulsatile flow during cardiopulmonary bypass (CPB) with of centrifugal pump (Sarns) and membrane oxygenator, on blood cells, hemodynamics, and hormonal response were studied. In the pulsatile group (group P) in which pulsatile flow was generated by centrifugal pump and a 20 Fr arterial cannula was used, hemolysis and reduction of platelet count during CPB were more marked than in the nonpulsatile group (group NP), in which the same type of circuit was used. When the 20 Fr arterial cannula was replaced with a 24 Fr cannula (group Pc), the rate of hemolysis during CPB was significantly reduced compared with that in group P (p less than 0.05). The rate of rise in plasma free hemoglobin from 10 to 70 minutes CPB in group Pc was 15.0 mg/dl/hr, this value did not exceed that in either group NP or in group Pr, in which a roller pump rather than centrifugal pump was used to generate pulsatile flow. These findings show that pulsatile CPB with a centrifugal pump produces no deleterious hematologic effect in clinical use. The rise in the level of angiotensin II in group P was significantly smaller than that in group NP (p less than 0.05), and the rise in plasma renin activity and levels of angiotensin I, adrenalin and noradrenaline were smaller than those in group NP, although these differences were no significance. These findings indicate that the centrifugal pump generates pulsatile flow effectively, although not so effectively as to prevent the rise in peripheral vascular resistance. During CPB, there was no change in levels of thyroid hormones, including free T3, free T4 and reverse T3, in either pulsatile groups P and Pc or nonpulsatile group. TSH level in group Pc was significantly elevated in contrast with that in the nonpulsatile group (p less than 0.05), in which no change in TSH level was seen. It is suggested that pulsatile perfusion using a centrifugal pump might maintain sufficient hypothalamic-pituitary function to permit

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

    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 ml.kg-1.min-1 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

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

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

    2014-01-01

    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.

  14. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures.

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    Menon, Prahlad G; Antaki, James F; Undar, Akif; Pekkan, Kerem

    2013-12-01

    Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subjecting the aorta to non-physiologic flow conditions that compromise cerebral perfusion. Therefore, we emphasize the importance of cannulation strategy and hypothesize engineering better CPB perfusion through a redesigned aortic cannula tip. This study employs computational fluid dynamics to investigate novel diffuser-tipped aortic cannulae for shape sensitivity to cerebral perfusion, in an in silico cross-clamped aortic arch model modeled with fixed outflow resistances. 17 parametrically altered configurations of an 8FR end-hole and several diffuser cone angled tips in combination with jet incidence angles toward or away from the head-neck vessels were studied. Experimental pressure-flow characterizations were also conducted on these cannula tip designs. An 8FR end-hole aortic cannula delivering 1 L/min along the transverse aortic arch was found to give rise to backflow from the brachicephalic artery (BCA), irrespective of angular orientation, for the chosen ascending aortic insertion location. Parametric alteration of the cannula tip to include a diffuser cone angle (tested up to 7°) eliminated BCA backflow for any tested angle of jet incidence. Experiments revealed that a 1 cm long 10° diffuser cone tip demonstrated the best pressure-flow performance improvement in contrast with either an end-hole tip or diffuser cone angles greater than 10°. Performance further improved when the diffuser was preceded by an expanded four-lobe swirl inducer attachment-a novel component. In conclusion, aortic cannula orientation is crucial in determining net head-neck perfusion but precise angulations and insertion-depths are difficult to achieve practically. Altering the cannula tip

  15. Low free triiodothyronine levels in mexican pediatric population with congenital heart disease after cardiac surgery undergoing cardiopulmonary bypass.

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    A Araujo Martínez

    2016-09-01

    Full Text Available BACKGROUND: Low free triiodothyronine level in patients undergoing heart surgery with cardiopulmonary bypass (CPB is well described in literature, but the prevalence in pediatric Mexican population is yet unknown. OBJECTIVE: To know the prevalence of postoperative low free triiodothyronine level and the associated complications after cardiopulmonary bypass exposure in pediatric population in Mexico. MATERIAL AND METHODS: A sample of free triiodothyronine (FT3 blood was obtained in the early postoperative period of patients undergoing CPB heart surgery. Postoperative low FT3 level (PLFT3 was defined as any blood value under 2.9 pg/mL. Logistical regression models were used for analysis of independent variables, adjusted for complexity score (RACHS-1 and Aristotle Comprehensive Complexity Score. RESULTS. PLFT3 was present in 35.7% of the patients (n=109. Correlation with PLFT3 the following variables were observed: prolonged CPB time (p=0.001 prolonged aortic cross clamp (p=0.002 level of complexity of the surgery as measured by Aristotle ≥3 (p=0.001 and RACHS-1 ≥3 (p=0.021. Associated complications were: postoperative arrhythmias (p=0.008 extended intubation period (p=0.008 and higher infection rate (p=0.002.

  16. Cardiopulmonary bypass during cardiac surgery modulates systemic inflammation by affecting different steps of the leukocyte recruitment cascade.

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    Jan Rossaint

    Full Text Available BACKGROUND: It is known that the use of a cardiopulmonary bypass (CPB during cardiac surgery leads to leukocyte activation and may, among other causes, induce organ dysfunction due to increased leukocyte recruitment into different organs. Leukocyte extravasation occurs in a cascade-like fashion, including capturing, rolling, adhesion, and transmigration. However, the molecular mechanisms of increased leukocyte recruitment caused by CPB are not known. This clinical study was undertaken in order to investigate which steps of the leukocyte recruitment cascade are affected by the systemic inflammation during CPB. METHODS: We investigated the effects of CPB on the different steps of the leukocyte recruitment cascade in whole blood from healthy volunteers (n = 9 and patients undergoing cardiac surgery with the use of cardiopulmonary bypass (n = 7 or in off-pump coronary artery bypass-technique (OPCAB, n = 9 by using flow chamber experiments, transmigration assays, and biochemical analysis. RESULTS: CPB abrogated selectin-induced slow leukocyte rolling on E-selectin/ICAM-1 and P-selectin/ICAM-1. In contrast, chemokine-induced arrest and transmigration was significantly increased by CPB. Mechanistically, the abolishment of slow leukocyte rolling was due to disturbances in intracellular signaling with reduced phosphorylation of phospholipase C (PLC γ2, Akt, and p38 MAP kinase. Furthermore, CPB induced an elevated transmigration which was caused by upregulation of Mac-1 on neutrophils. CONCLUSION: These data suggest that CPB abrogates selectin-mediated slow leukocyte rolling by disturbing intracellular signaling, but that the clinically observed increased leukocyte recruitment caused by CPB is due to increased chemokine-induced arrest and transmigration. A better understanding of the underlying molecular mechanisms causing systemic inflammation after CPB may aid in the development of new therapeutic approaches.

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

    Institute of Scientific and Technical Information of China (English)

    陈益君

    2014-01-01

    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

  18. Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; GAO Chang-qing; WANG Gang; WANG Jia-li

    2012-01-01

    Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9%) and 62 male (48.1%) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3%) patients underwent mitral valve repair,27 (20.9%) mitral valve replacement,27 (20.9%) left atrial myxoma removal,and 14(10.9%) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100%),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100%),and aortic

  19. Development of an instrument to indirectly monitor arterial pCO2 during cardiopulmonary bypass.

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    Høgetveit, Jan Olav; Kristiansen, Frode; Pedersen, Thore H

    2006-01-01

    Arterial blood carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CBP) is important to the conduct of perfusion with alpha-stat or pH-stat strategy. Temperature changes during CBP complicate any attempts to monitor carbon dioxide tension in the exhaust outlet of an oxygenator (PexCO2) because CO2 becomes more soluble with decreasing temperatures. Normally, this would have been the obvious and easy choice of method to indirectly measure the patient's PaCO2. Several tests have been performed with ordinary capnographs modified to measure pCO2 at the oxygenator exhaust gas port. These tests have shown varying degrees of precision (Br I Anaesth 1999; 82(6): 843-46; 1 Extra-Corpor Technol 2003; 35(3): 218-23; Br JAnaesth 2000; 84: 536; J Extra-Corpor Technol 1994; 26: 64-67). Some of the best results have been achieved by Potger et al. (JExtra-Corpor Technol 2003; 35(3): 218-23), who found a strong correlation between the arterial temperature-corrected PexCO2 when using a standard capnograph monitoring the PaCO2 measured from a blood gas analyser (PbCO2). Our group has developed a new instrument, especially designed for oxygenator gas exhaust monitoring. The new instrument has automatic temperature correction, enabling it to show both original and corrected pCO2 values, simultaneously. Ordinary capnograph functions, such as zeroing, flow control and calibration routines, are included. The solution consists of a pCO2 sensor module, a temperature sensor, a water trap and a dedicated PC mounted on a heart-lung machine. Since the heart-lung machine was already equipped with a computer for data logging and a temperature sensor, only a box containing the pCO2 sensor module and the water trap had to be added. The PC uses a specially written program designed to collect data, make the necessary calculations and display the results on the computer screen. A temperature correction was developed based on a linear regression analysis for a data-set of 15 patients, assuming

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

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    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

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

    Science.gov (United States)

    Wang, Xiaocou; Xue, Qinghua; Yan, Fuxia; Liu, Jinping; Li, Shoujun; Hu, Shengshou

    2015-01-01

    Objective 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. Methods 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. Results 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

  2. A reduction of prothrombin conversion by cardiac surgery with cardiopulmonary bypass shifts the haemostatic balance towards bleeding.

    Science.gov (United States)

    Kremers, Romy M W; Bosch, Yvonne P J; Bloemen, Saartje; de Laat, Bas; Weerwind, Patrick W; Mochtar, Bas; Maessen, Jos G; Wagenvoord, Rob J; Al Dieri, Raed; Hemker, H Coenraad

    2016-08-30

    Cardiac surgery with cardiopulmonary bypass (CPB) is associated with blood loss and post-surgery thrombotic complications. The process of thrombin generation is disturbed during surgery with CPB because of haemodilution, coagulation factor consumption and heparin administration. We aimed to investigate the changes in thrombin generation during cardiac surgery and its underlying pro- and anticoagulant processes, and to explore the clinical consequences of these changes using in silico experimentation. Plasma was obtained from 29 patients undergoing surgery with CPB before heparinisation, after heparinisation, after haemodilution, and after protamine administration. Thrombin generation was measured and prothrombin conversion and thrombin inactivation were quantified. In silico experimentation was used to investigate the reaction of patients to the administration of procoagulant factors and/or anticoagulant factors. Surgery with CPB causes significant coagulation factor consumption and a reduction of thrombin generation. The total amount of prothrombin converted and the rate of prothrombin conversion decreased during surgery. As the surgery progressed, the relative contribution of α2-macroglobulin-dependent thrombin inhibition increased, at the expense of antithrombin-dependent inhibition. In silico restoration of post-surgical prothrombin conversion to pre-surgical levels increased thrombin generation excessively, whereas co-administration of antithrombin resulted in the normalisation of post-surgical thrombin generation. Thrombin generation is reduced during surgery with cardiopulmonary bypass because of a balance shift between prothrombin conversion and thrombin inactivation. According to in silico predictions of thrombin generation, this new balance increases the risk of thrombotic complications with prothrombin complex concentrate administration, but not if antithrombin is co-administered.

  3. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

    Science.gov (United States)

    Naik, Rakesh; George, Gladdy; Karuppiah, Sathappan; Philip, Madhu Andrew

    2016-01-01

    Objectives of the Study: To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. Methods: A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded. Results: Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001). Conclusions: Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively

  4. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery.

    Science.gov (United States)

    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

    2011-02-01

    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 whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

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

    LENUS (Irish Health Repository)

    Harmon, Dominic C

    2012-02-03

    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) KIU.hr(-1). 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.

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

    LENUS (Irish Health Repository)

    Coleman, E T

    2012-02-03

    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

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

    Science.gov (United States)

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

    2015-08-01

    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

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

    Directory of Open Access Journals (Sweden)

    Jarbas Jakson Dinkhuysen

    2014-09-01

    Full Text Available 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% and valvular surgery (32.8%. Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+, lactate desidrogenase (UI/L, fibrinogen level (mg/dL and platelet count (nº/mm3. Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application.

  9. The advance of platelet preservation during cardiopulmonary bypass%围体外循环期血小板保护的研究进展

    Institute of Scientific and Technical Information of China (English)

    魏海燕; 史宏伟; 张媛

    2011-01-01

    Platelets can release α -granules when activated by various kinds of factors and then proceed to adhension, aggregation, contraction and releasing. Therefore, the quantities and qualities of platelets are decreased after cardiac operation. The function of platelets can be protected by some drugs used during cardiopulmonary bypass. Plateletphoresis can preserve the quantities and function of platelets by making some platelets avoid cardiopulmonary bypass. This review addresses the advance of platelet preservation during cardiopulmonary bypass.%在体外循环过程中,血小板可经各种途径被激活,导致α-颗粒释放,发生粘附、聚集、收缩、释放等反应,导致术后血小板数量和质量的下降.通过在围体外循环期使用某些药物可对血小板进行功能性保护,而血小板分离技术可使血小板避免体外循环的打击,得到数量和功能的双重保护.本文将就体外循环期间血小板保护的研究进展作一综速.

  10. Peripheral cardiopulmonary bypass with modified assisted venous drainage and transthoracic aortic crossclamp: optimal management for robotic mitral valve repair.

    Science.gov (United States)

    Sobieski, Michael A; Slaughter, Mark S; Hart, David E; Pappas, Patroklos S; Tatooles, Antone J

    2003-09-01

    The purpose of this study was to evaluate peripheral cardiopulmonary bypass (CPB) with modified assisted venous drainage (MAVD) and transthoracic aortic cross-clamping to maintain a bloodless surgical field, adequate myocardial protection, systemic flow and pressure during robotic surgical repair of the mitral valve. Peripheral CPB was established with a standard Duraflo-coated closed circuit with femoral arterial and venous cannulation. An additional 17 Fr wire-bound cannula was inserted into the right internal jugular vein and drainage rates of 200-400 mL/min were regulated using a separate roller-head pump. A transthoracic aortic crossclamp with antegrade cardioplegia was used for myocardial protection. Mitral valve (MV) repair was then performed through two 1-cm ports for the robotic arms and a 4-cm intercostal incision for the camera and passing suture. From October 2001 to October 2002, 25 patients underwent robotic MV repair. Average surgical times include leaflet resection and repair, 20 min, and insertion of annuloplasty ring, 28 min; average perfusion times, crossclamp 88 min and total bypass time of 126 min. There were no incisional conversions, no reoperations for bleeding and no deaths, strokes or perioperative myocardial infarctions. Twenty-one (84%) patients were extubated in the operating room. Average LOS was 2.7 days with eight (32%) patients discharged home in less than 24 hours. In conclusion, peripheral CPB with gravity drainage of the lower body and MAVD of the upper body allow safe and effective support during robotically assisted minimally invasive MV repair. This approach may be applied to other forms of minimally invasive cardiac surgery that requires CPB. PMID:14604249

  11. 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.

    Science.gov (United States)

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

    2010-03-01

    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

  12. Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery: study protocol for a randomised controlled trial

    DEFF Research Database (Denmark)

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

    2016-01-01

    to be 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 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...

  13. Surgical removal of infected pacemaker leads without cardiopulmonary bypass after failed extraction using the Excimer Laser Sheath Extraction System.

    Science.gov (United States)

    Tokunaga, Chiho; Enomoto, Yoshiharu; Sato, Fujio; Kanemoto, Shinya; Matsushita, Shonosuke; Hiramatsu, Yuji; Aonuma, Kazutaka; Sakakibara, Yuzuru

    2012-03-01

    With the growing number of cardiac pacemakers and internal cardioverter defibrillator implantations, problems with endocardial lead infection have been increasing. The newly developed Excimer Laser Sheath Lead Extraction System has been recognized as being highly useful for removing chronic infected leads. However, serious bleeding complications are a concern when this system is used. Here we report our experience with a 67-year-old man who was diagnosed with pacemaker endocarditis. Initially, lead removal was attempted using the Excimer Laser Sheath Extraction System, though this was abandoned because of severe adhesion of the leads and the junction of the supra vena cava (SVC) with the right atrium. Surgical removal of the leads was performed without using cardiopulmonary bypass and the leads were removed without any complications. During surgery, we found there was a silent perforation of the innominate vein brought about by the Excimer Laser Sheath System. Also, the junction of the SVC with the right atrium was thought to be an area potentially at high risk of perforation, because of a lack of surrounding tissue. It is our opinion that those who carry out procedures with the Excimer Laser Sheath System should understand the potential risk of perforation based on cardiac anatomy and should be prepared for lethal bleeding complications. Also, for emergent situations, we believe that close backup by a cardiovascular surgical team should be considered essential for performing the Excimer Laser Sheath Lead Extraction safely.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...

  15. THE STUDY ON THE CHANGES OF ZINC,COPPER,CALCIUM AND MAGNESIUM IN PLASMA AND ERYTHROCYTES DURING CARDIOPULMONARY BYPASS

    Institute of Scientific and Technical Information of China (English)

    耿希刚; 李兆志; 李明; 师桃

    2004-01-01

    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.

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

    Science.gov (United States)

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

    2016-01-01

    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

  17. Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters.

    Science.gov (United States)

    Driessen, J J; Dhaese, H; Fransen, G; Verrelst, P; Rondelez, L; Gevaert, L; van Becelaere, M; Schelstraete, E

    1995-01-01

    The present study investigated the influence of pulsatile or nonpulsatile flow delivery with a centrifugal pump for cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in two randomized groups of 19 patients each. All patients received a standard anaesthetic and surgical protocol. Pulsatile perfusion during CPB was created by accelerating the baseline pump speed of the Sarns centrifugal pump at a rate of 50 cycles per minute. Measurements included perioperative systemic haemodynamics and oxygen exchange, total haemolytic complement (CH50), polymorphonuclear (neutrophil) granulocyte (PMN) count and plasma granulocyte elastase bound to alpha 1-proteinase inhibitor (E-alpha 1-PI). Laboratory measurements were corrected for haemodilution. During and after CPB there were only a few significant differences between the groups in systemic haemodynamics and oxygenation, i.e. a lower mean arterial blood pressure after the end of CPB in the nonpulsatile group (65 mmHg, SD = 11 vs 76 mmHg, SD = 11) and a lower SvO2 during rewarming on CPB in the nonpulsatile group (62%, SD = 8 vs 67%, SD = 8). The decrease in percentage of PMNs in the total white blood cell count during CPB was greater in the nonpulsatile group than in the pulsatile group (from 61 to 46% vs 63 to 53% of prebypass value). The steep increase of PMN count at the end of CPB and postoperatively was comparable in both groups. The maximal decrease of CH50 levels, occurring after surgery, was significantly higher in the nonpulsatile group (70% SD = 15 vs 79%, SD = 16, of baseline value), suggesting a greater complement activation. E-alpha 1-PI levels increased significantly in both groups during and after CPB with higher peak levels, obtained at one hour after admission to an intensive care unit, in the nonpulsatile group (316 micrograms/l, SD = 102) than in the pulsatile group (247 micrograms/l, SD = 106). There was a partly inverse correlation between the peak postoperative elastase levels and

  18. 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

    Science.gov (United States)

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

    2015-01-01

    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

  19. 部分体外循环在胸降主动脉瘤手术中的应用%Use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm

    Institute of Scientific and Technical Information of China (English)

    刘建华; 刘海霞; 孙建全

    2008-01-01

    Objective To summarize the experience of use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm. Methods Thirty five patients were undertaken surgery of descending thoracic aneurysm using partial cardiopulmonary bypass and beating-heart technique in our hospital. The partial cardiopulmonary bypass includes left heart bypass (left atrial to femoral artery bypass), pulmonary artery to femoral artery bypass, femoral vein to femoral artery bypass. Results Only one patient died, the other thirty four patients experienced an uneventful recovery. There was no any complication related to partial cardiopulmonary bypass. Conclusion The use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm can reduce and avoid the complications of nervous system and urinary system effectively.%目的 总结胸降主动脉瘤手术中采用部分体外循环的管理经验.方法 回顾性分析35例胸主动脉瘤手术中采用心脏不停跳部分体外循环资料,包括左心转流(左房-股动脉转流)、肺动脉-股动脉转流、股静脉-股动脉转流.结果 全组患者1例死亡,余34例痊愈出院,未发生体外循环相关的并发症.结论 胸降主动脉瘤手术采用部分体外循环,能有效的减少和避免神经系统和泌尿系统等并发症的发生.

  20. Association of blood products administration during cardiopulmonary bypass and excessive post-operative bleeding in pediatric cardiac surgery.

    Science.gov (United States)

    Agarwal, Hemant S; Barrett, Sarah S; Barry, Kristen; Xu, Meng; Saville, Benjamin R; Donahue, Brian S; Harris, Zena L; Bichell, David P

    2015-03-01

    Our objectives were to study risk factors and post-operative outcomes associated with excessive post-operative bleeding in pediatric cardiac surgeries performed using cardiopulmonary bypass (CPB) support. A retrospective observational study was undertaken, and all consecutive pediatric heart surgeries over 1 year period were studied. Excessive post-operative bleeding was defined as 10 ml/kg/h of chest tube output for 1 h or 5 ml/kg/h for three consecutive hours in the first 12 h of pediatric cardiac intensive care unit (PCICU) stay. Risk factors including demographics, complexity of cardiac defect, CPB parameters, hematological studies, and post-operative morbidity and mortality were evaluated for excessive bleeding. 253 patients were studied, and 107 (42 %) met the criteria for excessive bleeding. Bayesian model averaging revealed that greater volume of blood products transfusion during CPB was significantly associated with excessive bleeding. Multiple logistic regression analysis of blood products transfusion revealed that increased volume of packed red blood cells (PRBCs) administration for CPB prime and during CPB was significantly associated with excessive bleeding (p = 0.028 and p = 0.0012, respectively). Proportional odds logistic regression revealed that excessive bleeding was associated with greater time to achieve negative fluid balance, prolonged mechanical ventilation, and duration of PCICU stay (p < 0.001) after adjusting for multiple parameters. A greater volume of blood products administration, especially PRBCs transfusion for CPB prime, and during the CPB period is associated with excessive post-operative bleeding. Excessive bleeding is associated with worse post-operative outcomes.

  1. Effects of beating-heart and arrested heart intracardiac procedure on the inflammation induced by cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhe; XIAO Ying-Bin; CHEN Lin; WANG Xue-feng; ZHONG Qian-jin

    2005-01-01

    Objective:To evaluate the effects of beating-heart and arrested heart intracardiac procedure on the expression of tumor necrosis factor alpha (TNF-α) mRNA in myocardium.Methods: Thirty congenital ventricular septal defect (VSD) patients aged from 5 to 10 years old were randomly divided into 2 groups equally. Group A underwent traditional arrested-heart intracardiac procedures; group B underwent beating-heart procedures. Specimens of myocardium were obtained at the onset (baseline) and the end of cardiopulmonary bypass (CPB) for the determination of TNF-α mRNA. Concentration of TNF-α was respectively measured after anesthetic induction (T1), 20 min after the beginning of CPB (T2), at the end of CPB (T3) and 6, 12, 24 h after CPB (T4-6) in all patients. After separating polymorphonuclear leucocyte (PMN), we distilled nuclear protein and mensurated the activation of nuclear factor-κB (NF-κB) by electrophoretic mobility shift assay (EMSA). Results:Compared with baseline, the expression of TNF-α mRNA significantly increased in both groups (P<0.05). TNF-α mRNA level of group A was significantly higher than that of group B at the end of CPB (P<0.05). The plasma concentration of TNF-α and neutrophil NF-κB activity in group A was significantly higher than that of group B at T4-6 (P<0.05). Conclusion:Compared with traditional arrested CPB, beating heart intracadiac procedure can effectively reduce the expression and release of TNF-α; it will benefit the protection of pediatric myocardial during CPB.

  2. Clinical evaluation of an instrument to measure carbon dioxide tension at the oxygenator gas outlet in cardiopulmonary bypass.

    Science.gov (United States)

    Kristiansen, Frode; Høgetveit, Jan Olav; Pedersen, Thore H

    2006-01-01

    This paper presents the clinical testing of a new capnograph designed to measure the carbon dioxide tension at the oxygenator exhaust outlet in cardiopulmonary bypass (CPB). During CPB, there is a need for reliable, accurate and instant estimates of the arterial blood CO2 tension (PaCO2) in the patient. Currently, the standard practice for measuring PaCO2 involves the manual collection of intermittent blood samples, followed by a separate analysis performed by a blood gas analyser. Probes for inline blood gas measurement exist, but they are expensive and, thus, unsuitable for routine use. A well-known method is to measure PexCO2, ie, the partial pressure of CO2 in the exhaust gas output from the oxygenator and use this as an indirect estimate for PaCO2. Based on a commercially available CO2 sensor circuit board, a laminar flow capnograph was developed. A standard sample line with integrated water trap was connected to the oxygenator exhaust port. Fifty patients were divided into six different groups with respect to oxygenator type and temperature range. Both arterial and venous blood gas samples were drawn from the CPB circuit at various temperatures. Alfa-stat corrected pCO2 values were obtained by running a linear regression for each group based on the arterial temperature and then correcting the PexCO2 accordingly. The accuracy of the six groups was found to be (+/- SD): +/- 4.3, +/- 4.8, +/- 5.7, +/- 1.0, +/- 3.7 and +/- 2.1%. These results suggest that oxygenator exhaust capnography is a simple, inexpensive and reliable method of estimating the PaCO2 in both adult and pediatric patients at all relevant-temperatures. PMID:16485695

  3. Removal of Gross Air Embolization from Cardiopulmonary Bypass Circuits with Integrated Arterial Line Filters: A Comparison of Circuit Designs.

    Science.gov (United States)

    Reagor, James A; Holt, David W

    2016-03-01

    Advances in technology, the desire to minimize blood product transfusions, and concerns relating to inflammatory mediators have lead many practitioners and manufacturers to minimize cardiopulmonary bypass (CBP) circuit designs. The oxygenator and arterial line filter (ALF) have been integrated into one device as a method of attaining a reduction in prime volume and surface area. The instructions for use of a currently available oxygenator with integrated ALF recommends incorporating a recirculation line distal to the oxygenator. However, according to an unscientific survey, 70% of respondents utilize CPB circuits incorporating integrated ALFs without a path of recirculation distal to the oxygenator outlet. Considering this circuit design, the ability to quickly remove a gross air bolus in the blood path distal to the oxygenator may be compromised. This in vitro study was designed to determine if the time required to remove a gross air bolus from a CPB circuit without a path of recirculation distal to the oxygenator will be significantly longer than that of a circuit with a path of recirculation distal to the oxygenator. A significant difference was found in the mean time required to remove a gross air bolus between the circuit designs (p = .0003). Additionally, There was found to be a statistically significant difference in the mean time required to remove a gross air bolus between Trial 1 and Trials 4 (p = .015) and 5 (p =.014) irrespective of the circuit design. Under the parameters of this study, a recirculation line distal to an oxygenator with an integrated ALF significantly decreases the time it takes to remove an air bolus from the CPB circuit and may be safer for clinical use than the same circuit without a recirculation line.

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

    International Nuclear Information System (INIS)

    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)

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

    International Nuclear Information System (INIS)

    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)

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

    Institute of Scientific and Technical Information of China (English)

    吴明; 卢韵碧; 陈如坤; 周汉良

    2003-01-01

    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. Predictors of Ominous Outcome in Infants who Undergo Cardiac Surgery and Cardiopulmonary By-Pass: S100B Protein.

    Science.gov (United States)

    Varrica, Alessandro; Satriano, Angela; Tettamanti, Guido; Pelissero, Gabriele; Gavilanes, Antonio D W; Zimmermann, Luc J; Vles, Hans J S; Florio, Pasquale; Pluchinotta, Francesca R; Gazzolo, Diego

    2015-01-01

    S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined timepoints before during and after surgery. In all CHD children, S100B levels showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 µg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be included among a series of parameters for adverse outcome prediction.

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

    Directory of Open Access Journals (Sweden)

    Fang-bao Ding

    2013-11-01

    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.

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

    Science.gov (United States)

    Hein, E; Munthe-Fog, L; Thiara, A S; Fiane, A E; Mollnes, T E; Garred, P

    2015-02-01

    The complement system can be activated via the lectin pathway by the recognition molecules mannose-binding lectin (MBL) and the ficolins. Ficolin-2 exhibits binding against a broad range of ligands, including biomaterials in vitro, and low ficolin-2 levels are associated with increased risk of infections. Thus, we investigated the biocompatibility of the recognition molecules of the lectin pathway in two different types of cardiopulmonary bypass circuits. Bloods were drawn at five time-points before, during and postoperatively from 30 patients undergoing elective cardiac surgery. Patients were 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 groups after start of operation (P < 0.0001), whereas soluble C3a and TCC in the samples were increased (P < 0.0001). Ficolin-2 was depleted from plasma during cardiac surgery when using heparin-coated bypass circuits and did not reach baseline level 24 h postoperation. These findings may have implications for the postoperative susceptibility to infections in patients undergoing extracorporeal circulation procedures.

  10. Influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    Shu-Tian Song; Ming Yang; Kun-Peng Li; Juan Xu; Chuan-Ming Bai; Ji-Wu Zhou

    2016-01-01

    Objective:To investigate and analyze the influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass.Methods:A total of 42 patients with open heart surgery with cardiopulmonary bypass during the period of June 2014 to January 2016 were randomly divided into the control group of 21 cases and the observation group of 21 cases. The control group was treated with routine postoperative treatment, and the observation group was treated with recombinant human brain natriuretic peptide on the basic treatment of control group, then the myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes of the two groups before the surgery and at 2 h, 12 h and 24 h after the surgery were respectively detected and compared.Results: There were no significant difference in myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes between two groups before the surgery (allP>0.05), while the myocardial enzymes and serum cardiac function indexes of the observation group at 2 h ,12 h and 24 h after the surgery were all significantly lower than those of control group, the oxygen metabolism indexes were significantly better than the levels of control group (allP<0.05).Conclusions:The recombinant human brain natriuretic peptide can effectively improve the myocardial enzymes, serum cardiac function indexes and oxygen metabolism state of patients with open heart surgery with cardiopulmonary bypass, and it has application value for the patients with the surgery is higher.

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

    OpenAIRE

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

    2014-01-01

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

    Science.gov (United States)

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

    2015-04-01

    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

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

    Science.gov (United States)

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

    2015-04-01

    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.

  14. Management of anticoagulation during cardiopulmonary bypass in a patient with allergy to heparin and heparin-like compounds: a case-report.

    Science.gov (United States)

    Balthazar, Séverine; Watremez, Christine; Vigneault, Louise; Eeckhoudt, Stéphane; Pirson, Françoise; Hermans, Cédric

    2014-12-01

    Hypersensitivity to heparin and heparin-like compounds is a rare condition that represents therapeutic challenges for patients requiring a cardiopulmonary bypass (CPB). We here report the case of a woman with a combined allergy to heparins (fractionated and unfractionated), danaparoid and fondaparinux. She underwent a mitral valve replacement under CBP using lepirudin for systemic anticoagulation. The use of lepirudin instead of unfractionated heparin (UFH) in this setting has many important implications. Lepirudin therapeutic index is narrow and so, overdosing can lead to catastrophic bleeding, whereas underdosing can result in clotting in the CPB tubing. Monitoring of lepirudin activity is essential. The usual activated clotting time monitoring is not a reliable method to monitor anticoagulation with lepirudin in the operating theater. Our experience suggests that the diluted thrombin time provides a valuable alternative during CPB. PMID:25004020

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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 ....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 TCC in the samples were increased (P

  16. Plasma cytokines do not reflect expression of pro- and anti-inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs

    DEFF Research Database (Denmark)

    Brix-Christensen, V.; Vestergaard, C.; Chew, M.;

    2003-01-01

    Background: Plasma concentrations of inflammatory markers are increased in response to the trauma of cardiac surgery and cardiopulmonary bypass (CPB). It is, however, unknown whether the plasma cytokine levels and cytokine mRNA expression at organ level reflect each other. Methods: Twenty...... poorly reflected mRNA expression of the pro- and anti-inflammatory cytokines....... increase in OI and increased plasma IL-8 and IL-10 concentrations in the CPB-pigs compared with the sham-pigs. Conclusion: The cytokine mRNA expression pattern was very different for the pigs killed already 0.5 h after the CPB procedure compared with the pigs killed 4 h post-CPB. The plasma cytokine levels...

  17. PROINFLAMMATORY CYTOKINES IN PATIENTS UNDERGOING HYPOTHERMIC CARDIOPULMONARY BYPASS%心内直视手术围术期血浆细胞因子的变化

    Institute of Scientific and Technical Information of China (English)

    石践; 邵展社; 李学文; 高宏; 马良龙

    2001-01-01

    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.

  18. Triiodothyronine increases myocardial function and pyruvate entry into the citric acid cycle after reperfusion in a model of infant cardiopulmonary bypass.

    Science.gov (United States)

    Olson, Aaron K; Bouchard, Bertrand; Ning, Xue-Han; Isern, Nancy; Rosiers, Christine Des; Portman, Michael A

    2012-03-01

    Triiodothyronine (T3) supplementation improves clinical outcomes in infants after cardiac surgery using cardiopulmonary bypass by unknown mechanisms. We utilized a translational model of infant cardiopulmonary bypass to test the hypothesis that T3 modulates pyruvate entry into the citric acid cycle (CAC), thereby providing the energy support for improved cardiac function after ischemia-reperfusion (I/R). Neonatal piglets received intracoronary [2-(13)Carbon((13)C)]pyruvate for 40 min (8 mM) during control aerobic conditions (control) or immediately after reperfusion (I/R) from global hypothermic ischemia. A third group (I/R-Tr) received T3 (1.2 μg/kg) during reperfusion. We assessed absolute CAC intermediate levels and flux parameters into the CAC through oxidative pyruvate decarboxylation (PDC) and anaplerotic carboxylation (PC) using [2-(13)C]pyruvate and isotopomer analysis by gas and liquid chromatography-mass spectrometry and (13)C-nuclear magnetic resonance spectroscopy. When compared with I/R, T3 (group I/R-Tr) increased cardiac power and oxygen consumption after I/R while elevating flux of both PDC and PC (∼4-fold). Although neither I/R nor I/R-Tr modified absolute CAC levels, T3 inhibited I/R-induced reductions in their molar percent enrichment. Furthermore, (13)C-labeling of CAC intermediates suggests that T3 may decrease entry of unlabeled carbons at the level of oxaloacetate through anaplerosis or exchange reaction with asparate. T3 markedly enhances PC and PDC fluxes, thereby providing potential substrate for elevated cardiac function after reperfusion. This T3-induced increase in pyruvate fluxes occurs with preservation of the CAC intermediate pool. Our labeling data raise the possibility that T3 reduces reliance on amino acids for anaplerosis after reperfusion.

  19. A novel blood-sparing agent in cardiac surgery? First in-patient experience with the synthetic serine protease inhibitor MDCO-2010: a phase II, randomized, double-blind, placebo-controlled study in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

    OpenAIRE

    Englberger, Lars; Dietrich, Wulf; Eberle, Balthasar; Erdös, Gabor; Keller, Dorothee; Carrel, Thierry

    2014-01-01

    BACKGROUND Antifibrinolytics have been used for 2 decades to reduce bleeding in cardiac surgery. MDCO-2010 is a novel, synthetic, serine protease inhibitor. We describe the first experience with this drug in patients. METHODS In this phase II, double-blind, placebo-controlled study, 32 patients undergoing isolated primary coronary artery bypass grafting with cardiopulmonary bypass were randomly assigned to 1 of 5 increasing dosage groups of MDCO-2010. The primary aim was to evalua...

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

    Directory of Open Access Journals (Sweden)

    Trethowan Brian A

    2011-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Samia Ragab El Azab

    2014-10-01

    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.

  2. 体外循环肺损伤动物模型的建立%Establishment of animal Model about cardiopulmonary bypass-induced lung injury

    Institute of Scientific and Technical Information of China (English)

    张仁腾; 汪曾炜; 王辉山; 宋恒昌; 李宁; 石云

    2011-01-01

    OBJECTIVE To establish stable and reasonable animal model of cardiopulmonary bypass - induced lung injury for promoting the study about lung protection during cardiopulmonary bypass ( CPB ) and cardiac surgery. METHODS Partly CPB was established on six healthy mongrel dogs, and at the same time, the left pulmonary artery was clamping on. After 90 minutes, CPB was ceased and the change in right pulmonary function was determined. After the left pulmonary artery was unclamped and re - perfusing for 3 hours, the changes in left and right pulmonary function were determined respectively. The different factor inducing lung injury during CPB were reviewed by the change of right or left pulmonary function. RESULTS Compared with the base values, the right lung compliance and oxygenation after 90 minutes of CPB decreased significantly and vascular resistance increased significantly. After the left pulmonary artery was unclamped and re - perfusing for 3 hours, there were different extents of aggravation in the right and left lung function. Compared with the right lung, the compliance, oxygenation and vascular resistance of left lung increased significantly.CONCLUSION The animal model used in this experiment could effectively reflect lung injury caused by the extracorporeal non -physiological circulation, and also definitely reflect the effect of ischemia - reperfusion injury on the lung, which were main factors leading to lung injury during CPB. Compared with clinical total CPB, this model could lessen animal trauma, elevate its tolerance, and profit to make further study about cardiopulmonary bypass - induced lung injury and lung protection.%目的 建立方便、合理的体外循环肺损伤动物模型,以促进体外循环心脏手术过程中肺保护的研究.方法 6 只健康家犬阻断左肺动脉及并行体外循环90 min,再灌注3 h.对比体外循环前后右肺功能、再灌注后左、右肺功能的变化比例,判断体外循环过程中不同因

  3. Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

    Directory of Open Access Journals (Sweden)

    Abdorasoul Anvaripour

    2011-01-01

    Full Text Available A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

  4. [Thrombosis of a cardiopulmonary bypass circuit despite recommended hypocoagulation with danaparoid during the acute phase of type II heparin-induced thrombocytopenia].

    Science.gov (United States)

    Salmi, L; Elalamy, I; Leroy-Matheron, C; Houel, R; Thébert, D; Duvaldestin, P

    2006-01-01

    A 36-year-old patient was admitted to our hospital with ischaemic stroke. The initial assessment allowed the diagnosis of an antiphospholipid syndrome (APS) and an intracardiac mass suggestive of a heart tumour. The patient was treated with unfractionated heparin. Type II heparin-induced thrombopenia (HIT) was diagnosed on the 18th day of therapy. Given the risk of stroke recurrence it was decided to remove the cardiac tumour surgically. Cardiopulmonary bypass (CPB) was performed using danaparoid in a state of deep hypothermia, in accordance with the well-established protocol in use in our department. As the CPB and surgical procedure came to an end a massive thrombus began forming in the circuit, requiring immediate displacement of the CPB cannulae. The anti-Xa activity level obtained had been considered effective at an estimated 1.20 IU/ml, although, the level recommended by Magnani is between 1.50 and 2.0 IU/ml. There was no clinical consequence and postoperative recovery was uneventful. The discrepancy between the satisfactory level of anti-Xa activity and the thrombus formation in the CPB circuit raises the issue of the diversity of published anticoagulation protocols, the difficulty to extrapolate within a surgical team, the need for intensive laboratory monitoring within a narrow therapeutic range, as well as the patient profiles variability with concurrent disorders complicating their clinical management. PMID:17174213

  5. Postoperative pulmonary hypertensive crisis caused by inverted left atrial appendage after cardiopulmonary bypass surgery for congenital heart disease in a neonate.

    Science.gov (United States)

    Zhao, Qifeng; Hu, Xingti

    2013-09-01

    Postoperative pulmonary hypertensive crisis (PHC) caused by an inverted left atrial appendage (ILAA) is a rare complication following cardiac surgery. We present a case of 23 day-old male infant who developed postoperative PHC attacks after undergoing cardiopulmonary bypass (CPB) surgery for repair of the coactation of aorta. A hyperechogenic left atrial mass was detected via bedside transthoracic echocardiography (TTE), which was identified as an ILAA and corrected following repeat surgery. In this case, both the negative pressure in vent catheter and the long left atrial appendage (LAA) with a narrow base led to an irreversible ILAA. As in this neonate, ILAA had significant influence on the left atrial volume and caused PHC since the ILAA was located on the mitral valve orifice and interfered with the blood flow through the valve. Therefore, we recommend that the vent catheter should be turned off before removing to avoid this potential complication. Additionally, LAA should be carefully inspected after CPB surgery, and intra-operative and post-operative transoesophageal echocardiography (TEE) should be performed to detect ILAA intraoperatively so as to avoid the reoperation. When an ILAA is diagnosed postoperatively, whether conservative treatment or surgery will depend on the balance of benefit and risk for a particular patient.

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

    Science.gov (United States)

    Ito, Toshiaki

    2015-07-01

    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.

  7. Urine and serum microRNA-1 as novel biomarkers for myocardial injury in open-heart surgeries with cardiopulmonary bypass.

    Science.gov (United States)

    Zhou, Xian; Mao, Anqiong; Wang, Xiaobin; Duan, Xiaoxia; Yao, Yi; Zhang, Chunxiang

    2013-01-01

    MicroRNA-1 (miR-1) is a cardio-specific/enriched microRNA. Our recent studies have revealed that serum and urine miR-1 could be a novel sensitive biomarker for acute myocardial infarction. Open-heart surgeries with cardiopulmonary bypass (CPB) are often accompanied with surgery injury and CPB-associated injury on the hearts. However, the association of miR-1 and these intra-operative and post-operative cardiac injures is unknown. The objective of this study was to test the hypothesis that urine and serum miR-1 might be a novel biomarker for myocardial injuries in open-heart surgeries with CPB. Serum and urine miR-1 levels in 20 patients with elective mitral valve surgery were measured at pre-surgery, pre-CPB, 60 min post-CBP, and 24h post-CBP. Serum cardiac troponin-I (cTnI) was used as a positive control biomarker for cardiac injury. Compared with these in pre-operative and pre-CPB groups, the levels of miR-1 in serum and urine from patients after open-heart surgeries and CPB were significant increased at all observed time points. A similar pattern of serum cTnI levels and their strong positive correlation with miR-1 levels were identified in these patients. The results suggest that serum and urine miR-1 may be a novel sensitive biomarker for myocardial injury in open-heart surgeries with CPB.

  8. Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: Early indicator of morbidity

    Directory of Open Access Journals (Sweden)

    P M Kapoor

    2011-01-01

    Full Text Available Background: Myocardial lactate assays have been established as a standard method to compare various myocardial protection strategies. This study was designed to test whether coronary sinus (CS lactates, pyruvate and lactate-pyruvate (LP ratio correlates with myocardial dysfunction and predict postoperative outcomes. Materials and Methods: This prospective observational study was conducted on 40 adult patients undergoing elective cardiac surgery with the aid of cardiopulmonary bypass (CPB. CS blood sampling was done for estimation of myocardial lactate (ML, pyruvate (MP and lactate-pyruvate ratio (MLPR namely: pre-CPB (T 1 , after removal of aortic cross clamp (T 2 and 30 minutes post-CPB (T 3 . Results: Baseline myocardial LPR strongly correlated with Troponin-I at T1 (s: 0.6. Patients were sub grouped according to the median value of myocardial lactate (2.9 at baseline T1 into low myocardial lactate (LML group, mean (2.39±0.4 mmol/l, n=19 and a high myocardial lactate (HML group, mean (3.65±0.9 mmol/l, n=21. A significant increase in PL, ML, MLPR and TropI occurred in both groups as compared to baseline. Patients in HML group had significant longer period of ICU stay. Patients with higher inotrope score had significantly higher ML (T2, T3. ML with a baseline value of 2.9 mmol/l had 70.83% sensitivity and 62.5% specificity (ROC area: 0.7109 Std error: 0.09 while myocardial pyruvate with a baseline value of 0.07 mmol/l has 79.17% sensitivity and 68.75% specificity (ROC area: 0.7852, Std error: 0.0765 for predicting inotrope requirement after CPB. Conclusion: CS lactate, pyruvate and LP ratio correlate with myocardial function and can predict postoperative outcome.

  9. 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

    Institute of Scientific and Technical Information of China (English)

    马燕; 于湘友

    2011-01-01

    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.

  10. 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

    Institute of Scientific and Technical Information of China (English)

    张玉梅; 范春兰; 韩萌萌

    2015-01-01

    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.

  11. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian;

    2007-01-01

    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...

  12. 体外循环心内直视手术后严重并发症的防治%Prevention and treatment of severe complications after cardiopulmonary bypass in open heart operation

    Institute of Scientific and Technical Information of China (English)

    冯永健; 何佳虹; 刘晓川; 董斌; 杨宁

    2014-01-01

    Objective:To investigate the prevention and treatment of severe complications after cardiopulmonary bypass in open heart operation. Methods:The group of 216 cases of cardiopulmonary bypass open heart surgery patients with serious complications of acute cardiac tamponade,low cardiac output syndrome and ventricular arrhythmia were retrospectively analyzed. Results:In this group,7 pa-tients died,and the mortality rate was 3. 2%. There were 25 cases of all kinds of complications,among which acute cardiac tamponade, low cardiac output syndrome and ventricular arrhythmia accounted for 72. 7 percent. Conclusion:It is crucial to have proper prevention and treatment of serious complications within 24 hours after surgery.%目的:探讨体外循环心脏直视手术后严重并发症的防治。方法:对本组216例体外循环心脏直视手术患者术后急性心包填塞,低心输出量综合征及室性心律紊乱等严重并发症进行回顾性分析。结果:本组共死亡7例,死亡率为3.2%,各种并发症25例,而上述三种并发症占72.7%。结论:术后24 h对于严重并发症的正确预防与处理是保证安全的关键所在。

  13. 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

    Institute of Scientific and Technical Information of China (English)

    苏日娜(综述); 于建设; 温再和(审校)

    2015-01-01

    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 .

  14. Experience of cardiopulmonary bypass in congenital heart disease surgery of low weight infants%低体重婴幼儿先心病手术的体外循环经验

    Institute of Scientific and Technical Information of China (English)

    黄东娇; 李传在

    2014-01-01

    目的:总结本院5年来10kg以下婴幼儿先天性心脏病的体外循环管理经验。方法:2009年7月-2014年7月收治先天性心脏病患儿123例,根据畸形复杂程度,采用浅低温或中低温体外循环,重视各种脏器的保护。结果:全组体外循环时间25~188 min,主动脉阻断时间10~123 min,转流中Hct 0.25~0.30,均顺利脱机。术后死亡5例。结论:对于婴幼儿先天性心脏病的 ECC 管理力求做到精细,能够减轻体外循环对婴幼儿的生理干扰,促进术后恢复,减少术后并发症及死亡率。%Objective:To summarize the management experience on cardiopulmonary bypass in congenital heart disease surgery of infants below 10kg weight in recent 5 years.Methods:123 infants with congenital heart disease were selected from July 2009 to July 2014,according to the complicated degree of deformity,we used extracorporeal circulation of mild hypothermia or in low temperature,we attached great importance to the protection of various organs.Results:the cardiopulmonary bypass time of the whole group was 25~188min,aortic cross clamping time was 10~123min,Hct in bypass was 0.25~0.30,all of them were successfully offline.5 cases were death in postoperative.Conclusion:For the ECC management of infants with congenital heart disease we must strive to do fine,so that can reduce the physiological disturbance of extracorporeal circulation on infants and promote postoperative recovery and reduce postoperative complications and mortality.

  15. Estudo comparativo do emprego da aprotinina em baixas doses X placebo, durante a circulação extracorpórea Comparative study of low-dose aprotinin x placebo during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    José Carlos D. V. PONTES

    2002-03-01

    damaging effects on cardiopulmonary bypass in fibrinolytic system, which may improve hemostasis. OBJECTIVE: To study the effect of low dose aprotinin in patients undergoing extracorporeal circulation. METHOD: Seventeen patients, underwent cardiopulmonary bypass to mitral valve replacement, was ramdomized in two groups: I (control -- 9 patients received placebo after anesthesia induction and each hour in the priming; II (aprotinin -- 8 patients received after anesthesia induction 30,000 KIU/kg and 7.500 KIU/kg each hour in the priming during the perfusion. The blood loss was observed through the first 24 hours postoperatively. Arterial blood samples were taken after anesthesia induction and after administration of protamina in order to analyse: prothrombin activity (PA, partial thomboplastin time (PTT, thrombin time (TT, euglobulin lysis time (ELT and to measure levels of fibrinogen (F, d-dimer (dD and antithrombin III (ATIII. RESULTS: Mean postoperative bleeding at the 24th hours was 690.67±377 in the control group and 248,.75±105 in the aprotinin group (p=0.0017. The results taken from the blood samples were shown above. CONCLUSION: It follows that aprotinin, in low dose, was able to inhibit fibrinolysis and reduced bleeding after cardiopulmonary bypass.

  16. Cardiopulmonary Resuscitation (CPR)

    Science.gov (United States)

    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 ...

  17. The effects pyruvate on RBC and its application during cardiopulmonary bypass%丙酮酸盐对红细胞的影响机制及在体外循环中的应用前景

    Institute of Scientific and Technical Information of China (English)

    谭洪婧; 苟大明; 周方强

    2011-01-01

    背景 体外循环(cardiopulmonary bypass,CPB)转机过程对患者红细胞的损伤是临床常见的病理过程.大量动物文献报道表明,丙酮酸盐能通过多个途径保护和恢复器官/细胞的功能,现就丙酬酸盐对红细胞的影响机制及在CPB中的应用前景作一综述; 目的 阐述丙酮酸盐对红细胞的影响机制,展望丙酮酸盐在CPB中的应用前景;内容 作为糖酵解中间产物的丙酮酸盐可通过促进细胞能量代谢,抗氧化和纠正细胞内酸中毒3种途径修复细胞损伤,恢复其功能,丙酮酸盐的这些作用机制可能适用于CPB过程中红细胞的保护;趋向 丙酮酸盐在CPB中应用可能为临床红细胞的保护提供新途径.%Background Various damage to red blood cells occurs during cardiopulmonary bypass (CPB). Multiple animal studies in literature indicated that pyruvate can protect and restore organ/cell function through multiple ways. This article reviewed the protective effect of pyruvate and its mechanisms on RBC during CPB. Objective Discussion of the effect and mechanisms of pyruvate on RBC. Content As an intermediate product of glycolysis, pyruvate can repair the RBC damage through anti-oxidation, modulation of energy metabolism and correction of metabolic acidosis, preserving RBC function, which might be applied to protect RBC during CPB. Trent Pyruvate in CPB of application might provide a new way of RBC protection.

  18. Cardiac Pediatric Surgery in Normothermia during Cardiopulmonary Bypass Cirugía cardiovascular pediátrica en normotermia durante la circulación extracorpórea

    Directory of Open Access Journals (Sweden)

    Luis Enrique Marcano Sanz

    2012-02-01

    Full Text Available

    Hypothermia during cardiopulmonary bypass is a method used in most of the protocols of pediatric cardiac surgery. There are evidences of its side effects. Normothermia in children as a novel strategy, was begun by Lecompte in 1995 and nowadays 12 000 surgical interventions have been performed in nine European centres during the last 15 years. Clinical reports show less incidence of complications and use of inotropic support, shorter cardiopulmonary bypass time, ventilator support and intensive care unit stay when normothermia was used. The aim of this review is identify the physiopathology issues of extracorporeal circulation in normothermia and hypothermia in pediatric cardiac surgery, as theoretical support to introduce normothermia as first line option. The conclusion is that normothermia is more physiological than hypothermia, able to protect organs of the human body in a safe and effective way.

    La hipotermia durante la circulación extracorpórea es un método comúnmente utilizado en cirugía cardiovascular infantil, pero existen evidencias de que induce efectos nocivos. La normotermia como alternativa novedosa en cirugía pediátrica fue introducida por Lecompte en 1995 y actualmente nueve centros europeos acumulan una experiencia de 12 000 intervenciones durante los últimos 15 años. Los reportes clínicos muestran menor  incidencia de complicaciones, disminución en el uso de inotrópicos, menores  tiempos de circulación extracorpórea, de ventilación mecánica y de estadía en terapia intensiva al compararla con la hipotermia. Se realizó una revisión bibliográfica con el objetivo de identificar elementos fisiopatológicos durante la circulación extracorpórea en normotermia e hipotermia en la cirugía cardiovascular pediátrica, como marco teórico para introducir la normotermia como modalidad de primera elección. Se concluye que la normotermia es una técnica más fisiológica, capaz de proteger los diferentes

  19. 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

    Institute of Scientific and Technical Information of China (English)

    姜建杰; 施丽萍; 邹煜

    2011-01-01

    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.

  20. EFECTOS DE LA HEMODILUCIÓN NORMOVOLÉMICA CON AUTODONACIÓN DE BAJO VOLUMEN SOBRE ALGUNOS PARÁMETROS HEMATOLÓGICOS EN LA CIRUGÍA CARDIOVASCULAR CON CIRCULACIÓN EXTRACORPÓREA / Effects of normovolemic hemodilution with low volume autologous donations on various hematological parameters in cardiovascular surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Shemanet García Cid

    2011-09-01

    Full Text Available Introduction and Objectives: Cardiac surgery with extracorporeal circulation is characterized by large perioperative blood loss and multifactorial disorders of coagulation parameters. For these reasons, there is frequent use of allogeneic transfusions. The purpose of this study was to determine the effects of intentional normovolemic hemodilution, with low volume autologous donation, on some hematological parameters in patients undergoing cardiopulmonary bypass. Method: A longitudinal, comparative, prospective study was performed in 27 patients who underwent cardiovascular surgery with cardiopulmonary bypass, subjected to intentional low volume normovolemic hemodilution. The following parameters were studied: the patient's blood volume, bleeding count, hematocrit figures, platelet count, thromboplastin time and INR before and after hemodilution and autotransfusion. Results: A blood volume average extraction of 10.5% for men and 13,12 % for women was found, with a highly significant reduction in hematocrit, and a significant reduction in platelet, although both variables were within normal values, without involvement of the coagulation parameters with hemodilution. After autotransfusion, a highly significant increase in hematocrit and platelet count was found, with significant reduction of thromboplastin time and INR. Conclusions: The low volume normovolemic hemodilution does not produce clinically important changes in the studied hematological parameters, and autotransfusion after cardiopulmonary bypass improves these parameters.

  1. 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

    Institute of Scientific and Technical Information of China (English)

    杨威; 董啸

    2011-01-01

    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.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    蒋玲; 喻杰锋

    2007-01-01

    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.

  3. 婴幼儿体外循环期间氨甲环酸血液浓度研究%Study of plasma concentration of tranexamic acid during cardiopulmonary bypass in infants with tetralogy of Fallot

    Institute of Scientific and Technical Information of China (English)

    孙国林; 李生德; 齐萍; 文仁国; 肖颖彬

    2013-01-01

    Objective To study the plasma concentration of tranexamic acid (TA) during cardiopul-monary bypass in infants with tetralogy of Fallot (TOF). Methods Five TOF infants with body weight of (7.36 ±2.08) kg were given an slow intravenous injection of initial dose of TA (100 mg/kg, 〉 10 min) before thoracotomy, following by another 100 mg/kg TA before the initiation of cardiopulmonary bypass (CPB). The concentration of TA was measured in blood plasma using 1H-NMR spectroscopy. Results Plasma TA concentrations were (224. 61 ± 195. 28) μg/mL before CPB (at 20 min after TA administration) , (509. 58 ± 181.57) μg/mL at 60 min after CPB initiation, and (243. 95 ±32. 30) μg/mL at the end of operation, respectively. The plasma TA concentration before CPB was not significantly different from that at 60 min after CPB initiation ( P = 0. 052) and that at the end of operation (P = 0. 83 ) , but there was significant difference between plasma TA concentration at 60 min after CPB initiation and that at the end of operation (P =0. 02). Conclusion A 100 mg/kg initial dose of TA followed by an infusion of 100 mg/kg before the initiation of CPB is sufficient enough to provide an effective plasma concentration, which is higher than 125 μg/mL for patients with high risk of bleeding, indicating the dose of TA can be decreased.%目的 研究婴幼儿法洛四联症(tetralogy of fallot,TOF)根治术体外循环(cardiopulmonary bypaass,CPB)期间应用氨甲环酸(tranexamic acid,TA)的血液浓度.方法 5例先天性TOF患儿,体质量(7.36±2.08)kg,在开胸前应用TA100 mg/kg,单次静脉缓慢注射(>10 min),CPB开始前再次注射100 mg/kg.应用磁共振波谱仪(1 H-NMR)方法,检测不同时间段TA的血液浓度.结果 CPB开始前(负荷剂量用药后约20 min)、CPB开始后1h、手术结束时的血液TA浓度分别为(224.61±195.28)、(509.58±181.57)、(243.95±32.30) μg/mL.CPB开始前与CPB开始后1h及手术结束时TA浓度比较均无统计学差异(P =0

  4. 氨甲环酸在心肺转流下心内直视手术麻醉中的应用%Clinical efficiency of tranexamic acid in cardiac patients undergoing cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    肖敬波; 汪卫兵; 周新; 王胜斌; 方才

    2011-01-01

    Aim To evaluate the efficiency and security of tranexamic acid in cardiac patients undergoing cardiopulmonary bypass. Meth ods 60 patients, scheduled for cardiopulmonary bypass were randomly divided into two groups with 30 patients in each group. In tranex amic acid group( group A ),patients received tranexamic acid( total dosage 90 mg · kg -1 ), one half of total dosage was injected after in duction of anesthesia,the remaining dosage was injected at a rate of 1.0 mg · kg -1 · h -1 via microinfusion pump during intraoperation. In placebo group( group B ), patients acted as group A injected normal saline( total dosage 9 ml · kg -1 ). The haematocrit( Hct) ,platelet counts( Plt )and level of creatinine both prime and postoperation in two groups were recorded. The postoperative mediastinal chest tube drainage during 24 hours, blood product transfusions were all recorded, and the allergic reactions for all patients were observed. Results The postoperative mediastinal chest tube drainage during 24 hours and blood product transfusions were significantly more in group B than in group A( P < 0.05 ), and no adverse effects such as allergic reactions, renal dysfunction were observed in two groups. Conclusion The tranexamic acid was effective to reduce postoperative bleeding and blood product transfusions in cardiac patients undergoing cardiop ulmonary bypass.%目的 观察和评估在心肺转流手术中应用抗纤溶药氨甲环酸的疗效和安全性.方法 60例拟行心肺转流手术患者,随机分为氨甲环酸组(A组,n=30)和对照组(B组,n=30),其中A组按总量90 mg·kg-1分两次给予氨甲环酸,诱导后切皮前静注1/2量,另1/2量术中持续泵注1.0 mg·kg-1·h-1.B组给予0.9%氯化钠液9 ml·kg-1.记录两组手术前后血细胞压积(Hct)、血小板计数(Plt)、肌酐、术毕及术后24 h心包纵隔引流量和输血量,并观察过敏反应.结果 与B组比较,A组术后24 h心包纵隔引流量和输血量显著降低(P<0.05),无

  5. 海藻酸钠交联肝素涂层在体外循环及人工心肺支持装置管路中的应用%Cross-linked alginate/heparin coated cardiopulmonary bypass support device

    Institute of Scientific and Technical Information of China (English)

    刘东; 李彤; 于美丽; 胡晓旻; 段大为; 李鑫

    2011-01-01

    BACKGROUND: Currently, non-heparin-coated pipe and tube have a great impact on internal cardiopulmonary bypass (CPB) cardiac surgery, which can cause blood damage, heavy inflammatory response, and influence the postoperative recovery and survival of patients.OBJECTIVE: To develop a new heparin-coated CPB pipe by using the bomedical polymer materials, and to study its stability and performance of anticoagulant.METHODS: CaCl2 was used to form Ca2+ membrane for modifying the inner surface of medical polyvinyl chloride (PVC) pipe cross-linking with sodium alginate and heparin. The Ca2+ reacted with Na+ which was in the sodium alginate and heparin, so that the linear polymer cross-linking molecules were to form chemical cross-linked sodium alginate-heparin complex network structure,a type of biomaterial heparin coating.RESULTS AND CONCLUSION: CaCl2 modified activated medical PVC cardiopulmonary bypass pipe reacting with heparin and sodium alginate to bring out the cross-linking reaction and form biological polymers heparin-coating pipe. The heparin-coated pipe has been proved that it has good blood compatibility, stability, anti-coagulation performance to meet short-term extracorporeal circulation bypass.%背景:目前国内体外循环心脏手术使用的非肝素涂层管路和插管对血液破坏大、炎性反应重,影响心脏手术后患者的恢复和生存.目的:采用生物医用高分子材料研制新型体外循环管道肝素涂层技术,并对其稳定性及抗凝血性能进行研究.方法:利用CaCl2将活化医用聚氯乙烯体外循环管道内表面修饰形成Ca2+膜,并与海藻酸钠和肝素交联;其中Ca2+与海藻酸钠、肝素钠中的Na+反应,从而使线型聚合物分子发生交联,形成化学交联海藻酸钠-肝素复合物的网状结构,实现生物型材料肝素化涂层.结果与结论:CaCl2修饰活化医用聚氯乙烯体外循环管道并与海藻酸钠和肝素交联反应,形成生物型高分子材料肝素化涂层

  6. [Cardiopulmonary Comorbidities].

    Science.gov (United States)

    Seiler, Frederik; von Hardenberg, Albrecht; Böhm, Michael; Bals, Robert; Maack, Christoph

    2016-02-01

    Cardiac and pulmonary diseases are primary causes of global morbidity and mortality. Since the prevalence of both cardiac and pulmonary diseases increases with age, cardiopulmonary comorbidities inflict especially the elderly. Due to the tight physiological connection of the heart and the lung, diseases of both organs affect each other beyond a mere coincidence. At the same time, due to the similarity of their respective symptoms, their differentiation is challenging in clinical practice and therefore, comorbidities can be easily overlooked. This article provides an overview on the characteristics of cardiopulmonary comorbidities and their specific-, but also mutual pathophysiology. PMID:26886042

  7. 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

    Institute of Scientific and Technical Information of China (English)

    金艳; 陈敏; 金振晓; 郑奇军; 王新利; 赵堃; 崔勤

    2012-01-01

    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

  8. Management of cardiopulmonary bypass for open heart surgery with beating heart%心脏跳动下心内直视手术的体外循环管理

    Institute of Scientific and Technical Information of China (English)

    杨宗英; 马瑞彦; 肖颖彬; 刘梅; 彭莉; 胡卫

    2011-01-01

    Objective To discuss the management melhods of cardiopulmonary bypass ( CPB) for palienls underwent open heart surgery with healing heart. Methods The CPB management melhods for 2 290 palienls underwenl open heart surgery with healing heart were summed-up. The left heart venling was established during the surgery and inlegraled sequelial de-airing procedure was conducted al the end of the surgery. The temperalure of nasopharynx was mainlained between 30 ~32 ℃, hemalocril was kept between 20% ~30% and the flow was controlled belween 2.4 ~3. 2 L·m-1· min-2 . Α-stat blood gas strategies were applied, meanwhile conventional ullrafilltration or modified ul-trafillralion was performed according to the condition. Results CPB went sucessful in all cases, the CPB time was 22 ~ 179 minules. Ventricular fibrillation was occurred in 256 cases and 181 cases experienced automatic recovery to healing. There were 22 cases died including 15 cases of complex congenital heart disease and 7 cases of severe valvular heart disease. No complication correlated wilh perfusion was oberved. Conclusion Open heart sugery wilh beating heart under mild hypothermia by cardiopulmonary bypass is safe and feasible, meanwhile it is easy for management and il can effectively prevenl ischemia reperfusion injury.%目的 探讨心脏跳动下心内直视手术中体外循环的管理方法.方法 总结分析2 290例心脏跳动下行心内直视手术的体外循环管理方法.术中均常规建立左心引流,术毕采用综合序贯排气技术.转流中鼻咽温维持在30~32 ℃,红细胞压积维持在20%~30%,流量控制在2.4~3.2 L·m-1·min-2,采用α稳态血气管理方法,术中酌情行常规超滤或改良超滤.结果 全组体外循环均顺利停机,转流时间22~179 min.术中室颤256例,其中181例自动复跳.全组死亡22例,其中复杂先天性心脏病15例,重症瓣膜病7例.全组无体外循环气栓并发症.结论 浅低温体外循环方法在心脏跳动

  9. 10kg以下婴幼儿先天性心脏病手术体外循环管理%Management of cardiopulmonary bypass for infants below 10 kilograms with congenital heart diseases

    Institute of Scientific and Technical Information of China (English)

    罗佳文; 李东玉; 龙明生; 李昆; 陈晓慨

    2012-01-01

    目的 总结10 kg以下婴幼儿先天性心脏病手术体外循环(cardiopulmonary bypass,CPB)中和术后的管理资料,探讨低体重患儿CPB管理经验.方法 回顾性分析我院2010年1月至2011年4月收治的122例年龄1.5个月~2岁、体重3~10kg的婴幼儿在浅低温或中低温CPB下行先天性心脏病手术治疗的临床资料.结果 122例患儿,转流时间13 ~118 min,平均(62.69 ±21.48) min;主动脉阻断时间0 ~ 86 min,平均(35.47±19.51) min;心脏全部自动复跳,转流过程平稳,停机顺利,未发现与CPB相关的严重并发症.3例患儿术后死亡(2.46%,3/122).结论 对10 kg以下的低体重先天性心脏病患儿行CPB时,应使用预充量尽可能少的膜式氧合器、管道及微栓过滤器,转流过程保持较高灌注流量,保证血流动力学稳定,维持合理的红细胞压积和胶体渗透压,提供良好的心肌保护,并且应用超滤技术减轻术后水肿的发生.%Objective To summarize the management of cardiopulmonary bypass(CPB) for infants below 10 kilograms with congenital heart diseases.Methods From Jan 2010 to Apr 2011,the clinical datas of 122 infants aged from 1.5 months to 2 years with body weight 3 to 10 kilograms,who underwent open heart surgery under mild or moderate hypothermia CPB were retrospectively analyzed.Results Among all the 122 infants,CPB time was 13 ~ 118 min [(62.69 ± 21.48) min],aortic cross-clamp time was 0 to 86 min [(35.47 ± 19.51) min].All patients were spontaneous resuscitation and successfully weared from the machine,no severe complications associated with CPB occurred,3 infants died (2.46%,3/122) after operation.Conclusion Using membrane oxygenator,circuit tubing and artery filter with less priming,and highflow perfusion during CPB,maintaining hemodynamics stable,holding reasonable hematocrit and colloid osmotic pressure,good myocardial protection and ultrafiltration are the significant elements of the management of CPB in infants with

  10. 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

    Institute of Scientific and Technical Information of China (English)

    张丽丽; 孙莹杰; 张铁铮

    2012-01-01

    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.

  11. The Clinical Study on Relation between Regional Cerebral Oxygen Saturation and Postoperative Delirium in Patients during Cardiopulmonary Bypass%体外循环术中局部脑氧饱和度与术后谵妄的关系

    Institute of Scientific and Technical Information of China (English)

    刘威; 齐娟; 于荣国; 姚祖武; 龚书榕; 顾恩郁

    2011-01-01

    Objective To study the relation between regional cerebral oxygen saturation (rScO2)and postoperative delirium in patients underwent cardiopulmonary bypass (CPB) of cardiac surgery.Methods Twenty-eight patients underwent elective cardiac surgery were enrolled in the study. Postoperative delirium was assessed by the CAM-ICU everyday during 7 days after operation. All of the patients were divided into two groups (delirium group and non-delirium group) based on the postoperative delirium. The rScO2 of all patients was monitored during operation. The value of the mean rScO2 in the 7 periods (preoperatiion, preinducement, from inducement to the beginning of CPB, from the beginning of CPB to the end of nose temperature cooling, from the end of nose temperature cooling to the beginning of warming, from the beginning of warming to the end of CPB, the 30 minutes after CPB) during the operation period were calculated. The area under the curve of the rScO2 was calculated. Results The AUC-rScO2 of the patients in delirium group was significantly larger than the non-delirium group (P<0.05).Conclusions The low rScO2 increases the postoperative delirium in patients who underwent cardiopulmonary bypass of cardiac surgery. Hence we should monitor the rScO2 during operation.%目的 探讨体外循环(CPB)心血管外科手术期间患者脑氧代谢与术后谵妄的关系.方法 收集择期行CPB下心内直视手术患者28例,术后7 d内,每日以ICU精神错乱评估量表(CAM-ICU)评估患者的精神状态,以是否发生谵妄分为谵妄组和非谵妄组.2组术中均以近红外光谱仪动态监测监测局部脑氧饱和度(rScO2),计算围手术期中7个时段(术前、诱导前、诱导至CPB前、CPB开始至鼻咽温降温末、鼻咽温降温末至复温初、复温初至CPB结束、CPB结束后30 min)rScO2均值;计算rScO2曲线下面积(AUC-rScO2).结果 谵妄组AUC-rScO2较非谵妄组增大(P<0.05).结论 心血管外科手术CPB期间患者出现低rScO2

  12. 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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

    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.

  13. 体外双循环下缺氧预处理对犬心肌的保护作用%Myocardial protective effect of hypoxic preconditioning with double cardiopulmonary bypass in canine hearts

    Institute of Scientific and Technical Information of China (English)

    陈林; 郑宏; 艾来提·塔来提

    2014-01-01

    目的 观察在体全心脏实施缺氧预处理的心肌保护效果.方法 选用健康比格犬随机分为空白对照组(C组,n=8)与缺氧预处理组(HPC组,n=8),分别在全身麻醉下开胸建立双体外循环(体循环+冠脉循环)模型,HPC组通过冠脉体外循环对在体全心脏实施缺氧预处理(缺氧3 min,复氧5 min,重复3次),C组不实施缺氧预处理;两组均实施冷灌注使心脏停搏,体外循环60 min后观察犬复跳成功率、心律失常发生率以及除颤次数等临床表现;复跳后30 min结扎冠状动脉的左前降支主干中下1/3,60 min后观察心肌梗死的面积,并取标本做电镜分析;在T1(术前)、T2(体外循环开始前)、T3(复跳后即刻)、T4(缝扎冠状动脉的左前降支30 min后)分别检测肌钙蛋白水平和心肌酶谱;并观察两组间心脏舒缩功能和心肌超微结构的影响.结果 HPC组在T3时点心肌酶谱水平高于C组(P<0.05),但在T4时点HPC组的心肌酶谱和肌钙蛋白均显著低于C组(P<0.05);HPC组在一次性复跳率和除颤例数数上均有显著低于空白对照组(7/8比4/8、1/8比5/8,P<0.05),HPC组心梗面积显著低于C组[(15.37±1.64)%比(29.77±3.38)%,P<0.05],电镜显示HPC组线粒体结构的损害及心肌细胞水肿的程度轻于C组.结论 在体全心脏缺氧预处理对于心肌细胞有显著的保护作用,能够提高心肌细胞对缺氧的耐受能力.%Objective To investigate the myocardial protective effect of hypoxic preconditioning in thein vivo canine hearts.Methods Healthy beagle dogs were randomly divided into two groups:the hypoxic preconditioning group (HPC group,n =8) and the control group (C group,n =8).The dog model of the double cardiopulmonary bypass (systemic and coronary circulation) was established after chest opening under general anesthesia.In HPC group,dog hearts were perfused by the coronary circulation and subjected to hypoxic preconditioning (3 min of hypoxia followed by 5 min of

  14. 改良肺动脉灌注在发绀型先天性心脏病体外循环术中的应用%Modified lung perfusion in cardiopulmonary bypass for cyanotic congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    朱耀斌; 范祥明; 李晓锋; 刘爱军; 王栋; 李刚; 续玉林; 刘迎龙

    2012-01-01

    Objective To evaluate the effect of modified lung perfusion with hypothermic histidine-ketoglutarate-trypto-phan( HTK) solution on lung function during cardiopulmonary bypass ( CPB) in children with cyanotic congenital heart disease ( CCHD). Methods Thirty children with CCHD were randomly divided into control group and perfusion group, fifteen cases in each group. The operation was performed with routine approach in control group,while the lung perfusion with hypothermic HTK during CPB was used in perfusion group. The level of plasma tumor necrosis factor-α(TNF-α) was measured. Lung biopsy specimens were obtained after operations for study on pathological changes. At the same time, perioperative period arterial blood gas analysis, cardiopulmonary bypass time, aortic clamping time, ventilation time, intensive care unit ( ICU) time and postoperative hospital stay were observed. Results There was no significant difference in CPB time,aortic clamping time and postoperative hospital stay between two groups ( P > 0. 05 ). The ventilation time and ICU time in the perfusion group was significantly lower than that in the control group respectively(P 0. 05). At 0,12,24 and 48 hours after hospitalization in ICU, the level of TNF-a in the perfusion group was significantly lower than that in the con-trol group (P <0.05). Lung biopsy showed that there were many alveolus with oedema,and many infiltration in alveolus;but the pathological change was significantly improved in the perfusion group. Conclusion Modified lung perfusion with hypother-mic HTK solution can effectively reduce the inflammatory response, and improve the pulmonary function after cardiopulmonary bypass in children with cyanotic congenital heart disease.%目的 研究体外循环中经肺动脉灌注低温组胺酸-酮戊二酸-色氨酸灌注液(HTK)对发绀型先天性心脏病患儿的肺保护作用.方法 30例发绀型先天性心脏病患儿随机分为灌注组和对照组.灌注组体外循环期间

  15. 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

    Institute of Scientific and Technical Information of China (English)

    陈纲; 贾兵; 刘晔; 闫宪刚; 何春兰; 叶明; 陶麒麟

    2009-01-01

    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

  16. 常温非体外循环下全胸腹主动脉替换术%Total thoracoabdominal aortic aneurysm repair: a normal thermic and non-cardiopulmonary bypass method

    Institute of Scientific and Technical Information of China (English)

    孙立忠; 程力剑; 朱俊明; 刘永民; 张宏家; 郑斯宏; 郑军; 白涛; 张明

    2011-01-01

    目的 总结常温非体外循环下全胸腹主动脉替换术(total thoracoabdominal aortic aneurysm repair,tTAAAR)的手术方式和早期治疗效果.方法 2009年2月至2010年12月,共完成41例全胸腹主动脉替换术,其中27例CrawfordⅡ型胸腹主动脉瘤(thoracoabdominal aortic aneurysm,TAAA)患者接受常温非体外循环tTAAAR治疗.男18例,女9例;平均年龄(41.85 ±10.11)岁.手术经左侧胸腹联合切口、腹膜外入路,常温非体外循环下建立降主动脉→双侧髂动脉旁路循环,然后采用分段阻断法,重建T6~T12肋间动脉及内脏血管.结果 所有患者均完成手术,降主动脉阻断(13.78 ±3.77) min.脊髓缺血( 19.19±3.93) min,内脏缺血(25.19 ±5.88) min.1例患者术中死亡,其余患者均生存.术后永久性脊髓损伤2例,呼吸系统并发症3例.结论 中国全胸腹主动脉瘤患者应早期积极治疗,常温非体外循环下的全胸腹主动脉替换术是一种安全、有效的治疗策略.%Objective Investigate the operative techniques and early results of a normal thermic and non-cardiopulmonary bypass fashion to perform total thoracoabdominal aortic aneurysm repair (tTAAAR).Methods Between February 2009 and December 2010,41 patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA) underwent tTAAAR in our hospital.Among them,27 patients underwent tTAAAR in a normal thermic and non-cardiopulmonary bypass fashion.The mean age of this group of patients is (41.85 ± 10.11 ) years ( range 23-61 years),including 18 male and 9 female.The operation was performed via a combined left thoracoabdominal incision.The intercostal incision was through the left fifth (or sixth) intercostal space and an amputated costal arch.The abdominal incision was from the left linea pararectalis to the level of the pubic symphysis via a retroperitoneal approach.The diaphragm was incised circularly to expose the aorta.After the iliac arteries and proximal descending aorta were

  17. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.

    2005-01-01

    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

  18. Outcomes after off-pump coronary bypass surgery

    NARCIS (Netherlands)

    Dijk, Diederik van

    2002-01-01

    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

  19. Epicardial ultrasound in coronary artery bypass surgery

    OpenAIRE

    Budde, R.P.J.

    2005-01-01

    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...

  20. Safety and Effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial

    Directory of Open Access Journals (Sweden)

    Martín Beatriz

    2011-10-01

    Full Text Available Abstract Background In cardiopulmonary bypass (CPB patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA reduced CPB-mediated inflammatory response (IR. Methods We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB or the double-dose group (40 mg/Kg TA before and after CPB. Results 160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; P = 0.030. After adjusting for hypertension, total protamine dose and temperature after CPB, TA2 showed a lower risk of IR compared with TA1 [OR: 0.29 (95% CI: 0.10-0.83, (P = 0.013]. Relative risk for IR was 2.5 for TA1 (95% CI: 1.02 to 6.12. The double-dose group had significantly lower chest tube bleeding at 24 hours [671 (95% CI 549-793 vs. 826 (95% CI 704-949 mL; P = 0.01 corrected-P significant] and lower D-dimer levels at 24 hours [489 (95% CI 437-540 vs. 621(95% CI: 563-679 ng/mL; P = 0.01 corrected-P significant]. TA2 required lower levels of norepinephrine at 24 h [0.06 (95% CI: 0.03-0.09 vs. 0.20(95 CI: 0.05-0.35 after adjusting for dobutamine [F = 6.6; P = 0.014 corrected-P significant]. We found a significant direct relationship between IL-6 and temperature (rho = 0.26; P P P P P P P Conclusions Prolonged inhibition of fibrinolysis, using an additional postoperative dose of tranexamic acid reduces inflammatory response and postoperative bleeding (but not transfusion requirements in CPB patients. A question which remains unanswered is whether the dose used was ideal in terms of safety, but not in terms of effectiveness. Current Controlled Trials number ISRCTN: ISRCTN84413719

  1. Revascularização do miocárdio sem circulação extracorpórea: experiência e resultados iniciais Myocardial revascularization without cardiopulmonary bypass: experience and initial results

    Directory of Open Access Journals (Sweden)

    Luiz Antônio BRASIL

    2000-03-01

    Full Text Available FUNDAMENTOS: A operação de revascularização do miocárdio sem circulação extracorpórea (CEC vem sendo utilizada como uma alternativa para o tratamento da insuficiência coronariana. OBJETIVO: Apresentar nossa experiência com este procedimento, descrevendo a técnica empregada e os resultados iniciais. CASUÍSTICA E MÉTODOS: Foram avaliados 23 pacientes submetidos à revascularização do miocárdio sem CEC. Foram selecionados para este estudo pacientes que apresentavam lesões nas artérias coronárias da região ântero-diafragmática do coração. A principal indicação cirúrgica foi insuficiência coronária crônica (78,3%. O sexo masculino predominou em 65% dos casos. A idade variou de 44 a 80 anos (média: 59,6 anos. A abordagem cirúrgica em todos os pacientes foi através de esternotomia mediana. Os enxertos utilizados foram: as artérias torácicas internas, veia safena e artéria radial. RESULTADOS: O tempo médio de operação foi de 3h15 min. Não houve intercorrências intra-operatórias. O número de enxertos por paciente variou de 1 a 3, num total de 36 enxertos realizados, com média de 1,56 enxerto/paciente. A artéria torácica interna esquerda foi o enxerto mais utilizado (41,7%. As artérias coronárias revascularizadas mais freqüentemente foram o ramo interventricular anterior (52,8% e a coronária direita (30,5%. A mortalidade hospitalar e a incidência de infarto pós-operatório foram de 4,3%. Não ocorreram complicações neurológicas, pulmonares, renais, hemorrágicas ou infecciosas. O tempo médio de internação hospitalar foi de 7 dias. CONCLUSÃO: A revascularização do miocárdio sem CEC é uma técnica eficaz e segura que pode ser realizada em casos selecionados, com baixa morbidade e mortalidade, com redução de custos e do tempo de internação hospitalar.BACKGROUND: Myocardial revascularization without cardiopulmonary bypass (CPB has been used as an alternative for treatment of coronary

  2. Transplantation of human amnion-derived mesenchymal stem cells alleviates ischemia-reperfusion-induced acute lung injury after cardiopulmonary bypass%人羊膜间充质干细胞移植减轻体外循环再灌注肺损伤

    Institute of Scientific and Technical Information of China (English)

    强勇; 梁贵友; 余丽梅; 齐斌; 高振宇

    2016-01-01

    BACKGROUND:In recent years, mesenchymal stem cels exhibit a good prospect in organ or tissue repair and therefore, and therefore, cel transplantation based on mesenchymal stem cel plasticity can promote cel regeneration and functional recovery from lung injury after cardiopulmonary bypass. OBJECTIVE:To investigate the effects of human amnion-derived mesenchymal stem cels (hAMSCs) transplantation on ischemia-reperfusion-induced acute lung injury in dogs after cardiopulmonary bypassand its mechanism for regulating inflammatory cytokines. METHODS:Eighteen adult healthy mongrel dogs were randomly divided into three groups (n=6 per group): black group (cardiopulmonary bypass with 1 mL physiological saline injectionvia the femoral vein without blocking the aorta), control group (cardiopulmonary bypass with blocking the aorta for 1 hour and then opening the aorta for 15 minutes plus 1 mL physiological saline injectionvia the femoral vein), experiment group (cardiopulmonary bypass with blocking the aorta for 1 hour and then opening the aorta for 15 minutes plus femoral vein injection of 1 mL physiological saline containing 2×107 hAMSCs). Arterial blood samples of 2 mL were taken to calculate oxygenation index and respiratory index before cardiopulmonary bypass (T1), 15 minutes (T2), 1 hour (T3), 2 hours (T4), 3 hours (T5) after opening the aorta. 8 mL intravenous blood samples were taken to detect the serum tumor necrosis factor α, matrix metaloproteinase-9, interleukin-8 and interleukin-10 by ELISA. Meanwhile, western blot assay was used to detect the expression of nuclear factor-κB in lung tissues, and histopathological changes of lung tissues observed under optical microscope. RESULTS AND CONCLUSION:Compared with the control group, the oxygenation index was significantly increased in the experimental group at 2 and 3 hours after transplantation, and the respiratory index was remarkably decreased at 1, 2, 3 hours after transplantation. Compared with the control group

  3. Occupational exposure to sevoflurane during cardiopulmonary bypass

    NARCIS (Netherlands)

    M.J. Blokker-Veldhuis; P.M.M.J. Rutten; S.G. de Hert

    2011-01-01

    Volatile anaesthetic agents are widely used for maintenance of anaesthesia in all kinds of surgical procedures. Despite the implementation of measures such as adequate ventilation of the operating room and the use of efficient scavenging systems, concern remains about the risks for occupational expo

  4. “Orpheus” Cardiopulmonary Bypass Simulation System

    OpenAIRE

    Morris, Richard W.; Pybus, David A.

    2007-01-01

    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 ...

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

    OpenAIRE

    Golab, Hanna

    2011-01-01

    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...

  6. 体外循环行肺动脉灌注液对术后肺功能的保护%Protection of Postoperative Lung Function by Cardiopulmonary Bypass Pulmonary Artery Perfusion Fluid

    Institute of Scientific and Technical Information of China (English)

    赵宇; 康忠奎

    2012-01-01

    Objective To study the protective effect of cardiopulmonary bypass (CPB) pulmonary perfusion on postoperative lung function. Methods Thirty patients receiving purely artificial mitral valve replacement surgery with CPB between January 2007 and April 2011 were randomly divided into the lung protection group and the control group with 15 patients in each. For patients in the lung protection group, pulmonary artery perfusion with hypothermic protective solution during the CPB period was performed, while patients in the control group received no protective solution. Then, we monitored respiratory index (RJ), oxygenation index (01), IL-6, and TNF-a after induction of anesthesia, 10 minutes after aortic cross-clamping, and 10 minutes, 2 hours, 12 hours, and 24 hours after aortic opening, and preoperative and postoperative pulmonary artery pressure (PAPm), static lung compliance (CLS), and airway resistance (AR). Furthermore, we compared the ICU caring time, postoperative ventilation time, hospital stay and the presence of postoperative complications between the two groups. Results IL-6, TNF-a, RJ, OI, PAPm, AR, and CLS between the two group of patients had significant differences (P 0.05). Conclusion Pulmonary arterial perfusion during CPB has a protective effect on postoperative pulmonary function.%目的 探讨体外循环(CPB)期间行肺动脉灌注液对术后肺功能的保护作用.方法 2007年1月-2011年4月30例在CPB下行单纯二尖瓣人工机械瓣置换术患者,随机分成肺保护组和对照组各15例,肺保护组患者CPB期间经肺动脉灌注低温肺保护液,对照组患者CPB期间未经肺动脉灌注低温肺保护液.监测两组患者在麻醉诱导后、阻断主动脉10 mm及开放主动脉10 min,2、12、24 h各时间点的呼吸指数(RI)、氧合指数(OI)、白介素6 (IL-6)、肿瘤坏死因子α(TNF-α)及术前、术后肺动脉压力(PAPm)、静态肺顺应性(CLS)、气道阻力(AR)变化,并比较术后ICU监护时间、术

  7. 体外循环中肺动脉灌注和间断肺通气的肺保护作用%Protective effects of pulmonary artery perfusion and intermittent ventilation on lung during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    任王胜; 吴延虎; 王晓伟; 刘翔; 梁永年; 朱锦富

    2011-01-01

    Objective:To explore the protective effects of comprehensive measures,including pulmonary artery perfusion with 4℃ oxygenated blood and intermittent ventilation on lung during CPB. Methods:Thirty patients with rheumatic heart disease (RHD) or congenital heart defect (CHD) were divided into two groups with random dumber table: protective group (n =15), given simultaneously intermittent ventilation and pulmonary artery perfusion with 4℃ oxygenated blood on lung during CPB; control group (n =15) , performed using routine approaches. Mechanical ventilation time was recorded, the lung oxygenate index (OI), respiratory index (RI), airway resistance(Raw) and lung static compliance (Cstat) were detected at the beginning, ending, 1 h and 6 h after CPB termination, respectively. Results:The time of mechanical ventilation was significantly shorter in protective group than in the control group. The OI and Cstat of protective group at 1 h and 6 h after CPB termination was significantly better than that of the control group (P<0.05, P<0.01, respectively); the Raw and RI of protective group was significantly lower than that of control group at 1 h and 6 h (P<0.05, P<0.01, respectively). Conclusion Comprehensive measures, pulmonary artery perfusion with 4℃ oxygenated blood and intermittent ventilation, has protective effects on lung injury during CPB.%目的:探讨肺动脉灌注4℃含氧冷血和间断肺通气对体外循环(cardiopulmonary bypass,CPB)肺损伤的保护作用.方法:将30例符合条件的心脏手术患者采用随机数字表法分为两组:肺保护组(n=15):CPB期间经肺动脉间断灌注4℃含氧冷血,并在灌注期间给予间断肺通气;对照组(n=15):常规行心脏手术.记录呼吸机支持时间;分别在CPB前和CPB结束及结束后1、6 h测算氧合指数(0I)、呼吸指数(RI)、肺气道阻力(Raw)和肺静态顺应性(Cstat).结果:术后肺保护组呼吸机支持时间明显短于对照组(P<0.05),

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

    Directory of Open Access Journals (Sweden)

    André Lupp Mota

    2008-03-01

    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

  9. 乌司他丁对体外循环术后外周血单核细胞亚群的影响%The effect of ulinastatin on peripheral blood monocyte subsets of the patients receiving cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    江春景; 郝星; 韩俊燕; 邢智辰; 郝禹; 曾辉; 侯晓彤

    2013-01-01

    Objective: To explore the effect of ulinastatin on immune response of the patients receiving cardiopulmonary bypass ( CPB) by monitoring the dynamic change of monocyte subsets absolute count and the function-related molecules. Methods: Twenty patients with heart valve replacement operations were randomly divided into two groups: ulinastatin group ( U + ) and control group ( U - ) . The U + group were given ulinastatin 1,0000U/kg at the immediate of CPB, while the U- groupwere not. Collect peripheral blood samples at four points, after anesthesia and before CPB operation (T1) , CPB weaning Oh (T2) , post-operation 1 d (T3) and 3 d (T4). The percentage and absolute count of monocyte subsets and the expression of TLR-4 and HLA-DR were detected by flow cytometry. Results: The absolute count of Mol, Mo2 and Mo3 monocyte subsets of U+ group and U - group were decreased at the time of CPB weaning 0 h; Mol and Mo2 were slowly increased at the day 1 after CPB; Mol and Mo2 were slowly declined at day 3 after CPB and the absolute count of Mol and Mo2 subsets in U + group were significant lower than that of U - group ( P < 0. 05 ) . Conclusion: The application of ulinastatin could attenuate CPB-induced inflammatory response by reducing the quantities of monocyte subsets at the CPB peri-operative period.%目的:通过动态监测体外循环前后单核细胞各亚群表型及数量变化,研究乌司他丁对体外循环患者免疫功能的影响.方法:收集择期行心脏瓣膜置换术患者20例,随机分成乌司他丁组(U+组)和对照组(U-组),每组10例.于麻醉后CPB前(T1)、CPB停机0h(T2)、术后1d(T3)及3d(T4)四个时间点采取外周抗凝血.采用流式细胞仪结合绝对计数法,观察乌司他丁的应用对于CPB术后患者单核细胞各亚群比例和数目,及不同单核细胞亚群表面免疫功能相关分子Toll样受体_4(toll-like receptor-4,TLR-4)和人白细胞抗原-DR (human leukocyte antigen DR,HLA-DR)表达动态变化的影响.

  10. 小儿体外循环手术围术期细胞间粘附分子-1的测定%Detection of Intercellular Adhesion Molecule-1 during Pediatric Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    李建华; 张泽伟; 陈黎勤

    2000-01-01

    To evaluate the role of serum intercellular adhesion molecule (ICAM-1)changes during pediatric cardiopulmonary bypass (CPB) surgery for congenital heart diseases (CHD)and the clinic significance of monitoring the serum ICAM-1 level. Methods: ICAM-1 levels were measured by double antibodies sandwich ELISA in arterial specimen from 33 CPB cases at various time points,the results were compared with those of 10 non-CPB patients and 30 normal children. Results:Patients with CHD had normal levels of serum ICAM-1 before surgery. The serum ICAM-1 levels in CPB group were significantly higher than those of controls (P〈0. 005). ICAM-1 levels started increasing as early as 30 minutes of CPB began and peaked 24 hours after surgery and stayed up 48 hours after surgery . The serum ICAM-1 levels in patients whose CPB lasted longer than 90 minuets were significantly higher (P<0.05). Conclusion:ICAM-1 showed higher and lasted longer after pediatric CPB surgery. The length of CPB is associated with elevation of ICAM-1. Monitoring of serumICAM-1 ,in certain degree,may help in predicting prognosis and complication after CPB surgery.%目的:探讨小儿体外循环(CPB)围术期血清细胞间粘附分子-1(ICAM-1)水平变化规律和升高原因及测定的临床意义。方法:采用双抗夹心法酶联吸附试验(ELISA)法分别于手术前、转流后30 min、手术毕、术后2 h、12 h、24 h、48 h共7个时点测定33例先天性心脏病(CHD)患儿;分别于术前,术中及术后2 h测定10例非体外循环普胸手术患儿及30例健康体检患儿ICAM-1水平。结果:CHD术前ICAM-1无变化;CPB术后ICAM-1水平较非CPB明显升高,P<0.005;血清ICAM-1值于CPB 30 min后开始上升,至24 h达到高峰后开始下降,48 h尚未降至术前水平;CPB时间≥90 min组ICAM-1显著升高,P<0.05。结论:小儿CPB心脏直视手术后血清ICAM-1升高明显,CPB时间是ICAM-1升高的主要原因,ICAM-1测定对预防及早期发现并

  11. 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

    Institute of Scientific and Technical Information of China (English)

    陈亦江; 王晓伟; 陈广明

    2003-01-01

    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

  12. CARACTERÍSTICAS NEUROPSICOLÓGICAS DE LA MEMORIA TRAS CIRUGÍA CARDÍACA CON CIRCULACIÓN EXTRACORPÓREA / Neuropsychological features of memory after cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Elizabeth Jiménez Puig

    2013-10-01

    Introduction: Cardiovascular diseases are the leading cause of death in developed countries and one of the therapeutic strategies is surgery with the use of extracorporeal circulation, which can cause undesirable effects on the neurologic system. Objective: To characterize neuropsychological functioning of the memory process in patients who have undergone surgery with extracorporeal circulation. Method: An exploratory-descriptive study in 25 patients operated at Cardiocentro Ernesto Che Guevara in the period from January to March 2012 was performed. The assessment was based on the multivariate test memory, Digits subtest of Wechsler scale, review of the clinical history and a semistructured interview to the patient. Results: There were limitations regarding the direct fixation of memory trace and retention process based on repetition, with specific manifestation in verbal and numerical retention. Regarding immediate memory, the quality of associations based on visual stimulation was evidenced and affectations presented in recalling, which is consistent with the difficulty in fixing and retention. The existence of alterations in declarative memory was also demonstrated. Conclusions: Male patients, between 50 and 70 years of age, with a low educational level were predominant. Difficulties in the direct fixation of memory traces were found, as well as failures in immediate recalling of stimuli offered and even after making good associations, and impaired declarative memory. This indicates the existence of neuropsychological limitations in the functional systems associated with declarative and non-declarative, voluntary and involuntary memory, in patients undergoing cardiopulmonary bypass.

  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

    Directory of Open Access Journals (Sweden)

    Richard K Firmin

    1988-04-01

    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. 小儿体外循环深低温暂停循环心内直视手术脑电图监测%Monitoring of Electroencephalogram During Open Heart Surgery in Chlidren with Deep Hypothermia Limited Cardiopulmonary Bypass or Total Circuiatory Arrest

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 张志芳; 黄惠民; 张佩敏

    1989-01-01

    This papcr reports and discusses the changes of electroencephalograph (EEG) during and after open heart snrgery in children with deep hypothermia (18℃-20℃),limiteà cardiopulmonary bypass,total Circulatory arrest (TOA,37-75min) or with moderate hypothermia (25℃-28℃),standa rd cardiopulmonary bypass(SCB).The conclusions are:(1) The patient after open heart surgery with TCA or SCB has an anomalous course of EEG,and has more changes in TCA group,but such anomalies tend to return to the preoperative level in followup.(2) Hypothermia is safe,with EEG becoraing normal and no cerebral complications,if circulatory arrest time is less than 60min.(3) When the rectal temperature is <25℃ and the blood perfusion cooling is continuing,EEG would be highly a bnormal,when the rectal teroperature is lower down to 18-25℃ or during circulatory arrest,the EEG appears as a horizontal line.It is necessary to improve the measures so as to prevent the spasm of brain vessels while cooling is continuing.%本文通过脑电图(EEG)监测未了解小儿深低温皙停循环心内直视手术对患儿脑功能的影响.指出血流降温至肛温18~20℃,停循环时问限于60分钟以内,术后及随访中EEG均能恢复术前水平,临床上亦无明显神经系统并发症.证明此技术是安全可行的.本文亦显示了深低温停循环枝术的术中,术后EEG变化及恢复规律.

  15. 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

    Institute of Scientific and Technical Information of China (English)

    童珊珊; 闵苏; 魏珂; 张光新

    2010-01-01

    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

  16. REM-PCL对体外循环犬心肌能量代谢的影响%Effect of REM-PCL on myocardial energy metabolism in dogs during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    方华; 杨淼; 张伟晶; 章建平; 张竞超; 章放香

    2015-01-01

    Objective To observe the effect of REM-PCL on myocardial energy metabolism in dogs during cardiopulmonary bypass.Methods Used CPB myocardial ischemia reperfusion model, 12 dogs were randomly divided into REM-PCL group (group RP,n=6) and control group (group C,n=6). RP group and C group respectively were given intravenous injection of 0.2mg/kg REM-PCL and normal saline before the driving of the rotary machine. Before the driving of the rotary machine, at 60 minutes of ischemia,and after 60 minutes reperfusion, myocardial mitochondrial swelling degree (MSD), malondialdehyde (MDA) content, adenylate (ATP, AMP, ADP, EC, TAN), reactive oxygen species (ROS) and total antioxidative capacity (T-AOC) were respectively determined. Before the driving of the rotary machine, at 60 minutes of ischemia,and after 60 minutes reperfusion, Mean arterial pressure (MAP), cardiac output (CO) and heart rate (HR) were measured. ResultsAfter ischemia, MDA, MSD and ROS of two groups were increased, and TAN, EC, T-AOC and ATP content were decreased(P<0.01). At 60 minutes of ischemia and reperfusion for 60 minutes, MDA, MSD and ROS of the RP group were significantly lower than those of C group (P<0.01), TAN, EC, T-AOC and ATP contents of the RP group were significantly higher than those of C group(P<0.01).At reperfusion for 30 minutes and 60 minutes, MAP, CO and HR of the RP group recovered more rapidly than those of group C (P<0.01).Conclusion Through the protection of myocardial mitochondrial structure and improve myocardial energy metabolism, REM-PCL can reduce myocardial ischemia reperfusion injury.%目的:观察犬体外循环(CPB)中REM-PCL对心肌能量代谢的影响。方法采用CPB心肌缺血再灌注模型,12只犬随机分为REM-PCL组(RP组,n=6)和对照组(C组,n=6)。RP组和C组分别于转机前静脉注射0.2mg/kg REM-PCL及等量生理盐水。分别于转机前、缺血60min和再灌注60min时,测定心肌线粒体肿胀度(MSD)、丙二醛

  17. 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

    Institute of Scientific and Technical Information of China (English)

    张兰; 王泉云; 肖红; 廖刃; 刘斌

    2001-01-01

    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

  18. Application of cardiopulmonary bypass for 260 infants with severe and emergent congenital heart disease within 6 months%260例半岁内危重先天性心脏病急诊体外循环

    Institute of Scientific and Technical Information of China (English)

    刘梅; 肖颖彬; 陈林; 王学锋; 王咏; 彭莉

    2011-01-01

    目的 探讨危重婴幼儿体外循环(CPB)方法,为危重婴幼儿心脏手术的安全实施提供一定的经验.方法 2006年1月至2010年12月,我科施行半岁内危重婴幼儿先天性心脏病手术260例,男156例,女104例,年龄3 d至6个月,平均(4.1±2.2)月,体重2.1~8.3 kg,平均(4.2±1.3)kg.CPB预充液以林格氏液为主,使晶胶比维持在(0.35:1)~(0.6:1),血细胞容积25%~28%.心肌保护均采用含血停跳液.CPB使用进口膜肺249例(95.8%),国产膜肺11例(4.2%),转流方式包括浅低温体外循环心脏不停跳转流33例,中低温体外循环心脏停跳转流168例,深低温低流量转流57例和深低温停循环2例.转流时间15~238 min,平均(78±36) min;阻断时间6~159 min,平均(47±23) min;术中使用改良超滤和/或普通超滤233例(89.6%),滤出液体50~650 mL,平均(230±140) mL.结果 术后呼吸机支持时间5~176 h,平均(16.5±8.6) h;入住ICU时间48~202 h,平均(72.6±29.8) h;术后住院时间12~28 d,平均(16.2±4.7) d.术后发生低心排28例(10.8%),肺、脑、肝、肾等重要脏器并发症30例(11.9%).全组死亡22例(8.5%),死亡原因包括低心排15例,心律紊乱3例,呼吸衰竭2例,因喂养不当误吸窒息1例,多器官功能衰竭1例.其余患儿恢复顺利,未发生与体外循环相关并发症,康复出院.结论 CPB期间和术后的液体管理及高质量CPB器材的使用可减少术后并发症发生.%Objective To explore the melhods of cardiopulmonary bypass ( CPB) in surgery for infanls with severe and emergent con-genilal heart disease in order to provide references for the relaled surgery. Methods Tolally 260 infanls wilhin 6 months were underwent surgery for severe and emergenl congenital heart disease from January 2006 Lo December 2010. There were 156 males and 104 females, the age is from 3 day to 6 monlhs, (4.1 ±2.2) monlhs in average,the weight is 2. 1 ~8. 3 kg, (4.2±1.3) kg in average. The priming solution of CPB was mainly the

  19. 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

    Institute of Scientific and Technical Information of China (English)

    陈美娇; 林玉琴

    2012-01-01

    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

  20. 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.

    Science.gov (United States)

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

    1988-01-01

    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

  1. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Houlind, Kim; Kjeldsen, Bo Juul;

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...

  2. Outcomes after off-pump coronary bypass surgery

    OpenAIRE

    van Dijk, Diederik

    2002-01-01

    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...

  3. 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

    Institute of Scientific and Technical Information of China (English)

    李静; 穆心苇; 章淬; 施乾坤

    2012-01-01

    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

  4. 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

    Institute of Scientific and Technical Information of China (English)

    钟晓绯; 朱达; 卢强; 刘斌; 彭玉兰

    2013-01-01

    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.

  5. 低温体外循环术后体温变化对血乳酸及氧代谢的影响%Effects of body temperature change on the level of lactic acid and oxygen metabolism after the hypothermic cardiopulmonary bypass(CPB)

    Institute of Scientific and Technical Information of China (English)

    张继芝; 彭玉兰; 秦卫华

    2009-01-01

    Objective To investigate the effects of body temperature change on the level of arterial blood lactic acid and oxygen metabolism after the hypothermic cardiopulmonary bypass(CPB),and to provide a basis for controlling body temperature of patients.Methods 60 patients performed the open cardiac operation under hypothermic cardiopulmonary bypass were monitored.The arterial and mixed venous blood gas,and the level of lactic acid were measured at four different rectal temperatures:37,37.5,38℃ and 38.5℃,by taking samples of arterial and venous bloods.Results The systemic arterial-venous oxygen content and oxygen extraction were increased during rewarming time.The level of arterial blood lactic acid at the rectal temperature of 37.5℃ mostly approachs the nornlal value.next is at the rectal temperature of 37℃ and 38 ℃,respectively.And the level of arterial blood laetic acid at the rectal temperature of 38.5℃ is the hilghest (hyperlactacidemia).The difference shows a statistically significance.Conclusions During the rewarming process after the hypothermic cardiopulmonary bypass(CPB),the body temperature change is a key factor influencing oxygen extraction and blood lactic acid level.The nursing staff should control the body temperature of patients with the safe range of around 37.5℃.%目的 探讨低温体外循环心脏术后复温过程中体温变化对血乳酸水平及氧代谢的影响,为合理控制患者体温提供依据.方法 对60例低温体外循环心脏术后患者进行监测,分别在肛温37,37.5,38,38.5℃时采集动、静脉血标本,检测动静脉血氧代谢及血乳酸值.结果 复温时全身的氧耗量明显增加;动脉血乳酸值在肛温37.5℃时最接近正常,37,38℃时次之,肛温38.5℃时血乳酸值最高(高乳酸血症),差异有统计学意义.结论 在低温体外循环心脏术后复温过程中,体温变化是影响氧耗量和血乳酸水平的重要因素,护理人员应将患者体温控制在37.5℃左右的安全范围内.

  6. The clinical experience of cardiopulmonary bypass in pediatric congenital heart disease complicated by infective endocarditis%小儿先心病并感染性心内膜炎手术治疗中的体外循环技术

    Institute of Scientific and Technical Information of China (English)

    汪力; 皮名安; 龚立; 王涛

    2011-01-01

    目的 总结2002年1月至2011年4月作者收治的15例先天性心脏病合并感染性心内膜炎( infective endocarditis,IE)患儿手术治疗中的体外循环经验(cardiopulmonary bypass,CPB).方法 15例患儿均采用浅低温(28℃~30℃)、较高流量[2.4~3.2 L/(min·m2)]灌注.手术方式为畸形矫治(ASD/VSD修补、右室流出道重建)、赘生物摘除、瓣膜整形或置换术.心肌保护采用4℃冷含血晶体保护液顺行灌注.结果 15例患儿CPB总时间85~ 180 min,主动脉阻断时间40~120 min,均顺利脱离CPB.均获痊愈.1例术后2年死于肺部感染及心功能衰竭.结论 CPB中HCT及胶体渗透压的良好控制、采用平衡超滤结合改良超滤、肝素化后监测ACT、CPB中加入敏感抗生素等对患儿术后恢复至关重要.%Objective To summarize retrospectively the clinical experience of cardiopulmonary bypass (CPB)in pediatric congenital heart disease (CHD) complicated by infective endocarditis (IE) from January 2002 to April 2011(15 cases). Methods CPB was performed with Shallow low temperature(28℃ ~30℃) and high flow rate [2. 4 ~3.21/(min·M2) ] perfusion. Operation method for Correcting the heart abnormality (ASD/VSD repaired., Right ventricular outflow reconstructed), excrescence excision, valve plastic or replacement. 4℃ cold crystalloid with blood was perfused by antegrade perfusion for myocardial protection. Result-s Among the total time CPB 85 ~ 180 min, aortic blocking time 40 ~ 120 min, 15 cases of patients were smoothly disconnected from CPB. All cases recovered completely. 1 case died in lyear due to heart failure. Conclusion The important factors in CPB are the good adjustment in colloid osmotic pressure( COP) and hem-atocrit( HCT) ,Balance ultrafiltration( BUF) and modified ultrafiltration( MUF) .monitor of activated clotting time (ACT) .sensitive antibiotics used in priming liquid.

  7. Surgical results of coronary artery bypass grafting without cardiopulmonary bypass: analysis of 3,410 patients Resultados cirúrgicos na revascularização do miocárdio sem circulação extracorpórea: análise de 3.410 pacientes

    Directory of Open Access Journals (Sweden)

    Ricardo de Carvalho Lima

    2003-09-01

    Full Text Available OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the method in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%. Hospital mortality (30 postoperative days was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB (2.2% versus 12.6% (pOBJETIVO: Nos últimos anos, tem-se observado um grande avanço na cirurgia de revascularização miocárdica sem circulação extracorpórea (RMSCEC. Esse desenvolvimento deveu-se à combinação dos avanços da técnica cirúrgica e ao desenvolvimento de instrumentos que possibilitam a realização deste procedimento nas mais variadas situações. Este é um estudo retrospectivo, que visa avaliar nossa experiência com este procedimento nos últimos 11,5 anos. Os autores enfatizam o rápido progresso do método nos últimos anos, suas indicações, contra-indicações e resultados. MÉTODO: No período de agosto de 1991 e dezembro de 2002, 3.410 pacientes consecutivos, portadores de angina

  8. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  9. 体外循环术对先天性心脏病儿童围术期凝血功能的影响及临床意义%Study on the clinical significance and effect of cardiopulmonary bypass on intraoperative blood clotting function in pediatric patients with congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    冯永健; 杨宁; 董斌; 徐远久

    2015-01-01

    目的观察先天性心脏病儿童行体外循环术中凝血功能的变化,并分析其监测的应用价值。方法选取2012年1月至2013年12月间30例先天性心脏病体外循环术患儿为研究组,并且选取同期15例先天性心脏病非外循环术患儿为对照组。观察两组患儿手术前后的凝血功能变化。结果研究组患儿手术前后凝血指标比较差异无统计学意义( P >0.05);研究组患儿术后24 h 凝血指标显著低于对照组,差异有统计学意义( P 0. 05). The changes in blood coagula-tion parameters in patients of study group in 24 h after surgery were significantly lower than those of control group,and the difference was statisti-cally significant( P < 0. 05). The difference in PLT counts in 3 h after surgery in patients with Fallot′s tetralogy and ventricular septal defect im-mediately after surgery and 3 h after surgery was statistically significant( P < 0. 05). The difference in levels of FIB in patients with Fallot′s tetral-ogy and patients with ventricular septal defect at immediately and 24 h after surgery was statistically significant( P < 0. 05). Conclusion The application of bypass circulation is better than traditional non - cardiopulmonary bypass in surgical treatment of patients with Fallot′s tetralogy and ventricular septal defect in pediatric patients with congenital heart disease,it had certain impact on coagulation parameters,but they return to nor-mal in 24 h after surgery. It is important to strengthen the monitoring of clinical coagulation parameters,hence it can better guide surgeons in oper-ations,thereby it may reduce the risk of surgery,and it is important to apply in clinical practice.

  10. 盐酸戊乙奎醚对心肺转流患者肠损伤和炎性因子的影响%Effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery

    Institute of Scientific and Technical Information of China (English)

    张丽丽; 孙莹杰; 张铁铮

    2011-01-01

    目的 探讨盐酸戊乙奎醚对心肺转流(CPB)患者肠损伤和炎性因子的影响.方法 40例ASA Ⅱ或Ⅲ级心瓣膜置换术患者,随机均分为盐酸戊乙奎醚组(P组)和对照组(C组),分别在CPB前10 min颈内静脉注射盐酸戊乙奎醚0.05 mg/kg或等容量生理盐水.分别于CPB前(T1)、主动脉开放10 min(T2)、停CPB即刻(T3)、术后2 h(T4)、6 h(T5)、18 h(T6)采取中心静脉血,应用ELISA法检测血清肠型脂肪酸结合蛋白(I-FABP)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)浓度.结果 与T1时比较,T2~T6时两组I-FABP、IL-6和IL-10浓度均显著升高(P<0.05).T2、T4、T5时P组I-FABP浓度显著低于C组,T4、T5时IL-6浓度亦显著低于C组(P<0.05).结论 盐酸戊乙奎醚0.05 mg/kg可减轻患者肠损伤和炎性因子的释放.%Objective To observe the effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery. Methods Forty patients undergoing heart valve replacement with cardiopulmonary bypass were randomly divided into two groups with 20 cases each: penehyclidine group(group P)and control group (group C) respectively. Patients in group P were injected PHC 0. 05 mg/kg before CPB 10 mins from the internal jugular vein, patients in group C were injected the same volume saline. Jugular vein blood was drawn at the 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(T5 ), 18 h after operation(T6 ). The density of blood I-FABP was detected by enzyme-linked immunosorbent assay as well as cytokine levels (IL-6, IL-10). Results Comparing with T1 (beforeCPB), the concentration of blood I-FABP, IL-6 and IL-10 all increased significantly at T2 ,T3 ,T4 ,T5 ,T6 (P< 0. 05). In group P, the concentration of blood I-FABP was significantly lower atT2 ,T4 ,T5 than those in group C(P<0. 05). In group P, the

  11. Combined ultrafiltration can attenuate lung injury duing cardiopulmonary bypass after cardioac operation in low weight infants%联合超滤减轻体外循环对低体质量婴儿心脏手术后的肺损伤

    Institute of Scientific and Technical Information of China (English)

    胡卫; 马瑞彦; 刘梅; 彭莉; 杨宗英; 肖娟; 肖颖彬; 陈林; 王学峰; 郝嘉; 陈劲进; 陈柏成; 王咏; 程伟

    2011-01-01

    Objective To compare the effects of combined ultrafiltration and conventional ultrafiltration in protecting patients'pulmonary function duing cardiopulmonary bypass of infants. Methods Forty infantile cardiac surgery patients(weight less than 6 kg)were divided into two groups:combined ultrafiltration group(n = 20)and conventional ultrafiltration group(n = 20). Combined ultrafiltration group did zero balanced ultrafiltration, conventional ultrafiltration and modified ultrafiltration in turn. Conventional group only did conventional ultrafiltration. The volume of ultrafiltration, hematocrit(HCT), concentration of serum album before/ after ultrafiltration were observed. The pulmonary function parameters after the operation, such as oxygenation index, alveolar-arte rial oxygen difference(A-aDO2), static lung compliance, ventilator time and ICU stay time, were respectively monitored. Results Comparing with the conventional group, the blood volume needed in the operation was significantly less, HCT and concentration of serum album in after operration were significantly much increased in the combined ultrafiltration group. The improvement of lung ventilation and gas exchange in the combined ultrafiltration group were significantly obvious than that in the conventional group. In the combined ultrafiltration group, the count of white blood cell, neutrophilic granulocyte after operation and other inflammatory mediators were significantly lower than those in conventional ultrafiltration. For the combined ultrafiltration group, the improvement of lung function was more obvious,especially to the low age and weight infants. Conclusion Combined ultrafiltration has more effictive in protecting patients' pulmonary function duing cardiopulmonary bypass of infants compared with conventional ultrafiltration, especially to the low age and weight infant.%目的 对比研究体外循环(CPB)中联合超滤方法和常规超滤方法对低龄低体质量婴幼儿心脏手

  12. 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

    Institute of Scientific and Technical Information of China (English)

    温昱鹏; 常诚; 王仲伦; 郑捷

    2015-01-01

    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

  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

    Institute of Scientific and Technical Information of China (English)

    李稼

    2014-01-01

    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. 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

    Institute of Scientific and Technical Information of China (English)

    陈煜; 黄延辉; 白洁

    2010-01-01

    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.

  15. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  16. Effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass%右美托咪定对心肺转流心内直视手术患儿血流动力学及应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    李晓松; 刘海涛; 任建军; 董振明

    2012-01-01

    Objective To evaluate the effects of dexmedetomidine infusion on hemodynamic and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass. Methods Thirty pediatric patients undergoing open heart surgery with cardiopulmonary bypass, ASA class D or 01, were randomly assigned to two groups: the group DEX (group D, n=15) and the group control (group C, n = 15). Patients In group D received an initial bolus dose of dexmedetomidine Cl. 0 礸/kg) over 10 minutes, immediately followed by a continuous infusion of 0. 5-1. 0 礸+kg -1穐-1 until the end of the operation. The same volume of normal saline was given in the control group. Hemodynamic parameters and concentrations of blood glucose, rartisol, norepinephrine and epinephrine were measured before injection(T0), 10 min and 15 min after administration Ti and T2), after incision (T3), after sternum saw (T4). after CPB(T6) and immediately after surgey(Ts). Results The values of HR, SBP. DBP and MAP decreased significantly at Ti-Ts in group D, and were significantly lower than those in group C, especially at T; (P<0. 05). In both groups, blood glucose,plasma cortisol, norepinephrine and epinephrine increased significantly at T4-T6. However, the values were lower in group D compared with those in group C(P <0.05). Conclusion Intraoperative dexmedetomidine infusion attenuated the hemodynamic and neuroendocrinal response to surgical trauma and cardiopulmonary bypass in pediatric patients undergoing corrective surgery for congenital heart disease%目的 观察右美托咪定连续输注对小儿先天性心脏病CPB心内直视手术期间的血流动力学及应激反应的影响.方法 CPB心内直视矫治手术患儿30例,ASAⅡ或Ⅲ级,随机均分为右美托咪定组(D组)和对照组(C组).D组接受初始剂量为1.0 μg/kg的右美托咪定(给药时间大于10 min),随后以0.5~1.0μg·kg-1·h-1的速度维持直至手术结束,C组则给予相

  17. Cardiopulmonary discipline science plan

    Science.gov (United States)

    1991-01-01

    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.

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

    OpenAIRE

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

    2014-01-01

    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...

  19. 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

    Directory of Open Access Journals (Sweden)

    Viviane dos Santos Augusto

    2011-03-01

    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

  20. 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?

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2009-09-01

    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

  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

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2010-03-01

    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. Dexamethasone : Benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting - A study on myocardial, pulmonary, renal, intestinal, and hepatic injury

    NARCIS (Netherlands)

    Morariu, AM; Loef, BG; Aarts, LPHJ; Rietman, GW; Rakhorst, G; van Oeveren, W; Epema, AH

    2005-01-01

    Study objectives: Cardiac surgery with cardiopulmonary bypass (CPB) results in perioperative organ damage caused by the systemic inflammatory response syndrome (SIRS) and ischemia/ reperfusion injury. Administration of corticosteroids before CPB has been demonstrated to inhibit the activation of the

  3. Study on the Protective Effect of Tranexamic Acid Evaluated by Thromboelastography in Cardiopulmonary Bypass%血栓弹力图评价氨甲环酸在体外循环中的血液保护效果的研究

    Institute of Scientific and Technical Information of China (English)

    丰巨龙; 吴海军; 姜文斌; 李征; 张杰; 程显峰

    2015-01-01

    [ ABSTRACT] Objective To evaluate the protective effect of tranexamic acid in valve replacement patients through thromboelastog-raphy on coagulation function of statistical evaluation,and further to determine the optimal dosage of tranexamic acid in cardiopulmonary by-pass.Methods One hundred cases of valve replacement patients were randomly divided into four groups:A,B,C,D groups.Group B,group C and group D were respectively treated with ammonia tranexamic acid powder( load Mo plug) and the dose is 20mg/kg,40mg/kg,60mg/kg (diluted to 50ml to join in the perfusion solution),each half of the total amount was given in priming solution during rewarming of cardiopul-monary Bypass.Group A was given 50ml normal saline at the corresponding time points,recording the activated clotting time( ACT) before, during and after CPB;before transfer(T1),heparin and after(T2),heparin and after 3h(T3),TEG examination were performed in the inter-nal jugular vein.Results There was no significant difference about the results of TEG among the four groups before CPB(T1).After neutral-ization(T2),there was no significant difference among the 4 groups.While in heparin and 3h(T3),compared to group A,the values of group B,C,D were significantly different,R values and K values were significantly lower than those in group A,MA and a values were significantly increased compared with A.But there were no significant difference among B,C,D three groups;The results of coagulation function tests be-fore and after CPB were compared and analysed,and the results showed that the two time points after CPB were significantly different.Com-pared to the preoperative,the value R and K were significantly prolonged,and the value MA and a were significantly decreased.Conclusion The application of tranexamic acid contribute to the protection of the coagulation system during cardiopulmonary bypas in heart valve replace-ment surgery,either to platelet or to coagulation factor fiber protein.20mg/kg,40 mg/kg,60mg

  4. 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

    Directory of Open Access Journals (Sweden)

    Ana Maria Rocha Pinto

    1998-12-01

    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

  5. 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

    Institute of Scientific and Technical Information of China (English)

    林国强; 罗万俊; 李迎秋; 蒋海河

    2012-01-01

    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

  6. 体外循环术中应用右旋美托咪啶对简单先天性心脏病患儿的脑保护作用%Dexmedetomidine on the clinical studies of cerebral injury affect in infant after cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    邱永升; 贾英萍

    2013-01-01

    Objective To observe the effect of application of dexmedetomidine on cerebral injury in infants after cardiopulmonary bypass.Methods 60 cases of congenital heart disease were divided into 3 groups,each group 20 infants,namely D1,D2 and N group.Group D1 dexmedetomidine 1.0μg/kg,in 0.2μg · kg-1 · h-1 intravenous infusion,until the end of operation; group D2 with dexmedetomidine 0.5 μg/kg,in 0.1 μg · kg-1 · h-1,drug concentration and injection speed was the same as the group D1.Group N intravenous normal saline in the whole operation process,infusion speed was the same as the experimental group,anesthesia and experimental group agreement.Take blood samples sent to laboratory before the operation (T1),at the end of CPB (T2),after CPB 2 h (T3),6 h (T4),24 h (T5) respectively,colleced records of perioperative data.Results There were no significant in 3 groups,for infant's age,weight,operation time,CPB time difference (P >0.05).In T1,there was no statistical difference between the 3 groups in S-100β protein and NSE (P > 0.05).In group N,S-100β protein and NSE in T2,T3,T4,T5 were increased significantly than the level in T1 (P < 0.05).In T2,compared with group D2,S-100β and NSE increased significantly in group N and D1 (P < 0.01),and there were more in D2 than D1 group.Differences in heart rate,blood pressure and hemodynamics were observed in infant during perioperative period was not significant (P > 0.05).Conclusion Dexmedetomidine can reduce the ascensional range of S-100β and NSE in infant after cardiopulmonary bypass,and relieve the cerebral injury.%目的 观察患儿体外循环(CPB)下应用右旋美托咪啶(Dex)对脑损伤的影响.方法 选择60例先天性心脏病患儿,按随机数字法分为研究组(D1组、D2组)和对照组(N组),每组20人.麻醉平稳后D1组静脉注入Dex 1.0 μg/kg,术中0.2μg·kg-1·h-1静脉泵注,直至手术结束;D2组静脉注入Dex 0.5μg/kg,术中0.1μg·kg-1 ·h-1静脉泵注,注射速度同D1

  7. Mathematical modeling of fluid dynamics in pulsatile cardiopulmonary bypass.

    Science.gov (United States)

    Pennati, Giancarlo; Fiore, Gianfranco B; Laganà, Katia; Fumero, Roberto

    2004-02-01

    The design criteria of an extracorporeal circuit suitable for pulsatile flow are quite different and more entangled than for steady flow. The time and costs of the design process could be reduced if mutual influences between the pulsatile pump and other extracorporeal devices were considered without experimental trial-and-error activities. With this in mind, we have developed a new lumped-parameter mathematical model of the hydraulic behavior of the arterial side of an extracorporeal circuit under pulsatile flow conditions. Generally, components feature a resistant-inertant-compliant behavior and the most relevant nonlinearities are accounted for. Parameter values were derived either by experimental tests or by analytical analysis. The pulsatile pump is modeled as a pure pulsatile flow generator. Model predictions were compared with flow rate and pressure tracings measured during hydraulic tests on two different circuits at various flow rates and pulse frequencies. The normalized root mean square error did not exceed 24% and the model accurately describes the changes that occur in the basic features of the pressure and flow wave propagating from the pulsatile pump to the arterial cannula. PMID:14961960

  8. Effect of flurbiprofen on tumor necrosis factor-a, and interleukin-6 in children undergoing cardiopulmonary bypass%氟比洛芬对心肺转流室间隔缺损患儿肿瘤坏死因子-α、白细胞介素-6的影响

    Institute of Scientific and Technical Information of China (English)

    张颖; 顾尔伟

    2011-01-01

    目的:探讨氟比洛芬(flurbiprofen axetil,FA)对心肺转流(CPB)心内手术患儿血浆肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平的影响.方法:选择20例在CPB下行心内直视手术的室间隔缺损(ventricular septal defect,VSD)患儿,随机均分为FA组(F组)和对照组(C组).F组在麻醉后切皮前 15 min 给予 FA1 mg/kg,C组用等容量脂肪乳剂代替.分别于麻醉后切皮前10 min(基础值,T1)、主动脉开放10 min(T2)、CPB结束后 30 min(T3)、4 h(T4)、24 h(T5)、48 h(T6)测定血浆 TNF-α、IL-6水平.记录呼吸机辅助时间、围术期血管活性药物使用量等.结果:与T1相比,2组患者T3和T5时点TNF-α血浆水平均增高(P0.05);围术期多巴胺使用量差异有统计学意义(P0.05).结论:FA可抑制CPB期间促炎性细胞因子TNF-α、IL-6的生成和释放,有助于患儿围术期血流动力学稳定,促进患儿早期康复.%Objective :To investigate the influence of flurbiprofen on cytokines tumor necrosis factor-ct (TNF-α), and interleukin-6 (IL-6) in children undergoing cardiopulmonary bypass ( CPB ). Methods: In this pilot, prospective, and randomized double-blinded study, twenty children with cardiac function class I -Ⅱ scheduled for repairing ventricular septal defect were divided into two groups:children in flurbiprofen group( F group,n = 10)were received 1 mog/kg flurbiprofen 15 min before skin incision and children in control group ( C group, n = 10 ) were received 0. 1 mL/kg intralipid instead of flurbiprofen. Blood samples were taken 10 min before skin incision(T1 ), 10 min after aorta declamped ( T2 ), 30 min ( T3 ), 4 h ( T4 ), 24 h ( T5 ), 48 h ( T6 ) after termination of CPB for determination of plasma TNF-α and IL-6 concentration. Results: The plasma TNF-α levels was higher at T3 and T5 compared to baseline (P < 0.05 -P <0.01),but F group was lower than in C group at T3(P <0.01). IL-6 was higher during T2 -T6 in C

  9. 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

    Directory of Open Access Journals (Sweden)

    Ricardo Vieira Reges

    2011-12-01

    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

  10. 体外循环心脏手术中复方丹参注射液对胃肠道保护作用的临床观察%Clinical Observation on Gastrointestinal Protective Effect of Composite Salviae Injection in Patients Undergoing Cardio-Pulmonary Bypass Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    郑利民; 刘小玲; 夏中元

    2001-01-01

    目的:探讨复方丹参注射液(简称丹参液)对体外循环(CPB)心脏手术中胃肠道的保护作用。方法:18例在体外循环下行心室间隔缺损或心房间隔缺损修补术患者,随机均分为两组:丹参组在CPB前静脉滴注丹参液0.5ml/kg,对照组则注入等量生理盐水。两组均采用张力计法测定胃粘膜内pH。结果:与CPB前比较,对照组胃粘膜内pH于CPB中及CPB后1、2h显著下降(P<0.05或P<0.01),丹参组除CPB中胃粘膜内pH显著下降(P<0.05)外,CPB后1、2h均无显著性改变;两组间相比较,丹参组在CPB中及CPB后1、2h,胃粘膜内pH均显著高于对照组(P<0.05)。结论:在CPB心脏手术中丹参液对胃肠道有一定的保护作用。%Objective: To observe the gastrointestinal protective effect ofComposite Salviae Injection (CSI) in patients undergoing cardio-pulmonary bypass (CPB) heart surgery. Methods: Eighteen patients, who were scheduled to cardiac surgery (either atrial or ventrical septal repairing) undergoing CPB were randomized equally into two groups. Before CPB, the CSI group was treated with CSI 0.5ml/kg by intravenous dripping and the control group was treated with normal saline in equal volume. The intragastric mucosa pH value (pHi) of patients was monitored by tensiometer. Results: As compared with the pre-CPB value, pHi lowered significantly during, 1h and 2 hrs after CPB in the control group (P<0.05 or P<0.01), while in the CSI group, pHi lowered significantly only during CPB (P<0.05), but with insignificant change at 1h and 2 hrs after CPB. Comparison between the two groups showed that pHi value in the CSI group was higher significantly than that in the control group at all respective monitoring period (P<0.05). Conclusion: CSI has gastrointestinal protective effect in patients undergoing CPB cardiosurgery to some extent.

  11. Temporary extracorporeal bypass modalities during aortic surgery.

    Science.gov (United States)

    Bassin, Levi; Bell, David

    2016-09-01

    The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios. PMID:27650344

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

    DEFF Research Database (Denmark)

    Møller, Christian H; Steinbrüchel, Daniel A

    2014-01-01

    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....

  13. Air embolism during off-pump coronary artery bypass graft surgery -A case report-

    OpenAIRE

    Chang, Choo-Hoon; Shin, Young Hee; Cho, Hyun-Sung

    2012-01-01

    There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.

  14. Outcome of Coronary Artery Bypass Grafts: Comparison between on Pump and off Pump

    OpenAIRE

    Rasoul Ibrahim Abdulrahman; Rezayat Parvizi

    2010-01-01

    The present study was undertaken to compare the in hospital results of coronary artery bypass graft (CABG) with (on pump) or without (off pump) cardiopulmonary bypass (CPB). Data were collected on all first-time isolated CABGs with saphenous vein and/or artery grafts at Shahid Madani Hospital in Tabriz-Iran, between 2006 and 2009. Age and clinical profile were marched between on pump and off pump group patients. Patients with concomitant cardiac operations or beating pump technique were exclu...

  15. Anesthetic considerations for the patients with off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expertise can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.

  16. Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery

    NARCIS (Netherlands)

    B. Atasever; C. Boer; P. Goedhart; J. Biervliet; J. Seyffert; R. Speekenbrink; L. Schwarte; B. de Mol; C. Ince

    2011-01-01

    The authors hypothesized that cardiopulmonary bypass (CPB) (on-pump) is associated with more severe changes in the microcirculatory blood flow and tissue oxygenation as compared with off-pump coronary artery bypass surgery. An observational study. A university hospital and teaching hospital. Patient

  17. Cardiopulmonary adaptation to weightlessness

    Science.gov (United States)

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

    1994-01-01

    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.

  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

    Directory of Open Access Journals (Sweden)

    Hugo Leonardo de Moura Luz

    2002-04-01

    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. Clinical study on the effect of continuous pulmonary artery perfusion with wxygenated warm blood containing L-arginine on lung injury during cardiopulmonary bypass%含L-精氨酸氧合温血肺动脉持续灌注对肺组织的保护作用

    Institute of Scientific and Technical Information of China (English)

    兰智新; 木拉提·瓦克力; 宋爱玲; 谷冰; 于鹏; 马革萍; 李培

    2010-01-01

    Objective To evaluate the protective effect on lung by using continuous pulmonary artery perfusion with oxygenated blood and L-arginine during cardiopulmonary bypass(CPB).Methods Forty five cases received mitral valve replacement were randomly divided into 3 groups and each group involved 15 cases. Group I(control group), patients received routine procedure of CPB. Proup Ⅱ, patients received rcontinuous pulmonary artery perfusion with oxygenated blood. Group Ⅲ,continuous pulmonary artery perfusion with oxygenated blood containing L-arginine (200 mg/kg) (n=15). All cases received routine procedure of CPB and continuously infused from the root of pulmonary artery until releasing aortaoaic clamp. Blood samples were collected from the radial artery respectively at the following time points:after the induction of anaesthesia, 1 hour after opening of aorta, 0, 6, 12, 24 hours after patients being taken back to ICU. ELISA test was used to detected the expression of tmmor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10). Lung tissue samples (1.0 cm ×1.0 cm×1.0 cm) were obtained from right lower lobe. The pathologicl changes of lung tissues were observed under light mi-croscope by using HE staining. Results at each time points, the expression of TNF-α, IL-6 in group Ⅱ and group Ⅲ weresignificantly lower than that in group Ⅰ (P<0.05). The level of TNF-α, IL-6 in group Ⅲ were lower than in group Ⅱ(P<0.05). However, the expression of IL-10 in group Ⅱ and group Ⅲ were higher than in group Ⅰ, and the level of IL-10 in group Ⅲ were higher than that in group Ⅱ(P<0.05). In the group Ⅰ: HE staining showed marked pulmonary interstitial edema, intra-alveolus neutrophilic granulocyte exudation with karyorrhexis. In the group Ⅱ, light capillary vessel hyperaemia and pulmonary interstitial lymphocyte exudation were detected. Nearly normal lung tissue were observed in group Ⅲ. Conclusion Continuous pulmonary artery perfusion

  20. A operação de Glenn bidirecional deve ser realizada com ou sem o auxílio de circulação extracorpórea? Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?

    Directory of Open Access Journals (Sweden)

    Ulisses Alexandre Crotti

    2004-09-01

    e mortalidade. Assim sendo, a operação sem CEC pode ser empregada com segurança quando os achados anatômicos forem apropriados e não houver hipóxia grave.OBJECTIVE: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB, analyzing the characteristics and confirming if there is superiority of either of the employed techniques. METHOD: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with seven patients (using CPB and group B with 9 patients (without the use of CPB. Gender, age, mean pulmonary artery pressure (MPAP, CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU, total hospitalization time and immediate complications were all compared between the two groups. RESULTS: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes, myocardial ischemia was 25 ± 33 minutes (0-80 minutes. Of these four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes. The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours. The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days. Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days. Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%. No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied. CONCLUSION: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or

  1. 瑞芬太尼后处理对犬心肺转流后心肌缺血-再灌注损伤的影响%Effects of remifentanil-postconditionging on myocardial ischemia-reperfusion injury after cardiopulmonary bypass in dogs

    Institute of Scientific and Technical Information of China (English)

    张颖; 赵其宏; 顾尔伟; 张雷

    2012-01-01

    Objective To study the effect of remifentanil-postconditioning on ischemia-reperfusion myocardium after cardiopulmonary bypass (CPB) in dogs and its potential mechanism. Methods Eighteen adult male dogs were equally randomized into ischemia -reperfusion group (group C). ischemia-postconditioning group (group I) and remifentanil-postconditioning group (group R). After CPB model was established, the ascending aorta were occluded for 60 min. At 55 min of aortic cross-clamping, warm-blood perfusion from aortic root was performed; after 60 min of aortic occlusion, reperfusion was initiated for 30 s followed by 30 s of reocclusion, repeated for three cycles in I groupt remifcmanil (4 μg·kg-1 ·min-l) were continuously infused for 5 nun with the warm blood in R group. Femoral artery blood samples were taken at 5 min before CPB (T0), 5 min after aortic cross-clamping release (T1), 30 min (T2) and 120 min (T3) after CPB for measuments of troponin I (cTnl) and malondialdehyde (MDA) contents and superoxide dismutase (SOD) activity, and the edema as well as ultrastructural changes of myocardium were analyzed after 120 rain of CPB. Result, The plasma contents of cTnI and MDA were significantly increased, and the SOD activity were significantly decreased at T1-T3 as compared with To in three groups (P<0. 01). In groups I and R. the plasma concentration of cTnI and MDA were lower than C group (P <0.01), SOD activity were higher than C group (P<0. 01) at the point of T1-T3. Compared with group C, the water content and uitrastruetural changes of myocardium were less (P <0. 01) in groups I and R. There was no significant differences between groups I and R. Conclusion Remifentanil-postconditioning reduces myocardial ischemia-reperfusion injury after CPB in dogs, which may be induced by the reduced oxidative stress via decreasing reactive oxygen species generation and increasing SOD activity.%目的 研究瑞芬太尼后处理对心肺转流(CPB)犬缺血再灌注心肌

  2. CPAP at 10 cm H2O during cardiopulmonary bypass does not improve postoperative gas exchange CPAP de 10 cmH2O durante a circulação extracorpórea não melhora a troca gasosa pós-operatória

    Directory of Open Access Journals (Sweden)

    Luciana Castilho de Figueiredo

    2008-06-01

    Full Text Available OBJECTIVE: To compare postoperative (PO pulmonary gas exchange indexes in patients submitted to myocardial revascularization (MR with or without the application of continuous positive airway pressure (CPAP during cardiopulmonary bypass (CPB. METHODS: Thirty adult patients submitted to MR with CPB between March and September 2005 were randomly allocated to two groups: CPAP (n=15, patients that received CPAP at 10 cmH2O during CPB, and control (n=15, patients that didn't receive CPAP. PaO²/FiO2 and P(A-aO2 were analyzed at four moments: Pre (just before CPB, with FiO2=1.0 ; Post (30min post-CPB, with FiO2=1.0; immediate PO period (12h post-surgery, with FiO2=0.4 by using a Venturi® facial mask and first PO day (24h post-surgery, with FiO2=0.5 by a facial mask. RESULTS: PaO2/FiO2 and P(A-aO2 tend to get significantly worst as time elapsed during the postoperative period in both groups, but no differences were observed between them at any moment. When PaO2/FiO2 was subdivided into three categories, a greater prevalence of patients with values between 200 mmHg and 300mmHg were observed in CPAP group only at moment Post (30min post-CPB; p = 0.02. CONCLUSION: CPAP at 10cmH2O administered during CPB, although had lightly improved PaO2/FiO2 at 30 minutes post-CPB, had no significant sustained effect on postoperative pulmonary gas exchange. We concluded that in patients submitted to MR, application of 10 cmH2O CPAP does not improve postoperative pulmonary gas exchange.OBJETIVO: Comparar os índices de trocas gasosas no pós-operatório de pacientes submetidos a revascularização do miocárdio (RM que receberam ou não pressão positiva contínua nas vias aéreas (CPAP durante a circulação extracorpórea (CEC. MÉTODOS: Trinta pacientes adultos submetidos a RM com CEC no período de março a setembro de 2005 foram alocados aleatoriamente em dois grupos: CPAP (n=15, pacientes que utilizaram CPAP a 10 cmH2O durante a CEC, e controle (n=15, pacientes que

  3. 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

    Institute of Scientific and Technical Information of China (English)

    王洪乾; 姚国泉; 孙莹杰; 张铁铮

    2014-01-01

    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

  4. 低潮气量机械通气对瓣膜置换病人肺换气功能影响的临床研究%Effects of low tidal volume ventilation on pulmonary gas exchange before and after mitral valve replacement with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    蔡宏伟; 田玉科; 任飞; 张海萍

    2006-01-01

    [Objective] To investigate the effect of low tidal volume ventilation on pulmonary gas exchange in patients undergoing mitral valve replacement with cardiopulmonary bypass (CPB). [Methods] A prospective randomized study was done in university hospital. Thirty patients undergoing mitral valve replacement with CPB were randomized to receive traditional tidal volume ventilation (TV; tidal volume, 9 mL/kg; respiratory rate, 12 times/min),or low tidal volume ventilation with conventional respiratory rate (LV; tidal volume, 7 mL/kg; respiratory rate, 12times/min), or low tidal volume ventilation with high respiratory rate (HR; tidal volume 7 mL/kg, 15 times/min)throughout surgery. During CPB, patients' lungs were kept inflated with 100% oxygen. [Results] Pulmonary gas exchange parameters were determined twice before CPB and after CPB. When final values after CPB were compared with the values before CPB, the arterial oxygen tension-inspired oxygen concentration ratio (PaO2/FiO2) was significantly decreased, and alveolar-artetal (A-a) oxygen gradient [P(A-a)O2] and intrapulmonary shunt (Qs/QT) were significantly increased in group LV. No significant differences were found in either group TV or group HR. [Conclusions] Low tidal volume ventilation with conventional respiratory rate in patients undergoing mitral valve replacement impaired pulmonary gas exchange early after CPB, while low tidal volume ventilation with high respiratory rate did not. These results suggest that low tidal volume ventilation with high respiratory rate may be useful for reducing lung injury caused by CPB and mechanical ventilation in patients undergoing mitral valve replacement.%目的以心输出量和肺换气功能为指标研究低潮气量通气对瓣膜置换病人心肺功能的影响.方法30例择期行二尖瓣置换手术病人随机分成3组:常规(传统)潮气量组(组Ⅰ),潮气量9mL/kg,呼吸频率12次/min;低潮气量常规频率组(组Ⅱ),潮气量7 mL/kg,呼吸频率12次/min

  5. Clinical research of the therapeutic effect of esmolol on refractory ventricular fibrillation occurred after release of aortic cross-clamp during cardiopulmonary bypass%艾司洛尔在体外循环主动脉开放后顽固性室颤中的应用

    Institute of Scientific and Technical Information of China (English)

    王学勇; 程卫平

    2013-01-01

    目的 评价艾司洛尔应用于体外循环主动脉开放后顽固性室颤的临床效果.方法 主动脉开放后出现顽固性室颤的瓣膜置换术患者40例,数字表法随机分为艾司洛尔组和对照组,每组20例.两组患者按照1 mg/kg分别静脉推注艾司洛尔(10 mg/ml)或利多卡因(10 mg/ml),2 min后继续除颤.2次除颤后仍不能复跳者,采取临床其他常月方法处理,直至心脏复跳.记录开放前主动脉阻断时间、肛温、平均动脉压、血乳酸值、血钾值、pH值;给予艾司洛尔或等浓度利多卡因后记录干预后除颤次数、复跳5 min后心律、心率,停机后记录体外循环时间及正性肌力药物用量.结果 两组相比较,艾司洛尔组除颤成功率高,复跳5 min后心率低,体外循环时间短,正性肌力药物用量少,差异均有统计学意义(P<0.05).结论体外循环升主动脉开放后复跳困难的患者,给予艾司洛尔可明显减少除颤次数,提高除颤成功率.同时还可以改善复跳后心脏功能,减少正性肌力药物依赖,缩短体外循环时间.%Objective To evaluate the effect of esmolol on refractory veatricular fibrillation just after aortic declamp during cardiopulmonary bypass.Methods 40 patients undergoing valve replacement occurring refractory ventricular fibrillation after release of aortic cross-clamp was randomly given esmolol (prepared to 10 mg/ml) 1 mg/kg(group esmolol,n =20),or Lidocaine (prepared to 10 mg/ml) 1 mg/kg(group control,n=20),the endocardial electric defibrillation was continued after 2min.If the fibrillation still can not be reversed after another two times defribrillation,the routine clinical method would beused.The time of aortic cross-clamp,rectal temperature,MAP,and the value of serum Lactic acid,potassium,and PH were recorded.After intervention,the times of defibrillation,heart rate and rhythm 5 min after reversal were recorded.At the end of CPB,the CPB time and the dosage of positive inotropic

  6. Effect of methylprednisolone pretreatment on cardiopulmonary bypass-induced intestinal barrier injury in patients undergoing cardiac surgery%甲基强的松龙预先给药对体外循环诱发心脏手术患者肠粘膜屏障损伤的影响

    Institute of Scientific and Technical Information of China (English)

    于建设; 韩志强; 吕亮亮; 解雅英; 龚玉华

    2012-01-01

    Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass(CPB)-induced intestinal barrier injury in patients undergoing cardiac surgery.Methods Ninety NYHA Ⅰor Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective cardiac surgery with CPB,were randomly divided into 3 gnoups(n =30 each):control group without CPB(group Ⅰ),control group with CPB(group Ⅱ)and administration of methylprednisolone before CPB group(group Ⅲ).Anesthesia was induced with midszolam,fentanyl,etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium.The patients were mechanically ventilated after tracheal intubation.In group Ⅲ,methylprednisolone 10 mg/kg was injected intravenously before operation and CPB.While in groups Ⅰ and Ⅱ,the equal volume of normal saline was injected instead.The blood samples were taken from the central vein before induetion of anesthesia(T1),before CPB(T2),at 30 min after the beginning of CPB(T3),at 30 rin afier the end of CPB(T4)and at 120 min after operation(T5)for determination of the plasma endotoxin concentration.Infection was recorded within 7 days after operation.Results The plasma endotoxin concentrations at T1 were within the normal range in all groups,without significant difference among the three gnoups(P >0.05).The plasma endotoxin concentration at T3-5 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ,while higher than those in group Ⅰ(P < 0.05).Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal harrier function in patients undergoing cardiac surgery.%目的 评价甲基强的松龙预先给药对体外循环(CPB)诱发心脏手术患者肠粘膜屏障损伤的影响.方法 择期心脏手术患者90例,年龄30-50岁,性别不限,体重50-75 kg,心功能分级Ⅰ或Ⅱ级,采用随机数字

  7. 血管加压素对心肺转流术后血管麻痹综合征患者血流动力学的影响%Effect of arginine vasopressin on systemic hemodynamicsin vasodilatoryvasoplegic syndrome patients following cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    袁志国; 谢红

    2011-01-01

    Objective To investigate the effects of arginine vasopressin (AVP) on hemodynamicsin vasodilatory vasoplegic syndrome patients following cardiopulmonary bypass(CPB). Methods Fourteen vasodilatory shock patients undergoing heart surgery following CPB were randomized into 2 groups (n = 7 each): norepinephrine group (NE group) and arginine vasopressin group (AVP group). In NE group, a NE infusion was started to maintain MAP higher than 65 mmHg,and AVP was added when NE infusion rate was higher than 0.4 μg/(kg·min). In AVP group, an AVP infusion was started at an infusion rate between 0.01 ~0.04 U/min. If necessary, a NE infusion was added to maintain MAP higher than 65 Hg. MAP (mean arterial pressure), HR (heart rate), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), urine output and catecholamine requirements were recorded when vasodilatory vasoplegic syndrome was diagnosed (T1), 24 h(T2), 48 h(T3),and 72 h (T4)after the treatment respectively. Systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were calculated. Meanwhile, side effects were recorded. Results There were no significant differences between the two groups with respect to age, sex, body weight, CPB time and aortic cross- clamping time, MAP, PVR( P >0.05). HR was lower and catecholamine requirements were less pronounced at T2~4 in group AVP when compared with those of group NE (P<0.05). SVR was higher in AVP group at T2,urine output was significantly higher at T2~3 in group AVP than in group NE( P < 0.05). No adverse side effects were observed. Conclusion AVP infusion can improve hemodynamics in vasodilatory vasoplegic syndrome patients undergoing cardiac surgery following CPB.%目的 评价血管加压素对心肺转流术(CPB)后血管麻痹综合征患者血流动力学的影响.方法 选取CPB下心脏手术后发生血管麻痹综合征患者14例,分为去甲肾上腺素(NE)

  8. 微量晶体心肌保护灌注法在婴幼儿体外循环中的应用%The application of micro pump crystal solution perfusion device in infants' con-genital heart diseases with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    陈祥舟; 刘梅; 肖颖彬; 王学锋; 王咏

    2014-01-01

    目的:观察在婴幼儿体外循环( CPB)中采用自制微量晶体心肌保护灌注方法的临床效果。方法选择10 kg以下择期在CPB下行室间隔缺损修补术的患儿100例,随机分为试验组和对照组,每组各50例。心肌保护均采用顺行灌注高K+含血停搏液,试验组采用微量晶体灌注方法,对照组采用传统储血罐灌注方法。分别于麻醉诱导后( T1)、CPB 20 min( T2)、主动脉开放后( T3)、手术结束即刻( T4)检测动脉血气的K+离子浓度、红细胞比容( Hct)、乳酸( Lac)并进行比较,比较患儿术前和术后一般情况、左室射血分数( EF)、CPB时间、主动脉阻断时间、心脏复苏、术中超滤量、CPB预充总量、围术期用血量,肌酸激酶( CK)和肌酸激酶同工酶( CKMB)等数据。结果①两组患儿术前一般情况、术前和术后EF值、CPB时间、阻断时间、心脏复苏率、术中超滤量无统计学差异( P>0.05)。②T1、T2、T3、T4的动脉血气K+、Hct、Lac均无统计学差异( P>0.05)。③两组患儿CK、CKMB在术前、术后1天、术后3天各时间点组间比较均无统计学差异( P>0.05),但CK、CKMB在术后1天明显升高,与术前比较有显著差异( P<0.01),术后3天较术后1天明显下降( P<0.01),但仍高于术前水平( P<0.05)。④试验组较对照组CPB预充总量和围术期用血量均明显减少( P<0.05)。结论在婴幼儿CPB中的心肌保护使用微量晶体灌注方法能获得与储血罐灌注法相同的效果,但预充液总量和围术期用血量明显减少。%Objective To observe the clinical effect of myocardial protection using micro pump crystal solution perfusion de-vice in infants'congenital heart diseases with cardiopulmonary bypass ( CPB) . Methods Form Jun. 2010 to Oct. 2012, 100 infants ( body weight 0.05) . 2. There were no sig

  9. Coronary Artery Bypass

    Science.gov (United States)

    ... to 3 days in the Intensive Care Unit (ICU). Life After Bypass After bypass surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes ...

  10. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  11. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials...... . Conversely, it has been suggested that revascularization after off pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated, coronary interventions. Since 2009, three major randomized controlled trials have...

  12. Emergency bypass post percutaneous atrial ablation: a case report.

    LENUS (Irish Health Repository)

    Hargrove, M

    2010-11-01

    A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.

  13. Gastric bypass surgery

    Science.gov (United States)

    ... Roux-en-Y; Weight-loss surgery - gastric bypass; Obesity surgery - gastric bypass ... bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of ...

  14. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  15. Comparison of current practices of cardiopulmonary perfusion technology in Iran with American Society of Extracorporeal Technology’s standards

    Science.gov (United States)

    Faravan, Amir; Mohammadi, Nooredin; Alizadeh Ghavidel, Alireza; Toutounchi, Mohammad Zia; Ghanbari, Ameneh; Mazloomi, Mehran

    2016-01-01

    Introduction: Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology. Methods: In this descriptive study, data was collected from 48 Iranian public hospitals and educational health centers through a researcher-created questionnaire. The data collection questionnaire assessed the standards which are recommended by American Society of Extracorporeal Technology. Results: Findings showed that appropriate measurements were carried out by the perfusion technology staffs to prevent the hemodilution and avoid the blood transfusion and unnecessary blood products, determine the initial dose of heparin based on one of the proposed methods, monitor the anticoagulants based on ACT measurement, and determine the additional doses of heparin during the cardiopulmonary bypass based on ACT or protamine titration. It was done only in 4.2% of hospitals and health centers. Conclusion: Current practices of cardiopulmonary perfusion technology in Iran are inappropriate based on the standards of American Society of Cardiovascular Perfusion. This represents the necessity of authorities’ attention to the validation programs and development of the caring standards on one hand and continuous assessment of using these standards on the other hand. PMID:27489600

  16. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Flavia Baggio Nerbass

    2010-01-01

    Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0, during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3 using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m² were randomized into control (n = 20 and massage therapy (n = 20 groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006 and Day 2 (p=0.028 in addition, they reported a more effective sleep during all three days (p=0.019 when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

  17. Audiometric changes after coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Khorsandi M T

    2007-09-01

    Full Text Available Background: Hearing is one of the most significant senses; There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery."nMethods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score, minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed."nResults: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients according to their audiometric results; those with slight changes ≤10 db (43 patients; and those having average deficits of more than 10 db (10 patients. All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002. Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors."nConclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery; however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.

  18. 体外循环不阻断升主动脉低温心室颤动左心室引流技术对心肌保护作用的实验研究%Experimental study of myocardial preservation with hypothermic ventricular fibrillation and left ventricular drainage during cardiopulmonary bypass without aortic cross-clamping

    Institute of Scientific and Technical Information of China (English)

    关晓海; 陈晶; 邬鹏宇; 伊雪; 蒲国华; 陈晨; 李占清

    2011-01-01

    Objective To evaluate the protective effect of hypothermic ventricular fibrillation by analyzing the index endothelin, nitric oxide, malondiadehyde, superoxide dismutase (SOD) in blood and the expression of endothelin receptor A (ETA) mRNA in myocardium. Methods The animal model cardiopulmonary bypass (CPB)was estibalsed. Before CPB, at 1, 2 hours of CPB and 1 hour after heart re-beating, blood from vein was withdrew and myocardium was taken from the left ventricle of each dog. The blood level of nitric oxide( NO), malondialdehyde ( MDA), endothelin and SOD were tested, as well as the expression of the local left ventricular ETA mRNA using reverse transcriptase-polymerase chain reaction. Results The levels of endothelin, malondiadehyde in both groups were higher than normal. At 1,2 hours of operation and 1 hour after heart beating, the endothelin, malondiadehyde level of control group were higher than those of experimental group[(70. 27 ± 7.03 ) ng/L vs ( 56.53 ±12.11 ) ng/L, ( 106.36 ± 6.61 ) ng/L vs (72.71 ± 12.72) ng/L; (4.71 ± 1.31 ) μmol/L vs ( 3.32 ± 0. 82 ) μmol/L,(8.27 ± 1.99) μmol/L vs (4.38 ± 1.02) μmol/L,P <0.01]. The NO, SOD levels in both groups reduced but more significantly in control group. At 2 hours of operation and 1 hour after heart beating, the NO and SOD levels of experimental group were higher than those of control group[(28.57 ±9.20) μmol/L vs (45.36 ± 16.59) μmol/L,(12.14 ±7.03) μ mol/L vs (47.50 ± 17. 18) μmol/L; (7. 23 ±2.59)μg/L vs (17.69 ±7.96)μg/L, (2.78 ±0.88) μg/L vs ( 18.52 ± 10.30 ) μg/L, P < 0. 05 or P < 0.01]. ETA mRNA showed an increase in both two groups. Compared to experimental group, the ETA mRNA level in control group at 1, 2 hours of operation and 1 hour after heart beating was significantly higher[( 0. 35 ± 0. 01 ) vs ( 0. 28 ± 0.05 ), ( 0. 49 ± 0. 05 ) vs ( 0. 31 ±0.04),(0.67±0.05)vs(0.38 ±0.07),P<0. 01]. Conclusion Myocardium is protected effectively by hypothermic ventricular

  19. Anestesia para o recém-nascido submetido a cirurgia cardíaca com circulação extracorpórea Anestesia para el recién nacido sometido a cirugía cardiaca con circulación extracorpórea Anesthesia for the newborn submitted to cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Sérgio Bernardo Tenório

    2005-02-01

    ítrico o los inhibidores de la fosfodiesterasa. CONCLUSIONES: El anestesista tiene papel preponderante en el ajuste de la homeostasia durante el período peri-operatorio. Conocimientos sobre el tipo de lesión cardiaca, la corrección a ser realizada, la respuesta del organismo a la CEC pueden ser útiles en el manoseo de estos niños.BACKGROUND AND OBJECTIVES: Congenital heart diseases affect 0.8% of liveborn infants and many need neonatal surgical correction. Cardiac surgery with cardiopulmonary bypass (CPB in this age is associated to higher risk of complications related to child's functional immaturity, lack of CPB equipment fully compatible with neonate (NN size and technical difficulties to correct cardiac defects. This article aimed at describing aspects related to anesthetic technique, CPB and their effects on NN. CONTENTS: High fentanyl or sufentanil doses promote adequate anesthesia without interfering with cardiocirculatory stability. Opioids residual respiratory depression is not a problem for these patients because most of them will need immediate postoperative respiratory assistance. CPB may be followed by heart manipulation-induced hypotension and/or bleeding. Inadequate venous and aortic cannula position may lead to severe complications, such as insufficient brain flow or difficult venous drainage. Deep hypothermia and total circulatory arrest are common during CPB. Hypothermia changes blood viscosity, which is treated with hemodilution and has implications on pH correction (alpha-stat versus pH stat. Low cardiac output is common during CPB weaning and adjustments in one or all its components (preload, contractility, afterload and heart rate may be necessary. In addition to classic drugs, such as epinephrine and dopamine, other substances may be needed, such as aprotinin, nitric oxide or phosphodiesterase inhibitors. CONCLUSIONS: Anesthesiologists play a major role in adjusting perioperative homeostasis. Understanding the type of cardiac disease, the

  20. Expression of high mobility group box 1 in the lung protection of oxygen controlled reperfusion against early ischemia-reperfusion injury with cardiopulmonary bypass in canines%氧控制性再灌注抗犬体外循环肺缺血再灌注早期损伤过程中高迁移族蛋白1的表达

    Institute of Scientific and Technical Information of China (English)

    荣健; 叶升; 吴钟凯; 陈光献; 梁孟亚; 刘海; 黄伟明; 王治平

    2010-01-01

    Objective To observe the expression of high mobility group box 1 (HMGB1)in the lung protection of oxygen controlled reperfusion against ischemia-reperfusion (I/R) with cardiopulmonary bypass (CPB) in canine. Methods Fourteen healthy canines were randomly divided into two groups:control group (n=7) and test group (n=7), and received CPB. The animals in the control group received 80% FiO2 throughout the whole procedure, whereas those in the test group received 40% immediately at the declamping of aorta, and an additional 10% every 5 min later until 80% FiO2 was reached. Other procedures were the same with control group. Arterial oxygen partial pressure (PaO2) was recorded after anesthesia was completed, before and at 5, 10, 15, 20, 25 min after sternotomy, and before withdrawal of CPB. HMGB1 expression by RT-PCR and Western blot, NF-κB expression by Western blot, IL-6 and TNF-α by ELISA were analyzed just after sternotomy(T1 ), 25 min after declamping(T2) and 90 min after declamping(T3). At the same time points, malondialdehyde, myeloperoxidase activity, wet/dry mass (Mw/MD) gnd tissue pathology were analyzed. Results PaO2 was significantly lower in the test group than that in the control group at 5, 10, 15 and 20 min after aortic declamping (all P<0.05). Compared with the control group at T2 and T3, the test group was found to have lower levels in HMGB1 mRNA and protein expressions (T2:0.926 0±0.013 9 vs 1.049 6±0.030 6;T3:0.832 5±0.015 4 vs 0.989 4±0.014 4, both P<0.05; T2:0.434 5±0.074 8 vs 0.551 2±0.047 4;T3:0.449 0±0.054 1vs 0.545 5±0.040 6, both P<0.05), NF-κB protein expression in the lung tissues, IL-6 and TNF-α in serum, Mw/MD ratio, MDA level and MPO activity (all P<0.05).Pathological scores in test group at T2 and T3 were significantly lower than those in control group (T2:2.0±0.7vs 3.8 ±0.5; T3:2.6±0.6 vs 4.2 ±0.8, both P<0.05). Conclusion Oxygen controlled reperfusion possesses lung protection in early stage of I/R injury with

  1. Oxidative Stress and Homocysteine Metabolism Following Coronary Artery Bypass Grafting by On-pump and Off-pump Techniques

    OpenAIRE

    Susan Hassanzadeh Salmasi; Mohammad Rahbani Noubar; Rezayat Parvizi

    2007-01-01

    Background: It is well documented that coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes ischemia and oxidative stress of the whole body. To compare the effect of on – pump and off –pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period.Methods: Plasma homocysteine, folate total antioxidant capacity (TAC) and...

  2. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou

    2010-01-01

    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  3. Effect of recombinant human erythropoietin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass%重组人促红细胞生成素对体外循环心脏瓣膜置换术患者脑损伤的影响

    Institute of Scientific and Technical Information of China (English)

    朱波; 张砡; 王嵘; 卿恩明; 叶铁虎

    2016-01-01

    d时Stroop字色干扰B完成时间缩短(P<0.05或0.01);与EPO1组比较,EP02组左侧△rSO2≥20%的发生率升高,T2-4和T6-8时右侧THI降低,T6,7时左侧△O2Hb和T8时右侧△O2Hb降低(P<0.05).结论 麻醉诱导前静脉注射rHuEPO40 IU/kg可减轻体外循环心脏瓣膜置换术患者脑损伤.%Objective To evaluate the effect of recombinant human erythropoietin (rHuEPO) on brain injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-five patients with chronic valvular heart disease,aged 36-62 yr,weighing 42-92 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with New York Heart Association of Ⅱ or Ⅲ,undergoing cardiac valve replacement with CPB,were randomly divided into 3 groups (n =15 each) using a random number table:control group (group C),and different doses of rHuEPO groups (EPO1 group,EPO2 group).In EPO1 and EPO2 groups,rHuEPO 40 and 80 IU/kg were injected intravenously before anesthesia induction,respectively.Before anesthesia induction (T0,baseline value),immediately after endotracheal intubation (T1),immediately after aortic cannulation (T2),immediately after cannulation of superior and inferior vena cava (T3),immediately after the beginning of CPB (T4),when each index was decreased to the minimal value during CPB (T5),after rewarming to 36.5 ℃ (T6),immediately after termination of CPB (T7),and at 1 h after termination of CPB (T8),regional cerebral oxygen saturation (rSO2),tissue hemoglobin index (THI),and changes in concentrations of oxyhemoglobin (△ O2Hb),deoxyhemoglobin (△ HHb) and total hemoglobin (△ cHb) in bilateral frontal lobes were recorded.The patients whose minimal rSO2 ≤ 50% and decrease in minimal rSO2 ≥ 20% of the baseline value (△rSO2) were recorded.At T0,T8 and 2 h after termination of CPB (T9),venous blood samples were taken for determination of serum concentrations of S100 protein and neuron-specific enolase (NSE) by

  4. Simulated Cardiopulmonary Arrests in a Hospital Setting.

    Science.gov (United States)

    Mishkin, Barbara H.; And Others

    1982-01-01

    Describes a simulated interdisciplinary role rehearsal for cardiopulmonary arrest to prepare nurses to function effectively. Includes needs analysis, program components, and responses of program participants. (Author)

  5. Aspectos da função tireóidea em lactentes submetidos à cirurgia cardíaca com circulação extracorpórea Aspectos de la función tiroidea en lactantes sometidos a cirugía cardíaca con circulación extracorpórea Thyroid function profile in infants submitted to cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Paula Maria da Cruz

    2004-06-01

    ; M2 - después del final de la cirugía; M3 - 6 horas después del final de la cirugía y M4 - 24 horas después del M1. Para complementar esta investigación, fueron estudiadas las variaciones de los siguientes parámetros: presión arterial media (PAM, temperatura sanguínea central (ºC, atributos de la oxigenación del tejido y del equilibrio ácido-base (M1, CEC, M2, M3 y M4. RESULTADOS: Las medias de edad, peso, altura y superficie corpórea de los pacientes fueron 3,9 meses; 4,708 kg, 0,65 m y 0,3 m²respectivamente. Las concentraciones plasmáticas de T3 (p BACKGROUND AND OBJECTIVES: Cardiac surgery with cardiopulmonary bypass (CPB is related to euthyroid disease or hypothalamic-pituitary-thyroid system depression. Abnormal hemodynamic status induced by CPB is responsible for several endocrine-metabolic changes, triggering complex systemic inflammatory response. This study aimed at evaluating triiodothyronine (T3, tetraiodothyronine (T4 and thyrotrophin (TSH behavior in infants submitted to cardiac surgery with CPB. METHODS: Participated in this study 15 infants. Blood samples for T3, T4 and TSH evaluation were collected in four moments: M1 - after anesthetic induction; M2 - at surgery completion; M3 - six hours after surgery completion; M4 - 24 hours after M1. To complete this study the following parameters were evaluated: mean blood pressure (MBP, central blood temperature (ºC, tissue oxygenation and acid-base attributes (M1, CPB, M2, M3 and M4. RESULTS: The patients' means aged, weigh, height and body surface were 3.9 months; 4.708 kg; 0.65 m and 0.3 m² respectivety. Plasma T3 (p < 0.0001, T4 (p < 0.0001 and TSH (p = 0.0021 concentrations have significantly varied throughout the study with T3 concentrations progressively decreasing. Lowest T3 and T4 values were coincident with highest Ht and Hb values, discarding hemodilution effects. Highest serum TSH concentrations have shown a possible hypothalamic-pituitary-thyroid system reaction to hypothermia and

  6. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... doctor may recommend a minimally invasive coronary artery bypass if you have a blockage in one or ...

  7. Patient directed perfusion pressure on bypass, an analogy from electrical engineering--a new concept.

    Science.gov (United States)

    Warwick, Richard; Poole, Robert; Palmer, Kenneth; Johnson, Ian; Poullis, Michael

    2010-03-01

    Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual's resting pre-procedural blood pressure. Four simulated arterial traces with variable morphology, but identical systolic and diastolic blood pressures, were analyzed to calculate the medical mean, arithmetic mean, and root mean square of the blood pressure tracing. Using the standard medical formula for calculation of mean blood pressure, you can potentially underestimate perfusion pressure by 12 mmHg in a normotensive subject. The root mean square pressure calculates the equivalent non pulsatile pressure that will deliver the same hydraulic power to the circulation as its pulsatile equivalent. Patient specific perfusion pressures, calculated via root mean square may potentially help reduce the incidence of organ ischemia during cardiopulmonary bypass. Clinical trials are needed to confirm or refute this concept.

  8. Patient Directed Perfusion Pressure on Bypass, an Analogy from Electrical Engineering—A New Concept

    Science.gov (United States)

    Warwick, Richard; Poole, Robert; Palmer, Kenneth; Johnson, Ian; Poullis, Michael

    2010-01-01

    Abstract: Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual’s resting pre-procedural blood pressure. Four simulated arterial traces with variable morphology, but identical systolic and diastolic blood pressures, were analyzed to calculate the medical mean, arithmetic mean, and root mean square of the blood pressure tracing. Using the standard medical formula for calculation of mean blood pressure, you can potentially underestimate perfusion pressure by 12 mmHg in a normotensive subject. The root mean square pressure calculates the equivalent non pulsatile pressure that will deliver the same hydraulic power to the circulation as its pulsatile equivalent. Patient specific perfusion pressures, calculated via root mean square may potentially help reduce the incidence of organ ischemia during cardiopulmonary bypass. Clinical trials are needed to confirm or refute this concept. PMID:20437793

  9. Flood Bypass Capacity Optimization

    Science.gov (United States)

    Siclari, A.; Hui, R.; Lund, J. R.

    2015-12-01

    Large river flows can damage adjacent flood-prone areas, by exceeding river channel and levee capacities. Particularly large floods are difficult to contain in leveed river banks alone. Flood bypasses often can efficiently reduce flood risks, where excess river flow is diverted over a weir to bypasses, that incur much less damage and cost. Additional benefits of bypasses include ecosystem protection, agriculture, groundwater recharge and recreation. Constructing or expanding an existing bypass costs in land purchase easements, and levee setbacks. Accounting for such benefits and costs, this study develops a simple mathematical model for optimizing flood bypass capacity using benefit-cost and risk analysis. Application to the Yolo Bypass, an existing bypass along the Sacramento River in California, estimates optimal capacity that economically reduces flood damage and increases various benefits, especially for agriculture. Land availability is likely to limit bypass expansion. Compensation for landowners could relax such limitations. Other economic values could affect the optimal results, which are shown by sensitivity analysis on major parameters. By including land geography into the model, location of promising capacity expansions can be identified.

  10. Left heart bypass support with the Rotaflow Centrifugal Pump® as a bridge to decision and recovery in an adult.

    Science.gov (United States)

    Kashiwa, Koichi; Nishimura, Takashi; Saito, Aya; Kubo, Hitoshi; Fukaya, Aoi; Tamai, Hisayoshi; Yambe, Tomoyuki; Kyo, Shunei; Ono, Minoru

    2012-06-01

    Since left heart bypass or biventricular circulatory assist with an extracorporeal centrifugal pump as a bridge to decision or recovery sometimes requires long-time support, the long-term durability of extracorporeal centrifugal pumps is crucial. The Rotaflow Centrifugal Pump(®) (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) is one of the centrifugal pumps available for long-term use in Japan. However, there have been few reports of left heart bypass or biventricular circulatory support over the mid-term. This is a case report of left heart bypass support with the Rotaflow Centrifugal Pump(®) as a bridge to decision and recovery for an adult patient who could not be weaned from cardiopulmonary bypass and percutaneous cardiopulmonary support after cardiac surgery. We could confirm that the patient's consciousness level was normal; however, the patient could not be weaned from the left heart bypass support lasting 1 month. Therefore, the circulatory assist device was switched to the extracorporeal Nipro ventricular assist device (VAD). This time, left heart bypass support could be maintained for 30 days using a single Rotaflow Centrifugal Pump(®). There were no signs of hemolysis during left heart bypass support. The Rotaflow Centrifugal Pump(®) itself may be used as a device for a bridge to decision or recovery before using a VAD in cardiogenic shock patients.

  11. Multiple dimensions of cardiopulmonary dyspnea

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na; XIONG Chang-ming; YAO Wei; FANG Qiu-hong; ZHU Yuan-jue; CHENG Xian-sheng; Karel P Van de Woestijne

    2011-01-01

    Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

  12. Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

    OpenAIRE

    Ghorbel, Mohamed T.; Cherif, Myriam; Mokhtari, Amir; Bruno, Vito Domenico; Caputo, Massimo; Angelini, Gianni D

    2010-01-01

    Off-pump coronary artery bypass surgery reduces the myocardial injury associated with on pump surgery with cardiopulmonary bypass (CPB) and ischemic-cardioplegic arrest (CA). We sought to find a mechanistic explanation for this by comparing the transcriptomic changes in the myocardium of patients undergoing on- and off-pump surgery. Transcriptomic analyses were performed on left ventricular biopsies obtained from patients prior to (pre-op) and after completion of all coronary anastomoses (pos...

  13. Bypassing damaged nervous tissue

    CERN Document Server

    Shneider, M N

    2016-01-01

    We show the principal ability of bypassing damaged demyelinated portions of nervous tissue, thereby restoring its normal function for the passage of action potentials. We carry out a theoretical analysis on the basis of the synchronization mechanism of action potential propagation along a bundle of neurons, proposed recently in [1]. And we discuss the feasibility of implement a bypass to restore damaged nervous tissue and creating an artificial neuron network.

  14. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass

    Directory of Open Access Journals (Sweden)

    Pawan Kumar Jain

    2015-01-01

    Full Text Available Cystic echinococcosis (hydatid disease arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.

  15. Clinical Evaluation of Poly(2-methoxyethylacrylate) in Primary Coronary Artery Bypass Grafting

    OpenAIRE

    Vang, See N.; Brady, Chad P.; Christensen, Kevin A.; Isler, Jack R.; Allen, Keith R.

    2005-01-01

    In an attempt to make cardiopulmonary bypass (CPB) less traumatic for patients undergoing cardiac surgery, extracorporeal circuits (ECC) have been modified to achieve this goal. Poly(2-methoxyethylacrylate) (PMEA, X-coating™) is a new polymer coating used in the ECC. PMEA studies have shown excellent biocompatibility with the components of blood. In this evaluation, PMEA-coated ECC were compared with control (CTR) circuits with emphasis on hematological parameters, perioperative homologous bl...

  16. Cardiopulmonary function and laparoscopic cholecystectomy.

    Science.gov (United States)

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  17. Cardiopulmonary resuscitation: update, controversies and new advances

    OpenAIRE

    Alexandre C. Zago; Cristine E. Nunes; Viviane R. da Cunha; Euler Manenti; Luís Carlos Bodanese

    1999-01-01

    Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of...

  18. LUCAS - Lund University Cardiopulmonary Assist System

    OpenAIRE

    Liao, Qiuming

    2011-01-01

    Lund University Cardiopulmonary Assist System (LUCAS) is a mechanical device providing automatic 5 cm deep chest compressions and active decompressions back to normal anatomical position with a frequency of 100 per minute, and a duty cycle of 50%, i.e., LUCAS is constructed to give chest compressions according to the latest international guidelines in cardiopulmonary resuscitation (CPR). The aim of the thesis was to study cardiac arrest using different porcine models of ventricular fi...

  19. Vasopressin decreases neuronal apoptosis during cardiopulmonary resuscitation

    OpenAIRE

    Ma, Chi; Zhu, Zhe; Wang, Xu; Zhao, Gang; Liu, Xiaoliang; Li, Rui

    2014-01-01

    The American Heart Association and the European Resuscitation Council recently recommended that vasopressin can be used for cardiopulmonary resuscitation, instead of epinephrine. However, the guidelines do not discuss the effects of vasopressin during cerebral resuscitation. In this study, we intraperitoneally injected epinephrine and/or vasopressin during cardiopulmonary resuscitation in a rat model of asphyxial cardiac arrest. The results demonstrated that, compared with epinephrine alone, ...

  20. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    Science.gov (United States)

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  1. Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump.

    Science.gov (United States)

    Tabry, Imad F; Zachariah, Zachariah P

    2013-01-01

    A previously described but rarely used surgical technique for the repair of complex or recurrent coarctation of the aorta through a right thoracotomy approach is presented in detail. It has the advantages of being simple and avoiding left chest re-entry, median sternotomy and cardiopulmonary bypass altogether.

  2. Your diet after gastric bypass surgery

    Science.gov (United States)

    Gastric bypass surgery - your diet; Obesity - diet after bypass; Weight loss - diet after bypass ... You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed ...

  3. Bypass Flow Study

    International Nuclear Information System (INIS)

    The purpose of the fluid dynamics experiments in the MIR (Matched Index of-Refraction) flow system at Idaho National Laboratory (INL) is to develop benchmark databases for the assessment of Computational Fluid Dynamics (CFD) solutions of the momentum equations, scalar mixing, and turbulence models for the flow ratios between coolant channels and bypass gaps in the interstitial regions of typical prismatic standard fuel element (SFE) or upper reflector block geometries of typical Modular High-temperature Gas-cooled Reactors (MHTGR) in the limiting case of negligible buoyancy and constant fluid properties. The experiments use Particle Image Velocimetry (PIV) to measure the velocity fields that will populate the bypass flow study database.

  4. Bypass Flow Study

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz

    2011-09-01

    The purpose of the fluid dynamics experiments in the MIR (Matched Index of-Refraction) flow system at Idaho National Laboratory (INL) is to develop benchmark databases for the assessment of Computational Fluid Dynamics (CFD) solutions of the momentum equations, scalar mixing, and turbulence models for the flow ratios between coolant channels and bypass gaps in the interstitial regions of typical prismatic standard fuel element (SFE) or upper reflector block geometries of typical Modular High-temperature Gas-cooled Reactors (MHTGR) in the limiting case of negligible buoyancy and constant fluid properties. The experiments use Particle Image Velocimetry (PIV) to measure the velocity fields that will populate the bypass flow study database.

  5. Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

    Science.gov (United States)

    Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco

    2016-01-01

    A 76-year-old man with situs inversus totalis underwent a successful off-pump three-vessel coronary artery bypass surgery. The postoperative course was uneventful, and the patient was discharged 8 days later. At 9-month follow-up a coronary computed tomography angiography confirmed the viability of all of the grafts, and one year after the operation the patient remained asymptomatic. It comprises the fifth Brazilian case of a coronary surgery in a patient with situs inversus totalis and the first one of the country of a coronary artery bypass surgery without the use of the cardiopulmonary bypass in this condition. PMID:27556323

  6. Bypassing AMPK Phosphorylation

    OpenAIRE

    Viollet, Benoit; Foretz, Marc; Schlattner, Uwe

    2014-01-01

    AMP-activated protein kinase (AMPK) functions as a signaling hub to balance energy supply with demand. Phosphorylation of activation loop Thr172 has been considered as an essential step in AMPK activation. In this issue of Chemistry & Biology, Scott and colleagues show that the small molecule direct AMPK activator, A-769662, bypasses this phosphorylation event, and acts synergistically with AMP on naive AMPK.

  7. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik;

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  8. Experimental laparoscopic aortobifemoral bypass.

    Science.gov (United States)

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  9. 丙泊酚和七氟醚复合麻醉对体外循环下心脏瓣膜手术老年患者术后认知功能障碍影响的比较%Comparison of effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    施乙飞; 韩建阁; 翟文倩; 耳建旭

    2016-01-01

    Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5%-2.5% sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P < 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.%目的 比较丙泊酚和七氟醚复合麻醉对体外循环下心脏瓣膜手术老年患者术后认知功能障碍的影响.方法 择期体外循环下行心脏瓣膜手术患者80例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄65 ~ 72岁,体重60~ 80 kg.采用随机数字表法分为2组(n=40):丙泊酚复

  10. Avaliação da função pulmonar em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea Evaluación de la función pulmonar en pacientes sometidos a cirugía cardíaca con circulación extracorpórea Evaluation of pulmonary function in patients undergoing cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ricardo Antonio Guimarães Barbosa

    2002-11-01

    analizados a través del análisis de variancia para medidas repetidas (p BACKGROUND AND OBJECTIVES: Pulmonary complications are still a major postoperative problem for cardiac surgeries with cardiopulmonary bypass (CPB. This study aimed at evaluating pulmonary function changes in patients undergoing myocardial revascularization, as compared to those submitted to valve replacement. METHODS: Participated in this study patients undergoing myocardial revascularization (MR Group, n=15 and valve replacement (VR Group, n=15 who were evaluated by the ratio between oxygen blood pressure and its inspired fraction (PaO2/FiO2, oxygen alveolar-arterial gradient (GA-aO2, pulmonary shunt, best compliance PEEP and static PEEP, evaluated in the preoperative period, after anesthetic induction, 1, 3 and 6 postoperative hours and 1st and 2nd postoperative days. Data were analyzed by analysis of variance for repeated measures (p < 0.05. RESULTS: Alveolar-arterial gradient and pulmonary shunt results were significantly higher for the MR group as compared to the VR group. PaO2/FiO2 ratio was significantly higher in the VR group. There were no differences between groups in static compliance. Postoperative best compliance PEEP was significantly higher in the MR group as compared to the VR group. CONCLUSIONS: Our study has shown that patients submitted to myocardial revascularization presented pulmonary function changes different from those submitted to valve replacement.

  11. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    Science.gov (United States)

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof

    2011-05-01

    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.

  12. Successful application of acute cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci

    2015-01-01

    Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.

  13. Impact of Obesity on Cardiopulmonary Disease.

    Science.gov (United States)

    Chandler, Marjorie L

    2016-09-01

    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

  14. 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

    OpenAIRE

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

    2008-01-01

    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...

  15. Axillobifemoral bypass grafting

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    Davidović Lazar B.

    2004-01-01

    Full Text Available INTRODUCTION Axillo-femoral bypass (AxF means connecting the axillar and femoral artery with the graft that is placed subcutaneously [1]. Usually, this graft is connected with contralateral femoral artery via one accessory subcutaneous graft, and this connection is known as axillobifemoral bypass (AxFF. This extra-anatomic procedure is an alternative method to the standard reconstruction of aortoiliac region when there are contraindications for general or local reasons. OBJECTIVE The objective of this paper is to show early and late results of AxFF bypass grafting as well as to show the indications for AxFF bypass. METHODS The sample consisted of 37 patients. The procedure was performed in 28 patients who suffered from aortoiliac occlusive disease and who were at high risk due to the comorbidity- in one patient with the rupture of juxtarenal aneurysm of abdominal aorta; in five patients with aortoenteric fistula, in two patients with iatrogenic lesion of abdominal aorta and in one female patient with anus preternaturalis definitivus who was treated for rectovaginal fistula. Donor's right axillary artery was used in 26 cases (70.3%, and donor's left axillary artery was used in 9 cases (29.7%. Dacron graft was used in 34 patients and Polytetrafluo-roethlylene graft was used in three patients. Simultaneously, profundo-plastic was done in four patients and femoro-popliteal bypass was performed in three patients. In five patients who suffered from aortoenteric fistula, simultaneous intervention of gastrointerstinal system has been done, x2 test was used for statistical evaluation and life table method was used for verification of late graft patency. RESULTS The rate of early postoperative mortality was 13.5%. The causes of death were: sepsis -1, MOFS - 3, and infarct myocardium -1. The mean follow up period was 40.1 months, ranging from six months to 17 years. During the follow up period, an early graft thrombosis was identified in two and late graft

  16. Uncalibrated pulse power analysis fails to reliably measure cardiac output in patients undergoing coronary artery bypass surgery

    OpenAIRE

    Broch, Ole; Renner, Jochen; Höcker, Jan; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Bein, Berthold

    2011-01-01

    Introduction Uncalibrated arterial pulse power analysis has been recently introduced for continuous monitoring of cardiac index (CI). The aim of the present study was to compare the accuracy of arterial pulse power analysis with intermittent transpulmonary thermodilution (TPTD) before and after cardiopulmonary bypass (CPB). Methods Forty-two patients scheduled for elective coronary surgery were studied after induction of anaesthesia, before and after CPB respectively. Each patient was monitor...

  17. Protective effects of N-acetylcystine on pulmonary microvascular permeability of lung injury in dog after cardiopulmonary bypass%N-乙酰半胱氨酸对体外循环后肺微血管通透性的保护作用

    Institute of Scientific and Technical Information of China (English)

    谢海辉; 陈淼; 屈献锋; 朱昭琼; 余志豪

    2008-01-01

    Objective To evaluate the protective effect on the pulmonary micmvascolar permeability and thereby to ameliorate the lungs injury attributed to cardiopuimonary bypass(CPB).Method Twenty-four adult hybrid health dogs were randomly divided into three groups(8 in each group):group C(normal saline given after CPB),group N1(NAC given intravenously just before CPB)and group N2(NAC given just after CPB).The changes of respiratory index(RI)and malondialdehyde(MDA)content in lung tissue were observed.Samples were taken three times,before CPB(T0),30 min after CPB surned off(T1)and 60 min after CPB sumed off(T2).The leucocyte count and slbumin content in bronchoalveolar lavage fluid(BAlF),the pulmonary micmvascular permeability index(PMPI),and the histological changes of lung under light microscope and electromicroscope in 3 groups were examined.Results No significant differences were found in the levels of Ri and MDA content of lung tissue between groups before CPB.However,they gradually reduced after CPB(P<0.05)in the three groups,but they still were significantly lower in group N1 and group N2 compared with those in group C at,T1 and T2(P<0.05)and those in group N1 were significantly lowere than those in group N2 at T1 and T2(P<0.05).MDA gradually increased after CPB in three groups(P<0.05),but it was still significantly lower in group N1 and group N2 than that in group C at T1 and T2(P<0.05).The leucocyte count and albumin content in BALF were significantly lower in group N1 and group N2 in comparison with those in group C(P<0.05)and they were significantly lower in group N1 compared with those in group N2(P<0.05).The PMPI were significantly lower in group N1 and sroup N2 compared with those in group C(P<0.05)and they were significantly lower in group N1 compared with those in group N2(P<0.05).By using electromicroscope,the apparent inflammatory change of lung with endothelium cellular swelling,inter-endothelial cells spaces widened,and the indistinctness,deformation or

  18. Hipercapnia acentuada durante circulação extracorpórea em cirurgia para revascularização do miocárdio: relato de caso Hipercapnia acentuada durante circulación extracorpórea en cirugía para revascularización del miocárdio: relato de caso Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization: case report

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    Maurício Serrano Nascimento

    2002-04-01

    ía estar conectado al cilindro de aire comprimido. CONCLUSIONES: Fallas mecánicas de los componentes del circuito de extracorpórea pueden ocurrir en el per-operatorio y exigen correcciones rápidas. Los avanzos tecnológicos en los equipamientos de anestesia, monitorización y normatizaciones de seguridad atenuaron la posibilidad de que casos como ese se repitan, más jamás substituirán la presencia vigilante del anestesiólogo.BACKGROUND AND OBJECTIVES: Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. CASE REPORT: A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg.kg-1. Anesthesia was induced with fentanyl (16 µg.kg-1, etomidate (0.3 mg.kg-1 and pancuronium (0.1 mg.kg-1, and was maintained with O2, isoflurane (0.5 - 1 MAC and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol.L-1; BE: 0 mmol.L-1; SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol.L-1; BE: -3 mmol.L-1; SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. CONCLUSIONS: Bypass circuit mechanical problems may

  19. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....

  20. Reposição volêmica intraoperatória: cristaloides versus coloides em revascularização cirúrgica do miocárdio sem circulação extracorpórea Reposición volémica intraoperatoria: cristaloides versus coloides en revascularización quirúrgica del miocardio sin circulación extracorpórea Intraoperative volume replacement: crystalloids versus colloids in surgical myocardial revascularization without cardiopulmonary bypass

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    Raquel Reis Soares

    2009-08-01

    study was to compare the effects of the intraoperative administration of crystalloids (normal saline - NS with those of colloids (modified fluid gelatin for surgical myocardial revascularization (SMR without cardiopulmonary bypass (CPB. METHODS: Forty patients undergoing SMR without CPB were randomly divided in two similar groups. The first group received modified fluid gelatin and NS and the second group received only NS. Urine output, hemoglobin level, intra- and postoperative bleeding, blood glucose levels, and intraoperative lactate in four distinct measurements were recorded. Postoperative morbidity and mortality, length of stay in the intensive care unit (ICU, and length of hospitalization were analyzed. RESULTS: Time to extubation in the gelatin group was 6.6 hours versus 7.3 hours in the NS group. The length of stay in the ICU was 2.4 days in the gelatin group versus 3.3 days in the NS group. The length of hospitalization was 10.3 days in the gelatin group versus 6.8 days in the NS group. The incidence of renal and respiratory complications, cardiac arrhythmias, myocardial infarctions, infections, reintubations, blood transfusions, and reoperation was the same in both groups. CONCLUSIONS: The use of colloids represented here by modified fluid gelatin associated with crystalloids or the use of crystalloids alone did not change the postoperative prognosis of patients undergoing SMR without CPB. Perhaps maintenance of the hemodynamic balance during the surgery is more important than the type of fluid administered.

  1. Efeito analgésico residual do fentanil em pacientes submetidos a revascularização do miocárdio com circulação extracorpórea Efecto analgésico residual del fentanil en pacientes sometidos a revascularización del miocárdio con circulación extracorpórea Residual analgesic effect of fentanyl in patients undergoing myocardial revascularization with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Adriana Machado Issy

    2002-09-01

    with cardiopulmonary bypass under general anesthesia with 50 µg.kg-1 intravenous fentanyl. Analgesia was evaluated by a numeric verbal scale at moments zero (extubation, 70 min, 3, 5, 8 and 12 hours in the first day; and moments zero (24 h after extubation, 70 min, 3, 5, 8 and 12 hours in second post-operative day. Pain intensity to vigorous cough and respiratory physical therapy was evaluated. At every measurement, patients were asked about the need for analgesic complementation. Plasma samples were collected in moments zero (extubation, 70 min, 3, 5, 8 and 12 hours during the first and second postoperative days for fentanyl radioimmunoassay. RESULTS: Mean pain intensity varied from 1.9 to 3.7 in the first day and from 2.1 to 3.8 in the second postoperative day. Fentanyl plasma levels (> 1 ng/ml evidenced its contribution to post-operative analgesia during the first postoperative day. CONCLUSIONS: In spite of the lack of correlation between residual fentanyl plasma concentration and pain intensity, patients referred only mild pain during the whole investigation period.

  2. Causas incomuns de instabilidade hemodinâmica durante revascularização miocárdica sem circulação extracorpórea Causas poco comunes de inestabilidad hemodinámica durante la revascularización miocárdica sin circulación extracorpórea Uncommon causes of hemodynamic instability during myocardial revascularization without cardiopulmonary bypass

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    Luciana Moraes dos Santos

    2010-02-01

    ón de la circulación extracorpórea (CEC, porque el destete de la CEC puede ser difícil en esos casos. El control intraoperatorio exige un ajuste hemodinámico estricto, y también puede ser eficaz, el uso del pinzamiento aórtico parcial para minimizar las alteraciones hemodinámicas. El objetivo fue relatar dos casos de inestabilidad hemodinámica durante la RM sin CEC, después del pinzamiento parcial de la aorta. RELATO DE LOS CASOS: En el primer caso, la paciente del sexo femenino presentaba un diámetro aórtico ligeramente reducido (2,8 cm, y el segundo paciente presentaba una fracción de eyección ventricular izquierda (FEVI de un 24% a la ecocardiografía. En los dos casos, observamos una importante hipotensión arterial y una elevación de la presión arterial pulmonar inmediatamente después del pinzamiento aórtico. Los equipos de cirugía recibieron el aviso y la inestabilidad hemodinámica de cada caso se resolvió después de la liberación del pinzamiento parcial de la aorta. Los pinzamientos posteriores se realizaron en una menor área aórtica y las anastomosis proximales se hicieron sin intercurrencias. CONCLUSIONES: Aunque las causas más frecuentes de la inestabilidad hemodinámica durante la RM sin CEC se refieran a la manipulación de la posición cardiaca y a las alteraciones de la precarga ventricular, en esos casos, la hipotensión arterial y la hipertensión pulmonar se debieron probablemente, a la reducción del débito cardíaco secundario, al aumento de la poscarga en pacientes con un diámetro reducido relativo de la aorta, o a la disfunción ventricular todos inclusive con pinzamiento parcial. El adecuado monitoreo intraoperatorio y la inmediata corrección de las alteraciones hemodinámicas, pueden minimizar la morbimortalidad quirúrgica.BACKGROUND AND OBJECTIVES: Myocardial revascularization (MR in patients with ventricular hypertrophy and/or dysfunction is frequently performed without cardiopulmonary bypass (CB, since it can be

  3. Physiological consequences : Cardiopulmonary, vestibular, and sensory aspects

    NARCIS (Netherlands)

    Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.

    2000-01-01

    Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high al

  4. Cardiopulmonary resuscitation: update, controversies and new advances

    Directory of Open Access Journals (Sweden)

    Zago Alexandre C.

    1999-01-01

    Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

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

    Directory of Open Access Journals (Sweden)

    Mohsen Mirmohammad-Sadeghi

    2009-01-01

    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.

  6. Anticoagulation management during cross-clamping and bypass.

    Science.gov (United States)

    Lander, H; Zammert, M; FitzGerald, D

    2016-09-01

    Anticoagulation is required for successful implementation of cardiopulmonary bypass (CPB), as well as for surgeries requiring temporary aortic occlusion. It is well established that both coagulation and fibrinolysis are activated during CPB (Teufelsbauer et al., 1992) [1]. Appropriate dosing, monitoring, and maintenance of anticoagulation are essential to prevent devastating thrombosis of the CPB circuit or the occluded aorta and to minimize the activation of the hemostatic system. Although numerous novel anticoagulants have been developed over the past decade, unfractionated heparin remains the primary anticoagulant utilized during these types of procedures, with monitoring systems primarily based upon the activated clotting time and/or heparin concentration. This article will review the current state of anticoagulation management during cross-clamp and CPB. PMID:27650345

  7. The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery

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    Boonstra Piet W

    2007-12-01

    Full Text Available Abstract Background Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. Methods A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a sliding scale protocol. Halfway the observation period, the dexamethasone protocol was changed. The single dose (1D group received a pre-operative dose of dexamethasone of 1 mg/kg. The double dose group (2D received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission. Results We included 116 patients in the 1D group and 158 patients in the 2D group. There were no significant baseline differences between the groups. Median Euroscore was 5. In univariable analysis, the glucose level was different between groups 1D and 2D at 4, 6, 9, 12 and 24 hours after ICU admission (all p Conclusion Dexamethasone exerts a hyperglycemic effect in cardiac surgery patients. Patients receiving high-dose corticosteroid therapy should be monitored and treated more intensively for hyperglycemic episodes.

  8. Pressure and oxygen debt on bypass - potential quality markers of perfusion?

    Science.gov (United States)

    Poullis, Mike; Palmer, K; Al-Rawi, O; Johnson, I; Ridgeway, T

    2012-05-01

    No markers of quality of perfusion pressure and oxygen delivery during cardiopulmonary bypass (CPB), to complement rewarming rate, maximum temperature on rewarming, lowest haematocrit, and blood glucose, exist. Using the electronic acquisition of blood pressure on bypass (JOCAP system), the percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, median, mode, standard deviation, variance, and average, maximum and cumulative oxygen debt were calculated. Numerous different readouts of achievement of maintenance of constant pressure on bypass and oxygen debt are now easily achievable with perfusion electronic data management systems. Mean, median, and mode offer poor discrimination of pressure control during CPB. Percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, and standard deviation all have discriminatory power, but need clinical correlation for their significance. A composite score involving non-pressure readouts (e.g. oxygen delivery, arterial and venous saturations, and flow rates) may need to be integrated into any perfusion quality marker. Assessment of adequacy of constant perfusion pressure and oxygen delivery may allow the scientific evaluation of pressure and oxygen delivery on bypass for patients to be compared accurately. Currently, in studies involving CPB, blood pressure targets are stated with no quantitative assessment of adequacy of achievement of these targets. Electronic data monitoring during cardiopulmonary bypass, when correlated with clinical outcome, may help to provide a marker of quality of perfusion pressure during CPB and may, indeed, allow patient-specific perfusion pressure strategies to be developed.

  9. Coronary Artery Bypass

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    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  10. Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

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    Kerem Yay

    2013-10-01

    Full Text Available Aim: Percutaneous coronary intervention is usually the initial treatment option for treatment of emergent and severe coronary atherosclerosis with suitable coronary arteries. We aimed to investigate the clinical features, morbidity and mortality rates of coronary artery bypass grafting performed following life-saving stent procedures and patency rates of these stents. Material and Method: Between January 2005 and December 2008, we performed coronary artery bypass grafting on 23 patients who had previous percutaneous coronary intervention to the culprit artery for acute myocardial infarction. Early postoperative coronary angiography was obtained for evaluation of stent patency. Results: In-hospital mortality occurred in five patients (21.7%. Coronary angiographic examination of the remaining patients revealed severe stenosis or occlusion at 16 out 20 stents (80%. The mean time interval between percutaneous coronary intervention and coronary artery bypass grafting was found to be statistically significant regarding stent patency (p=0.007. Discussion: Bypass grafting to a previously stented coronary artery may be the relevant approach even if the angiographic findings are normal, because intraoperative manipulation and systemic effects of cardiopulmonary bypass if used will result in deformity or occlusion of the stent.

  11. Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

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    Hafiz Abdul Moiz Fakih

    2016-02-01

    Full Text Available Background: Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB. Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation: We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion: Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.

  12. History of the evolution of cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    George Karlis

    2013-04-01

    Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references

  13. Spiritual Bypass: A Preliminary Investigation

    Science.gov (United States)

    Cashwell, Craig S.; Glosoff, Harriet L.; Hammond, Cheree

    2010-01-01

    The phenomenon of spiritual bypass has received limited attention in the transpersonal psychology and counseling literature and has not been subjected to empirical inquiry. This study examines the phenomenon of spiritual bypass by considering how spirituality, mindfulness, alexithymia (emotional restrictiveness), and narcissism work together to…

  14. Influência do emprego de albumina humana sobre a função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea Influencia del empleo de albúmina humana sobre la función pulmonar de pacientes sometidos a la cirugía cardíaca con circulación extracorpórea Influence of human albumin on pulmonary function of patients submitted to heart surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Hugo Leonardo de Moura Luz

    2004-08-01

    hidratación en el período pós-CEC. La relación entre la presión arterial de oxígeno y su fracción inspirada (PaO2/FiO2, o gradiente alvéolo-arterial de oxígeno (GA-aO2 y el shunt pulmonar fueron evaluados después de la inducción anestésica, al final de la cirugía y en el primer y segundo día de pós-operatorio y comparados en los dos grupos a través de Análisis de Variancia para medidas repetidas (p BACKGROUND AND OBJECTIVES: Human albumin in heart surgeries with cardiopulmonary bypass (CPB is controversial although being a frequent procedure. This study aimed at evaluating the effects of human albumin on pulmonary gaseous exchange function in patients submitted to myocardial revascularization with CPB. METHODS: Participated in this study 20 patients randomly distributed in two groups according to CPB perfusate solution: control group (n = 10 - total dilution with lactated Ringer's solution, also used for intraoperative hydration; albumin group (n = 10 - 20 g human albumin were added to CPB perfusate or as part of post-CPB hydration. Oxygen arterial tension and inspired fraction ratio (PaO2/FiO2, oxygen alveolar-arterial gradient (GA-aO2 and pulmonary shunt were evaluated after anesthetic induction, at surgery completion and in the first and second postoperative day and were compared in both groups by Analysis of Variance for repeated measures (p < 0.05. RESULTS: Both groups were comparable in preoperative characteristics, CPB and surgery duration. PaO2/FiO2, GA-aO2 and pulmonary shunt values were not statistically different between groups. CONCLUSIONS: Our study has shown that the addition of human albumin to CPB perfusate or as part of intraoperative hydration during myocardial revascularization with cardiopulmonary bypass has not improved pulmonary function. Since albumin is expensive, its routine use is not justified.

  15. Efeitos hemodinâmicos da combinação de dexmedetomidina-fentanil versus midazolam-fentanil em crianças submetidas à cirurgia cardíaca com circulação extracorpórea Efectos hemodinámicos de la combinación de dexmedetomidina-fentanil versus midazolam-fentanil en ninõs sometidos a la cirugía cardíaca con circulación extracorpórea Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2010-08-01

    íaca con circulación extracorpórea (CEC en niños. MÉTODO: Treinta y dos niños, con edad entre 1 mes y 10 años, citados para cirugía cardíaca con circulación extracorpórea, que fueron distribuidos aleatoriamente en dos grupos: el Grupo MDZ recibió midazolam 0,2 mg.kg-1.h-1, mientras que el Grupo DEX recibió dexmedetomidina 1 µg.kg-1.h-1 durante una hora y enseguida el ritmo de infusión se redujo a la mitad en los dos grupos. Los dos grupos recibieron fentanil 10 µg. kg-1, midazolam 0,2 mg.h-1 y vecuronio 0,2 mg.kg-1 para la inducción de la anestesia. Las mismas dosis de fentanil con vecuronio de la inducción fueron infundidas durante la primera hora después de la inducción y enseguida reducidas a la mitad. Las infusiones fueron iniciadas inmediatamente después de la inducción y mantenidas hasta el final de la cirugía. El isoflurano se administró por un corto tiempo para el control de la respuesta hiperdinámica a la incisión y esternotomía. RESULTADOS: En los dos grupos, la presión arterial sistólica y la frecuencia cardíaca se redujeron ostensiblemente después de una hora de infusión anestésica, pero el aumento de la presión arterial sistólica y diastólica y el de la frecuencia cardíaca al momento de la incisión de la piel, fueron significantemente menores en el Grupo DEX. Un número significativamente menor de pacientes exigió un suplemento con isoflurano en el Grupo DEX. Después de la CEC, los pacientes de los dos grupos tuvieron respuestas hedominámicas similares. CONCLUSIONES: La infusión sin bolo de dexmedetomidina parece ser un adyuvante efectivo del fentanil en la promoción de la sedación y el control de las respuestas hemodinámicas durante la cirugía para las cardiopatías congénitas en niños.BACKGROUND AND OBJECTIVES: To evaluate the efficacy of the combined infusion of dexmedetomidine and fentanyl on the hemodynamic response during cardiac surgery with cardiopulmonary bypass (CPB in children. METHODS: Thirty

  16. Survival after in-hospital Cardiopulmonary Resuscitation

    OpenAIRE

    M Adib Hajbaghery; H. Akbari; GA. Mousavi

    2005-01-01

    Background: During recent years, cardiopulmonary resuscitation (CPR) in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and unt...

  17. Conversion of cardiac bypass into an extracorporeal membrane oxygenation circuit: a case from Pakistan.

    Science.gov (United States)

    Rasheed, Riffat; Hidayat, Ijaz; Amanullah, Muneer; Hasan, Babar Sultan

    2014-05-01

    A 35 days old neonate with d-loop transposition of great arteries, underwent an arterial switch operation following which he developed hypotension attributed to left ventricular failure. During cardiopulmonary resuscitation decision was made to place him on cardiac bypass again. Due to limited resources and unavailability of a specialized extracorporeal membrane oxygenator machine, the CPB was modified and converted an ECMO. The neonate was successfully decannulated after 72 hours and discharged home after 3 weeks of the operation without any sequel. ECMO is a viable option in developing countries and may help in improving the outcome especially in neonatal congenital heart disease.

  18. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  19. Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients

    NARCIS (Netherlands)

    Tigchelaar, Izaak; Huet, Rolf C. G. Gallandat; Boonstra, Piet W.; van Oeveren, Willem

    1998-01-01

    Ten per cent low molecular weight hydroxyethyl starch is a plasma substitute only recently used as priming solution in an extracorporeal circuit, in contrast to human albumin and gelatin. To evaluate the effect of priming solutions on haemodynamics and colloid osmotic pressure, we studied 36 patient

  20. Cold intermittent cardioplegia reduces the acidosis during prolonged cardiac surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Nollo, Giandomenico; Ferrari, Paolo; Graffigna, Angelo C

    2011-01-01

    The effect on acid-base balance efficacy of intermittent warm and cold blood cardioplegia (IWBC, ICBC) was assessed in 44 patients who underwent cardiac surgery with prolonged aortic cross clamping. With this purpose a customized multi sensor probe was inserted in the coronary sinus, and pH, PO(2), PCO(2) and temperature were continuously measured at 1 Hz sampling rate. The mean cross-clamping time was of 76 ± 26 min on 19 IWBC cases and of 80 ± 24 min on 14 ICBC cases. With IWBC perfusion, at the end of every ischemic period, the lowest pH and PO(2) progressively decreased and the maximal PCO(2) increased. During ICBC the minimum of pH and PO(2) and maximum of PCO2 at the end of different ischemic period during time were constant, also during long cross-clamping time. With IWBC, myocardial ischemia seemed not completely reversed by standardized reperfusions, as reflected by steady deterioration of PCO(2) and pH after each reperfusion.

  1. Comparison of three early biomarkers for acute kidney injury after cardiac surgery under cardiopulmonary bypass

    OpenAIRE

    Moriyama, Takahiro; Hagihara, Shintaro; Shiramomo, Toko; Nagaoka, Misaki; Iwakawa, Shohei; Kanmura, Yuichi

    2016-01-01

    Background Acute kidney injury (AKI) is a serious complication after cardiac surgery, being associated with a high mortality. We assessed three urinary biomarkers, L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and angiotensinogen, which are elevated through different mechanisms, and investigated which of these biomarkers was the earliest and most useful indicator of AKI after cardiac surgery. Methods This study was a prospective observational s...

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

    OpenAIRE

    Melchior, Richard

    2016-01-01

    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 oxy...

  3. Amylase:creatinine clearance ratios, serum amylase, and lipase after operations with cardiopulmonary bypass.

    Science.gov (United States)

    Smith, C R; Schwartz, S I

    1983-09-01

    Forty-two adults who underwent cardiac operations were studied prospectively for evidence of clinical or subclinical pancreatitis. Clinically detectable pancreatitis was not seen. Serum amylase and lipase levels did not change significantly following operation. The amylase:creatinine clearance ratio (ACCR) immediately following operation was abnormally elevated in 31% of the samples obtained, and the mean ACCR increased from 2.08 +/- 1.85% before operation to 6.2% +/- 6.77% (P less than 0.05). An abnormally elevated ACCR was most often associated with a low urine creatinine concentration. The mean urine creatinine level decreased significantly from 78 +/- 53 mg/dl before operation to 38 +/- 49 mg/dl immediately following operation (P less than 0.02), and 73% of the samples obtained at that time had an abnormally low urine creatinine level (P less than 0.01). The abnormalities observed in ACCR and urine creatinine could not be related to any of several variables presumed to reflect the degree of perioperative physiologic stress, nor could they be related to postoperative hemodynamic performance. It was concluded that ACCR rises following cardiac operation because of perioperative changes in renal function, and not as a reflection of subclinical pancreatic injury.

  4. Amylase:creatinine clearance ratios, serum amylase, and lipase after operations with cardiopulmonary bypass.

    Science.gov (United States)

    Smith, C R; Schwartz, S I

    1983-09-01

    Forty-two adults who underwent cardiac operations were studied prospectively for evidence of clinical or subclinical pancreatitis. Clinically detectable pancreatitis was not seen. Serum amylase and lipase levels did not change significantly following operation. The amylase:creatinine clearance ratio (ACCR) immediately following operation was abnormally elevated in 31% of the samples obtained, and the mean ACCR increased from 2.08 +/- 1.85% before operation to 6.2% +/- 6.77% (P less than 0.05). An abnormally elevated ACCR was most often associated with a low urine creatinine concentration. The mean urine creatinine level decreased significantly from 78 +/- 53 mg/dl before operation to 38 +/- 49 mg/dl immediately following operation (P less than 0.02), and 73% of the samples obtained at that time had an abnormally low urine creatinine level (P less than 0.01). The abnormalities observed in ACCR and urine creatinine could not be related to any of several variables presumed to reflect the degree of perioperative physiologic stress, nor could they be related to postoperative hemodynamic performance. It was concluded that ACCR rises following cardiac operation because of perioperative changes in renal function, and not as a reflection of subclinical pancreatic injury. PMID:6193594

  5. A NEW APPROACH TO SOLVING GENERAL ANAESTHESIA INDIVIDUALIZATION PROBLEM DURING SURGICAL OPERATIONS WITH CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    V. M. Magilevets

    2009-01-01

    Full Text Available The computerized system to control depth of anesthesia during surgical operation was developed in our research center. The depth of anesthesia is regulated by controlled intravenous infusion of propofol. The varied propofol rate is controlled by the closed-loop propofol system (CLPS with mean arterial pressure (MAP controller. MAP is used in the CLPS as input parameter and indicator of anesthesia depth. CLPS consists PC, invasive blood pressure (BP sensor and Graseby 3400 infusion pump. The C language computer program sets the propofol infusion rate based on empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP. The propofol concentrations are calculated by Runge–Kutta’s method PK/PD model differential equations solving with Marsh’s microconstants and Kazama’s BIS effect site microconstant and age depended BP effect site microconstants every 30 s. The designed CLPS was effective and useful for anesthesia maintenance during open-heart surgery, especially for early extubation. 

  6. SURGICAL CORRECTION OF HEART VALVE DISEASE WITH CARDIOPULMONARY BYPASS IN PATIENTS AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. A. Belokurov

    2013-01-01

    Full Text Available Aim. Evaluation of the possibility heart valve replacement in renal transplant recipients from a position of safe- ty for graft function. Materials and methods. 5 patients, heart valve replacement was performed with a func- tioning kidney transplant at a satisfactory its function. The average age of patients at the time of cardiac surgery was 38,8 ± 12,6 years, among whom were two (40% men and 3 (60% women. The interval between renal transplantation and heart surgery was 40,3 ± 44,1 (2 to 120 months. Prior to kidney transplantation, all patients were on renal replacement therapy with hemodialysis program for 50,2 ± 48,6 months. In 4 of the 5 patients of heart disease was the cause of infective endocarditis. Results. Average time IR was 81,2 ± 21,7 minutes , the average time of aortic clamping 63,6 ± 20,9 minutes and hypothermia during CPB 29,2 ± 3,2 °C. All patients were implanted with double-leaf mechanical prostheses "MedEng-2" and "SarboMedics". All 5 patients in sa- tisfactory condition were discharged from the hospital. The average duration of the postoperative period was 14,2 ± 3,4 days. All patients had relatively smooth flow after surgery, no infectious complications, a satisfactory renal transplant function and prosthetic heart valves. In the late period in four patients and transplant graft func- tion is satisfactory in terms of the observation of 5 years, 3 years and 6 months after surgery. Conclusion. Our experience shows the possibility of successful correction of heart defects in IR in renal transplant recipients. 

  7. A comparison of urinary neutrophil gelatinase-associated lipocalin in patients undergoing on- versus off-pump coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Wagener, Gebhard; Gubitosa, Gina; Wang, Shuang;

    2009-01-01

    OBJECTIVE: The purpose of this study was to compare urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in off-pump and on-pump coronary artery bypass graft (CABG) surgery. DESIGN: A matched cohort study. SETTING: A tertiary university hospital. PARTICIPANTS: Thirty adult patients...... undergoing CABG surgery without cardiopulmonary bypass (off-pump) matched to 30 patients with on-pump CABG surgery by age, preoperative serum creatinine, Parsonnet score, ejection fraction, body mass index, and number of coronary artery grafts. INTERVENTIONS: None, observational. MEASUREMENTS AND MAIN...

  8. Coronary artery bypass grafting in a patient with hemophilia B: continuous recombinant factor IX infusion as per the Japanese guidelines for replacement therapy.

    Science.gov (United States)

    Suzuki, Tomoyuki; Kawamoto, Shunsuke; Kumagai, Kiichiro; Adachi, Osamu; Kanda, Keisuke; Ishikawa, Masaaki; Okitsu, Yoko; Harigae, Hideo; Kurosawa, Shin; Saiki, Yoshikatsu

    2016-08-01

    We herein report our experience of successfully managing the hemostatic system by controlling serum factor IX levels throughout the perioperative period in a patient with hemophilia B. Coronary artery bypass grafting with cardiopulmonary bypass was planned for a 52-year-old man with moderate severity of hemophilia B. During surgery, recombinant factor IX (rFIX; BeneFIX(®) Pfizer Japan inc., Tokyo, Japan) was administered by bolus infusion followed by continuous infusion as per the guidelines of the Japanese Society on Thrombosis and Hemostasis. The operative course was uneventful without any considerable bleeding or complications. PMID:25523881

  9. Coronary artery bypass grafting and sensorineural hearing loss, a cohort study

    Directory of Open Access Journals (Sweden)

    Ashraf Omer

    2005-12-01

    Full Text Available Abstract Background Sudden sensorineural hearing loss is routinely encountered by the otologist. The etiology is varied and often identifiable. One of the relatively less frequent causes is surgery. Apart from being an established entity with otological surgeries, sensorineural hearing loss has also been known to occur after non-otological procedures under general anesthesia. Commonest amongst these procedures is cardiopulmonary bypass, an association that has long been recognized. However, despite the proposition of diverse hypotheses in the past, the pathophysiology remains unclear. Methods The study is a prospective matched cohort study that will be carried out in Aga Khan University Hospital, Karachi, Pakistan. Participants among exposed would include all those patients who would be undergoing coronary artery bypass surgery in the hospital who fall under the criteria for inclusion. Unexposed group would comprise of patients undergoing a non-bypass procedure of similar duration under the same type of anesthesia who meet the selection criteria. Both these groups will undergo audiometric testing at our hospital on three different occasions during the course of this study. Initially before the procedure to test the baseline hearing capacity; then one week after the procedure to assess any changes in hearing ability following the surgery; and finally a third audiogram at six weeks follow-up to assess further changes in any hearing deficits noted during the second phase of testing. Certain variables including the subjects' demographics and those concerning the procedure itself will be noted and used later for risk factors analysis. A detailed past medical and surgical history will also be obtained. Data analysis would include calculation of relative risk and significance of the results, by running the chi-square test. Other statistical tests like Fisher exact test may then be employed to facilitate data interpretation. Continuous scale may then be

  10. Comparison of the effects of on-pump and off-pump coronary artery bypass surgery on cerebral oxygen saturation using near-infrared spectroscopy

    OpenAIRE

    Demir, Guray; Çukurova, Zafer; Eren, Gülay; Hergünsel, Oya

    2014-01-01

    Background Central nervous system complications are the most clinically important of those affecting mortality in patients undergoing coronary artery surgery. Newly developed sophisticated techniques and surgical interventions obviating the need for cardiopulmonary pumps have facilitated avoidance of these complications. In this study, we compared the impact of on-pump and off-pump coronary artery bypass surgery on cerebral oxygenation using near-infrared spectroscopy. Methods This study incl...

  11. 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

    OpenAIRE

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

    2015-01-01

    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...

  12. MEASUREMENT OF CARDIOPULMONARY FUNCTION BY REBREATHING METHODOLOGY IN PIGLETS

    Science.gov (United States)

    The use of a multiple gas rebreathing method for the measurement of cardiopulmonary function in mechanically ventilated neonates was evaluated. The following indices of cardiopulmonary function were assessed in 20 piglets (mean weight, 2.3 kg): (1) pulmonary capillary blood flow ...

  13. CK-MB release following coronary artery bypass grafting in the absence of myocardial infarction.

    Science.gov (United States)

    Lee, M E; Sethna, D H; Conklin, C M; Shell, W E; Matloff, J M; Gray, R J

    1983-03-01

    Elevation of levels of the myocardial-specific isoenzyme of creatine kinase (CK-MB) in the immediate postoperative period in patients undergoing coronary artery bypass grafting is usually associated with myocardial necrosis. However, mean isoenzyme elevations of 18 +/- 2 IU/L (standard error of the mean) were recently observed in 6 patients in the absence of electrocardiographic or scintigraphic (technetium 99m stannous pyrophosphate) evidence of perioperative myocardial infarction. To test the hypothesis that surgical trauma of the atrium and aorta during cannulation for cardiopulmonary bypass might contribute to elevated CK-MB levels, biopsy of the right atrial appendage and aorta of 7 patients was done at operation, the tissue samples were assayed for total creatine kinase (CK) activity using the Rosalki technique, and for CK-MB using column chromatography. The results indicate that the human atrium is a rich source of CK, with the proportion of CK-MB similar to that present in the ventricle (20%). In addition, technical considerations inherent in the performance of coronary bypass surgery may result in release of CK-MB, causing elevated serum enzyme levels in the post-coronary artery bypass patient in the absence of myocardial infarction.

  14. Awake off-pump coronary artery bypass surgery in 25 patients

    Institute of Scientific and Technical Information of China (English)

    GUO Huiming(郭惠明); Murali Chakravarthy; Vivek Jawali; K Jayaprakash; NV Shivananda

    2003-01-01

    Objectives To test the fea-sibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotony. There was no mortality. Mean length of stay in the intensive care tnit was 16.2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypassesin conscious patients without endotracheal general an esthesia.

  15. Bypass Rewiring and Robustness of Complex Networks

    CERN Document Server

    Park, Junsang

    2016-01-01

    A concept of bypass rewiring is introduced and random bypass rewiring is analytically and numerically investigated with simulations. Our results show that bypass rewiring makes networks robust against removal of nodes including random failures and attacks. Especially, random bypass rewiring connects all nodes except the removed nodes on an even degree infinite network and makes the percolation threshold $0$ for arbitrary occupation probabilities. In our example, the even degree network is more robust than the original network with random bypass rewiring while the original network is more robust than the even degree networks without random bypass. We propose a greedy bypass rewiring algorithm which guarantees the maximum size of the largest component at each step, assuming which node will be removed next is unknown. The simulation result shows that the greedy bypass rewiring algorithm improves the robustness of the autonomous system of the Internet under attacks more than random bypass rewiring.

  16. Bypass rewiring and robustness of complex networks

    Science.gov (United States)

    Park, Junsang; Hahn, Sang Geun

    2016-08-01

    A concept of bypass rewiring is introduced, and random bypass rewiring is analytically and numerically investigated with simulations. Our results show that bypass rewiring makes networks robust against removal of nodes including random failures and attacks. In particular, random bypass rewiring connects all nodes except the removed nodes on an even degree infinite network and makes the percolation threshold 0 for arbitrary occupation probabilities. In our example, the even degree network is more robust than the original network with random bypass rewiring, while the original network is more robust than the even degree networks without random bypass. We propose a greedy bypass rewiring algorithm which guarantees the maximum size of the largest component at each step, assuming which node will be removed next is unknown. The simulation result shows that the greedy bypass rewiring algorithm improves the robustness of the autonomous system of the Internet under attacks more than random bypass rewiring.

  17. Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing

    Directory of Open Access Journals (Sweden)

    Michael K. Stickland

    2012-01-01

    Full Text Available The cardiopulmonary exercise test (CPET is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption (V˙O2max is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation (V˙O2 = cardiac output × arterial-venous O2 content difference. In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.

  18. In situ bypass og diabetes

    DEFF Research Database (Denmark)

    Jensen, Leif Panduro; Schroeder, T V; Lorentzen, J E

    1993-01-01

    From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p...... decreased survival rate was found in diabetics (p bypass technique very useful in the treatment of critical ischaemia of the lower limb in diabetic patients. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non...

  19. Doppler spectral characteristics of infrainguinal vein bypasses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; von Jessen, F; Sillesen, H;

    1993-01-01

    With the aim of assessing the velocity profile of femoropopliteal and femorocrural vein bypasses, 128 patients undergoing infrainguinal vein bypass surgery entered a postoperative Duplex surveillance protocol, which included clinical assessment and Duplex scanning, using Doppler spectral analysis...

  20. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Papasavas, Pavlos K; Yeaney, Woodrow W; Caushaj, Philip F; Keenan, Robert J; Landreneau, Rodney J; Gagné, Daniel J

    2003-10-01

    Access to the bypassed stomach is difficult following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The bypassed stomach is not readily available for endoscopic or radiographic evaluation. Diagnosis and treatment of peptic ulcer disease and its complications in the excluded stomach becomes difficult. We present a case of perforation in the bypassed stomach following LRYGBP secondary to peptic ulcer disease.

  1. Automated cardiopulmonary resuscitation: a case study.

    Science.gov (United States)

    Spiro, Jon; Theodosiou, Maria; Doshi, Sagar

    2014-02-01

    Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices.

  2. 40 CFR 403.17 - Bypass.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Bypass. 403.17 Section 403.17... GENERAL PRE-TREAT-MENT REGULATIONS FOR EXIST-ING AND NEW SOURCES OF POLLUTION § 403.17 Bypass. (a) Definitions. (1) Bypass means the intentional diversion of wastestreams from any portion of an Industrial...

  3. Undiagnosed phaeochromocytoma following infrainguinal bypass surgery

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1998-01-01

    We present a rare case of undiagnosed phaeochromocytoma following infrainguinal bypass surgery. The patient, a 59-year-old lady, had a one year history of hypertension following a first femoro-tibial bypass and presented as a cardiorespiratory emergency in the admission room following her...... contralateral femoro-tibial bypass. The patient recovered after some days in intensive care despite a delayed diagnosis....

  4. Evaluation of coma patients after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping

    2005-01-01

    Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.

  5. Interventions in Infrainguinal Bypass Grafts

    International Nuclear Information System (INIS)

    The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft

  6. Deep-water sediment bypass

    NARCIS (Netherlands)

    Stevenson, Christopher J.; Jackson, Christopher A L; Hodgson, David M.; Hubbard, Stephen M.; Eggenhuisen, Joris T.

    2015-01-01

    Submarine gravity flows are a key process for transporting large volumes of sediment from the continents to the deep sea. The location, volume, and character of the sediment bypassed by these flows dictates the areal extent and thickness of the associated deposits. Despite its importance, sediment b

  7. Cardiopulmonary disease in the geriatric dog and cat

    International Nuclear Information System (INIS)

    The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs

  8. Cardiopulmonary function and scoliosis severity in idiopathic scoliosis children

    OpenAIRE

    Huh, Seokwon; Eun, Lucy Yougmin; Kim, Nam Kyun; Jung, Jo Won; Choi, Jae Young; Kim, Hak Sun

    2015-01-01

    Purpose Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. Methods Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thora...

  9. Bypass materials in vascular surgery

    Directory of Open Access Journals (Sweden)

    Willich, Stephan N.

    2006-03-01

    Full Text Available Introduction: Arteriosclerotic changes can lead to circulatory disturbances in various areas of the human vascular system. In addition to pharmacological therapy and the management of risk factors (e. g. hypertension, diabetes, lipid metabolism disorders, and lifestyle, surgical interventions also play an important role in the treatment of arteriosclerosis. Long-segment arterial occlusions, in particular, can be treated successfully with bypass sur-gery. A number of different materials are available for this type of operation, such as autologous vein or pros-thetic grafts comprised of polytetrafluoroethylene (PTFE or Dacron®. Prosthetic materials are used especially in the treatment of peripheral artery disease, such as in aortoiliac or femoropopliteal bypass surgery. The present report will thus focus on this area in order to examine the effectiveness of different bypass materials. Among the efforts being made to refine the newly introduced DRG system in Germany, analysing the different bypass materials used in vascular surgery is particularly important. Indeed, in its current version the German DRG system does not distinguish between bypass materials in terms of reimbursement rates. Differences in cost structures are thus of especial interest to hospitals in their budget calculations, whereas both private and statutory health insurance funds are primarily interested in long-term results and their costs. Objectives: The goal of this HTA is to compare the different bypass materials used in vascular surgery in terms of their medical efficiency and cost-effectiveness, as well as with regard to their ethical, social and legal implications. In addition, this report aims to point out the areas in which further medical, epidemiological and health economic research is still needed. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information

  10. Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Elayne Kelen de Oliveira

    2013-09-01

    Full Text Available INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P 3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17 and smoking (OR=4.07 were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10 was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction 24 hours for the intensive care unit and presence of infection for the ward.

  11. On Pump versus Off Pump Coronary Artery Bypass Surgery in Patients Over Seventy Years Old with Triple Vessels Disease and Severe Left Ventricle Dysfunction: Focus on Early Clinical Outcomes

    OpenAIRE

    Seyed Jalil Mirhosseini; Seyed Khalil Forouzannia; Sadegh Ali-Hassan-Sayegh; Mehdi Hadad-Zadeh; Mohammad Hassan Abdollahi; Hossein Moshtaghiom; Habiballah Hosseini

    2013-01-01

    Cardiovascular disease is the leading reason of morbidity in older people. Coronary artery bypass graft (CABG) surgery is the most common type of operations in world. This study was designed to characterize comparison of early clinical outcome following on pump vs. off pump in patients over 70 years old with triple vessels disease and severe left ventricle dysfunction. 80 patients were divided into two groups: In group A (n=40) on pump CABG was performed with hypothermic cardiopulmonary bypas...

  12. Cardiopulmonary effects of intermittent mandatory ventilation.

    Science.gov (United States)

    Douglas, M E; Downs, J B

    1980-01-01

    IMV is a combination of spontaneous and mechanical ventilation. For numerous reasons, IMV is potentially more advantageous than conventional techniques. By maintaining spontaneous breathing, mechanical augmentation can be titrated to adjust alveolar minute ventilation levels to normal, thereby decreasing the incidence of respiratory alkalemia. There are major differences between the cardiopulmonary effects of IMV and conventional mechanical ventilation. Spontaneous inspiration decreases Ppl and results in better distribution of inspired gas, a better V/Q, and less physiological dead space. In addition, transmural filling pressures, venous return, and cardiac output are more normal than during conventional mechanical ventilation. Maintenance of spontaneous ventilation lowers mean Paw and pulmonary vascular resistance. If venous admixture occurs, it can be minimized by titrating PEEP. Thus, more effective therapy for hypoxemia is possible. If spontaneous breathing is to persist and be efective, work-of-breathing must be minimized. This can be accomplished best when a continuous flow of gas provides optimal CPAP to maintain FRC and to minimize the effects of decreased compliance without depressing cardiac function. PMID:7007253

  13. The Cardiopulmonary effect of passive movement

    Directory of Open Access Journals (Sweden)

    L. Loram

    2002-02-01

    Full Text Available Eleven articles were reviewed on the cardiopulmonary effects of passive movements. These included two articles on theneurological effects of passive movements. Of the eleven articles, four were considered to have level II evidence in accordance with Sackett’s rules of evidence. There was little consensus regarding the rate or duration of passive movements. There were some suggestions that upper limb movement produces a greater ventilatory response than lower limb movement. There was a statistically significant increase (p< 0.05 in minute ventilation when the movement was done at a rate of 40 repetitions per minute or more, but this change may not be clinically significant. Passive movements were not detrimental to neurosurgical patients with a normal or slightly elevated intracranial pressure, although the values of the intracranial pressure were not stated.  The studies were limited in that eight of the eleven had small sample sizes and most studies were conducted using normal subjects. Further studies with higher levels of evidence need to be  conducted to verify any results reported to date in the literature. Studies that are relevant to clinical practice also need to be conducted in populations such as sedated intensive care patients.

  14. Cardiopulmonary Exercise Testing in Heart Failure.

    Science.gov (United States)

    Malhotra, Rajeev; Bakken, Kristian; D'Elia, Emilia; Lewis, Gregory D

    2016-08-01

    Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET) precisely defines maximum exercise capacity through measurement of peak oxygen uptake (VO2). Peak VO2 values have a critical role in informing patient selection for advanced HF interventions such as heart transplantation and ventricular assist devices. Oxygen uptake and ventilatory patterns obtained during the submaximal portion of CPET are also valuable to recognize because of their ease of ascertainment during low-level exercise, relevance to ability to perform activities of daily living, independence from volitional effort, and strong relationship to prognosis in HF. The ability of peak VO2 and other CPET variables to be measured reproducibly and to accurately reflect HF severity is increasingly recognized and endorsed by scientific statements. Integration of CPET with invasive hemodynamic monitoring and cardiac imaging during exercise provides comprehensive characterization of multisystem reserve capacity that can inform prognosis and the need for cardiac interventions. Here, we review both practical aspects of conducting CPETs in patients with HF for clinical and research purposes as well as interpretation of gas exchange patterns across the spectrum of preclinical HF to advanced HF. PMID:27289406

  15. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  16. The study of neuropsychological alterations following coronary artery bypass operation as predicted by computed tomography scan of the brain

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Atsushi; Sato, Kiyoharu (Sendai Tokushu-kai Hospital (Japan)); Sadahiro, Mitsuaki; Endo, Masato; Yokoyama, Hitoshi; Ohmi, Mikio

    1993-01-01

    The objective of this clinical study is to provide information regarding the association between coexistent cerebrovascular disease and neuropsychological abnormalities after coronary artery bypass operations. Computed tomography scan of the brain was performed in 104 patients pre-operatively, and their post-operative neuropsychological functions were evaluated. The patients were categorized as follows according to the CT findings. Seventy-three patients showed normal or slight cerebral cortical atrophy which usually seen in patients over fifty of age (group A). Sixteen showed moderate or severe cortical atrophy (group B). Fifteen patients demonstrated the characteristic findings of Binswanger type; severe white matter hypodensity especially in frontal horns and dilated ventricles (group C). Overt neuropsychological dysfunction was not observed in patients in groups A and B. Six patients in group C showed a combination of dementia, bizarre behavior, disorientation and gait dyspraxia following bypass operations. The pseudobulbar signs were also found in 3 patients. These clinical abnormalities persisted for six days to three weeks, and were most often reversible. Although the underlying mechanism of these deleterious alterations is not elucidated, the ischemic nature of the characteristic white matter lesions was highly suspected. The arteriosclerotic changes of the arteriole of the cerebral cortex and hypoperfusion during cardio-pulmonary bypass were supposed to be responsible. Therefore it was concluded that special attention should be focused on neurological evaluation for bypass surgery in group C patients. (author).

  17. Perioperative Changes of Plasma Endothelin-1 in Patients Undergoing Coronary Artery bypass Grafting and the Effect of Nitroglycerin

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 蒋英硕; 徐明; 陈振强; 郭子黄

    2002-01-01

    Objectioe To observe the dynamic changes of the plasma ET-1 and the effect of low dose nitroglycerin in patients with coronary artery bypass surgery. Methods Forty patravenous nitroglycerin 1 μg @ kg-1 @ rain-1 perioperatively. RIA was used to assay the plasma ET-1 lev-el. All the hemodynamie parameters were recorded by the Swan-Ganze catheter. Results The preoperative plasma ET-1 level in patients with coronary artery disease was significantly higher than the normal level. Five minutes after cardiopalmouary bypass in these patients the plasma ET-1 level was increased significantly until 6 to 8 h after operation. The increasing plasma ET-1 level in group B was less intense than that in group A. There was a positive correlation between the plasma ET-1 level and the mean pulmonary artery pressure in group A 2 and 8 h after operation. Conclusion In patients undergoing coronary artery bypass surgery, the increased plasma ET-1 level may be due to the influence of cardiopulmonary bypass partly. Low dose nitroglycerin is beneficial to these patients.

  18. End tidal CO2 versus arterial CO2 monitoring in patients undergoing coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Hassani E

    2009-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Measuring end tidal carbon dioxide (ETCo2 is one of the methods used for estimating arterial carbon dioxide (PaCo2 during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation."n"nMethods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73 years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0 and after (T1 cardiopulmonary bypass."n"nResults: Mean P(a-ETCo2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2 during, before and after cardiopulmonary bypass (p>0.870. Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0

  19. Epidemiology of coronary artery bypass grafting at the Hospital Beneficência Portuguesa, São Paulo

    Directory of Open Access Journals (Sweden)

    Alexandre Gonçalves de Sousa

    2015-02-01

    Full Text Available Introduction: The knowledge of the prevalence of risk factors and comorbidities, as well as the evolution and complications in patients undergoing coronary artery bypass graft allows comparison between institutions and evidence of changes in the profile of patients and postoperative evolution over time. Objective: To profile (risk factors and comorbidities and clinical outcome (complications in patients undergoing coronary artery bypass graft in a national institution of great surgical volume. Methods: A retrospective cohort study of patients undergoing coronary artery bypass graft in the hospital Beneficência Portuguesa de São Paulo, from July 2009 to July 2010. Results: We included 3,010 patients, mean age of 62.2 years and 69.9% male. 83.8% of patients were hypertensive, 36.6% diabetic, 44.5% had dyslipidemia, 15.3% were smokers, 65.7% were overweight/obese, 29.3% had a family history of coronary heart disease. The expected mortality calculated by logistic EuroSCORE was 2.7%. The isolated CABG occurred in 89.3% and 11.9% surgery was performed without cardiopulmonary bypass. The most common complication was cardiac arrhythmia (18.7%, especially acute atrial fibrillation (14.3%. Pneumonia occurred in 6.2% of patients, acute renal failure in 4.4%, mediastinites in 2.1%, stroke in 1.8% and AMI in 1.2%. The in-hospital mortality was 5.4% and in isolated coronary artery bypass graft was 3.5%. The average hospital stay was 11 days with a median of eight days (3-244 days. Conclusion: The profile of patients undergoing coronary artery bypass graft surgery in this study is similar to other published studies.

  20. Extracorporeal Cardiopulmonary Resuscitation: Predictors of Survival

    Science.gov (United States)

    Kim, Dong Hee; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2016-01-01

    Background The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). Methods Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. Results Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). Conclusion These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients. PMID:27525236

  1. Teamwork and leadership in cardiopulmonary resuscitation.

    Science.gov (United States)

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan

    2011-06-14

    Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

  2. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Bouwes Aline

    2012-08-01

    Full Text Available Abstract Background Acute posthypoxic myoclonus (PHM can occur in patients admitted after cardiopulmonary resuscitation (CPR and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP and electroencephalogram (EEG. Methods Patients with acute PHM (focal myoclonus or status myoclonus within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used. Good outcome was defined as good recovery or moderate disability after 6 months. Results Acute PHM was reported in 79/391 patients (20%. SEPs were available in 51/79 patients and in 27 of them (53% N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64% patients fulfilling criteria for a cortical origin. Nine patients (12% had a good outcome. A broad variety of drugs was used for treatment. Conclusions The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.

  3. Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

    Science.gov (United States)

    Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro

    2016-01-01

    Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413

  4. Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration.

    Science.gov (United States)

    Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro

    2016-06-01

    Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413

  5. Análise da celularidade do lavado bronco-alveolar em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea: relato de três casos Análisis de la celularidad del lavado bronco-alveolar en pacientes sometidos a revascularización del miocardio con circulación extracorpórea: relato de tres casos Broncho-alveolar lavage cellularity in patients submitted to myocardial revascularization with cardiopulmonary bypass: three case reports

    Directory of Open Access Journals (Sweden)

    Luciano Brandão Machado

    2006-06-01

    determinantes de la respuesta inflamatoria sistémica (SIRS en cirugía cardiaca. Quedó demostrado en modelo experimental que la CEC puede llevar a un aumento en la producción de las citocinas. Con el objetivo de evaluar la activación celular en el pulmón después del CEC, se estudió la celularidad en el lavado bronco-alveolar (LBA en pacientes sometidos a la cirugía de revascularización del miocardio (RM con CEC. RELATO DE LOS CASOS: Se estudiaron, como sondeo, tres pacientes adultos sometidos a la RM con CEC. Después de la inducción de anestesia general e intubación traqueal, la ventilación mecánica se realizó con sistema circular valvular; excepto durante la CEC, el volumen corriente se mantuvo entre 8 y 10 mL.kg-1 con O2 y aire, en una proporción de 50%. Antes del despinzamiento de la aorta, se realizaron insuflaciones pulmonares con presión de 40 cmH2O y recolectadas dos muestras de LBA de cada paciente, al comienzo de la intervención quirúrgica y al final del procedimiento, después de la reversión de la anticoagulación. Después de la infusión de 60 mL de solución fisiológica a 0,9% por el canal del broncofibroscopio, se aspiró el LBA, siendo el material enviado al laboratorio. El análisis mostró un aumento del número total de células, como promedio, de 0,6.10(6 cél.dL-1 para 6,8.10(6 cél.dL-1 con aumento de neutrófilos de 0,8% para 4,7%; 0,6% para 6,2% y 0,5% para 5,3% en cada paciente, respectivamente. Se observó en la lámina el aumento de celularidad en el fluido pulmonar después de la CEC. CONCLUSIONES: El influjo de leucocitos se describe en diversas condiciones clínicas pulmonares inflamatorias como en el síndrome de la angustia respiratoria del adulto. Se conoce que la CEC está relacionada con la inflamación sistémica y pulmonar, demostrando aumento del número de células después de la CEC con el predominio de macrófagos.BACKGROUND AND OBJECTIVES: Cardiopulmonary bypass (CPB is a primary determinant of systemic inflammatory

  6. Atrial fibrillation post cardiac bypass surgery

    OpenAIRE

    Mostafa, Ashraf; EL-Haddad, Mohamed A.; Shenoy, Maithili; Tuliani, Tushar

    2012-01-01

    Atrial fibrillation occurs in 5-40% patients after coronary artery bypass graft surgery. Atrial fibrillation increases mortality and morbidity in the post-operative period. We sought to conduct a comprehensive review of literature focusing on pathophysiology, risk factors, prevention and treatment of post coronary artery bypass graft atrial fibrillation.

  7. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  8. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    NARCIS (Netherlands)

    T.G.V. Cherpanath (Thomas); W.K. Lagrand (Wim); M.J. Schultz (Marcus); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractCardiopulmonary interactions induced by mechan-ical ventilation are complex and only partly understood. Ap-plied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes

  9. Retention of Cardiopulmonary Resuscitation Skills in Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin

    2016-01-01

    Background/Objective: For effective bystander cardiopulmonary resuscitation (CPR), retention of CPR skills after the training is central. The objective of this study was to find out how much of the CPR skills a group of Nigerian secondary school students would retain six weeks after their first exposure to the conventional CPR training. Materials…

  10. QUALITY-OF-LIFE AFTER CARDIOPULMONARY-RESUSCITATION

    NARCIS (Netherlands)

    MIRANDA, DR

    1994-01-01

    Objectives: This study evaluates the influence of Cardiopulmonary Resuscitation (CPR) on the components of quality of life (QOL) of patients after discharge from the hospital. Design: Extracted from a prospective national survey on Dutch intensive care units (ICUs). Setting: Thirty-six ICUs of both

  11. Release of endogenous vasopressors during and after cardiopulmonary resuscitation.

    OpenAIRE

    Lindner, K. H.; Haak, T; Keller, A; Bothner, U.; Lurie, K. G.

    1996-01-01

    OBJECTIVE: To assess whether plasma endothelin, adrenaline, noradrenaline, arginine vasopressin, adrenocorticotropin, and cortisol concentrations were higher during cardiopulmonary resuscitation in patients in whom resuscitation was successful than in those in whom it failed, and to measure the concentrations of these hormones in the immediate post-resuscitation phase. DESIGN: Prospective, descriptive study. SETTING: Emergency medical service at a university hospital. PATIENTS: 60 patients wi...

  12. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Stephen M McHugh

    2016-01-01

    Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

  13. Comparison of end-tidal carbon dioxide levels with cardiopulmonary resuscitation success presented to emergency department with cardiopulmonary arrest.

    Science.gov (United States)

    Akinci, Emine; Ramadan, Hayri; Yuzbasioglu, Yucel; Coskun, Figen

    2014-01-01

    Objective: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm. Methods: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients’ PetCO2 values were recorded. Results: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes. Conclusion: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived. PMID:24639823

  14. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Science.gov (United States)

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong

    2009-12-01

    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  15. Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

    Directory of Open Access Journals (Sweden)

    Malheiros Suzana M. F.

    2001-01-01

    Full Text Available Coronary artery bypass surgery (CABG without cardiopulmonary bypass (CPB may potentially reduce the number of microembolic signals (MES associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.

  16. Secondary coolant purification system with demineralizer bypass

    International Nuclear Information System (INIS)

    Apparatus and method are provided for a nuclear stream supply system for adequately controlling the chemistry of the secondary coolant. The invention includes means for the addition of volatile chemicals, a full flow condensate demineralizer, continuous blowdown capability, radiation detection means, a condensate demineralizer bypass line, and an auxiliary demineralizer bypass line, and an auxiliary demineralizer sized to handle full blowdown flow. The auxiliary demineralizer is cut into the system and the steam generator feedwater flow is bypassed around the full flow condensate demineralizer whenever radioactivity is detected in the secondary coolant

  17. 34 CFR 76.677 - Continuation of a bypass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Continuation of a bypass. 76.677 Section 76.677... Be Met by the State and Its Subgrantees? Procedures for Bypass § 76.677 Continuation of a bypass. The Secretary continues a bypass until the Secretary determines that the grantee or subgrantee will meet...

  18. Exhaust gas bypass valve control for thermoelectric generator

    Science.gov (United States)

    Reynolds, Michael G; Yang, Jihui; Meisner, Greogry P.; Stabler, Francis R.; De Bock, Hendrik Pieter Jacobus; Anderson, Todd Alan

    2012-09-04

    A method of controlling engine exhaust flow through at least one of an exhaust bypass and a thermoelectric device via a bypass valve is provided. The method includes: determining a mass flow of exhaust exiting an engine; determining a desired exhaust pressure based on the mass flow of exhaust; comparing the desired exhaust pressure to a determined exhaust pressure; and determining a bypass valve control value based on the comparing, wherein the bypass valve control value is used to control the bypass valve.

  19. Variation of Perioperative Blood cTnT Levels in Patients Undergoing Cardiopulmonary Bypass and Its Clinical Implication

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The clinical value of cardiac Troponin T (cTnT) as a marker in assessing myocardial cell damage in the patients undergoing open heart surgery was studied. Serum cTnT and CK-MB levels were measured in serial blood samples from 20 patients undergoing open heart surgery before operation, at aorta clamping, aorta opening, the end of CPB and the operation, and subsequently one h, one day, 3 days and one week after operation respectively. Ten patients receiving thoracic surgery were also subjected to the measurement of cTnT and CK-MB before and 24 h after operation. The results showed that peak concentrations were reached earlier in cTnT than in CK-MB, and the circulation cTnT remained high when CK-MB had already decreased to normal. In 10 patients receiving thoracic surgery, cTnT level was normal and CK-MB was increased in 4 patients after surgery. It was concluded that the sensitivity and specificity of cTnT was more than those of CK-MB and cTnT could be used as a routine indicator for myocardiac protection.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    and receptor-related flow regulation, whereas arrhythmia vulnerability appeared to be comparable with that in non-cardioplegia group. In this study, preconditioning with cyclosporine had no detectable protective effect on coronary circulation or arrhythmia vulnerability after CPB. © 2013 Liuba et al.; licensee...

  1. Reliability of point-of-care hematocrit, blood gas, electrolyte, lactate and glucose measurement during cardiopulmonary bypass.

    NARCIS (Netherlands)

    Steinfelder-Visscher, J.; Weerwind, P.W.; Teerenstra, S.; Brouwer, M.H.J.

    2006-01-01

    BACKGROUND: Recently, the GEM Premier blood gas analyser was upgraded to the GEM Premier 3000. In addition to pH, pCO2, pO2, Na+, K+, Ca2+, and hematocrit measurement, glucose and lactate can be measured on the GEM Premier 3000. In this prospective clinical study, the analytical performance of the G

  2. Comparison of topical use of protamine and tranexamic acid in surgical patients requiring cardio-pulmonary bypass

    International Nuclear Information System (INIS)

    To determine the effectiveness of local protamine in reducing post-operative blood loss compared to local tranexamic acid. Study Design: Randomized controlled trial. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from January 2011 to September 2011. Patients and Methods: One hundred and twenty cardiac surgical patients were randomly divided into two equal groups, one receiving local protamine while the other group receiving local tranexamic acid before chest closure. The efficiency was measured as post-operative blood loss and requirement of blood and blood products in the post-surgical ICU. Results: Average blood loss in protamine group was significantly less (252.97 ml) compared to tranexamic acid group (680.67 ml). Number of patients requiring no post-operative blood transfusion was significantly higher in protamine group (76.7%) compared to tranexamic acid group (53.3%). Conclusion: Local protamine is more effective in reducing post-operative blood loss than local tranexamic acid. (author)

  3. Successful resection of osteosarcoma pulmonary metastasis extending into left side of heart under cardiopulmonary bypass: a case report

    Institute of Scientific and Technical Information of China (English)

    柴(王莹); 沈钢

    2002-01-01

    @@ Cancerous thrombi of metastatic tumors rarely extend into the cardiac cavity, but such cases usually contraindicate surgery. Here, we report a patient in whom osteosarcoma pulmonary metastasis extended into the left side of the heart, which had metastasized to the left lung after surgery of the chondroblastoma of the left knee, was successfully excised in bloc under CPB.

  4. MHD Energy Bypass Scramjet Engine

    Science.gov (United States)

    Mehta, Unmeel B.; Bogdanoff, David W.; Park, Chul; Arnold, Jim (Technical Monitor)

    2001-01-01

    Revolutionary rather than evolutionary changes in propulsion systems are most likely to decrease cost of space transportation and to provide a global range capability. Hypersonic air-breathing propulsion is a revolutionary propulsion system. The performance of scramjet engines can be improved by the AJAX energy management concept. A magneto-hydro-dynamics (MHD) generator controls the flow and extracts flow energy in the engine inlet and a MHD accelerator downstream of the combustor accelerates the nozzle flow. A progress report toward developing the MHD technology is presented herein. Recent theoretical efforts are reviewed and ongoing experimental efforts are discussed. The latter efforts also include an ongoing collaboration between NASA, the US Air Force Research Laboratory, US industry, and Russian scientific organizations. Two of the critical technologies, the ionization of the air and the MHD accelerator, are briefly discussed. Examples of limiting the combustor entrance Mach number to a low supersonic value with a MHD energy bypass scheme are presented, demonstrating an improvement in scramjet performance. The results for a simplified design of an aerospace plane show that the specific impulse of the MHD-bypass system is better than the non-MHD system and typical rocket over a narrow region of flight speeds and design parameters. Equilibrium ionization and non-equilibrium ionization are discussed. The thermodynamic condition of air at the entrance of the engine inlet determines the method of ionization. The required external power for non-equilibrium ionization is computed. There have been many experiments in which electrical power generation has successfully been achieved by magneto-hydrodynamic (MHD) means. However, relatively few experiments have been made to date for the reverse case of achieving gas acceleration by the MHD means. An experiment in a shock tunnel is described in which MHD acceleration is investigated experimentally. MHD has several

  5. Phrenic Nerve Injury during Coronary Artery Bypass

    OpenAIRE

    Guinn, Gene A.; Beall, Arthur C.; Lamki, Neela; Heibig, Jacques; Thornby, John

    1990-01-01

    After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery gr...

  6. Monsanto may bypass NIH in microbe test.

    Science.gov (United States)

    Sun, Marjorie

    1985-01-11

    The Monsanto Company is planning to ask the Environmental Protection Agency for clearance to field test a genetically engineered microbial pesticide, bypassing the traditional approval process of the National Institutes of Health. Although only federally funded institutions are required to obtain NIH approval for genetic engineering tests, Monsanto is the first company to bypass the NIH regulatory process, which has become mired in a lawsuit brought by Jeremy Rifkin.

  7. Bypass diode for a solar cell

    Science.gov (United States)

    Rim, Seung Bum; Kim, Taeseok; Smith, David D.; Cousins, Peter J.

    2012-03-13

    Bypass diodes for solar cells are described. In one embodiment, a bypass diode for a solar cell includes a substrate of the solar cell. A first conductive region is disposed above the substrate, the first conductive region of a first conductivity type. A second conductive region is disposed on the first conductive region, the second conductive region of a second conductivity type opposite the first conductivity type.

  8. An experimental study of nerve bypass graft

    Institute of Scientific and Technical Information of China (English)

    XU Jie; LI Xue-shi

    2008-01-01

    Objective: To study the use of a nerve "bypass" graft as a possible alternative to neurolysis or segmental resection with interposition grafting in the treatment of neuroma-in-continuity. Methods: A sciatic nerve crush injury model was established in the Sprague-Dawley rat by compression with a straight hemostatic forceps. Epineurial windows were created proximal and distal to the injury site. An 8-mm segment of radial nerve was harvested and coaptated to the sciatic nerve at the epineurial window sites proximal and distal to the compressed segment (bypass group). A sciatic nerve crush injury without bypass served as a control. Nerve conduction studies were performed over an 8-week period. Sciatic nerves were then harvested and studied under transmission electron microscopy. Myelinated axon counts were obtained. Results: Nerve conduction velocity was significantly faster in the bypass group than in the control group at 8 weeks (63.57 m/s±5.83 m/s vs. 54.88 m/s±4.79m/s, P<0.01). Myelinated axon counts in distal segments were found more in the experimental sciatic nerve than in the control sciatic nerve. Significant axonal growth was noted in the bypass nerve segment itself. Conclusion: Nerve bypass may serve to augment peripheral axonal growth while avoiding further loss of the native nerve.

  9. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Science.gov (United States)

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari

    2010-06-01

    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care. PMID:20642055

  10. Role of cardiopulmonary mechanoreceptors in the postural regulation of renin

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, R.A.; Marco, E.J.; Oliveri, C.; Otero, F.J.; Degrossi, O.; Moledo, L.I.; Julius, S.

    1987-04-01

    To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

  11. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Science.gov (United States)

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari

    2010-06-01

    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  12. Lethal systemic Degos disease with prominent cardio-pulmonary involvement

    International Nuclear Information System (INIS)

    Degos disease (DD) is a rare obstructive vasculopathy characterized by distinctive skin lesions. Involvement of the soles, palms and genitalia is rare. In most cases disease has an unfavorable course and involves gastrointestinal tract, central nervous system and occasionally other organs. Pleural and pericardial involvements are usually minor manifestations with prolonged course. Death occurs in approximately 50% of the patients usually due to intestinal perforation or central nervous system bleeding. We describe a 48-year-old man of lethal systemic DD. Widespread skin lesions with involvement of palm plantar surfaces, genitalia and scalp were ignored for 3 years, whereas the disease revealed its own malignant nature. The disorder progressed to nervous, gastrointestinal and cardiopulmonary system that led to death after 5 months from onset of systemic involvement as severe restrictive cardio-pulmonary insufficiency. Autopsy showed diffuse fibrotic changes in serial membranes and internal organs. (author)

  13. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    OpenAIRE

    Bhavani Shankar Kodali; Urman, Richard D.

    2014-01-01

    Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 ). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlat...

  14. Strategy analysis of cardiopulmonary resuscitation training in the community

    OpenAIRE

    Wang, Jin; Ma, Li; Lu, Yuan-qiang

    2015-01-01

    Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest. This appreciation produced immense efforts by professional organizations to train laypeople for CPR skills. However, the rate of CPR training is low and varies widely across communities. Several strategies are used in order to improve the rate of CPR training and are performed in some advanced countries. The Chinese CPR training in communities could gain enlightenment from them.

  15. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    DEFF Research Database (Denmark)

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E

    1990-01-01

    Cerebral blood flow (CBF) and cardiac output (CO) were measured during cardiopulmonary resuscitation in patients who were unsuccessfully resuscitated by use of C14-iodoantipyrine injected into the left ventricle. CO varied between 1.3 and 2.2 l/min with mean 1.8 +/- 0.6 l/min (+/- SD) (28 ml...... resuscitation showed signs of maldistribution suggestive of a patchy and incomplete perfusion....

  16. Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

    OpenAIRE

    MÀkinen, Marja

    2010-01-01

    Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and ...

  17. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    International Nuclear Information System (INIS)

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000

  18. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis.

    Science.gov (United States)

    Soeda, Rie; Taniguchi, Fumika; Sawada, Maiko; Hamaoka, Saeko; Shibasaki, Masayuki; Nakajima, Yasufumi; Hashimoto, Satoru; Sawa, Teiji; Nakayama, Yoshinobu

    2016-01-01

    A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  19. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis

    Directory of Open Access Journals (Sweden)

    Rie Soeda

    2016-01-01

    Full Text Available A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  20. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-bing; SHU Jian; YANG Wen-tao; SHI Li; GUO Xu-feng; WANG Fei-ge; QIAN Yong-yue

    2012-01-01

    Background The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging,but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial.The purpose of this study was to assess differences in the incidences of stroke,atrial fibrillation (AF),and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.Methods A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline,the Science Citation Index Expanded,the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc.A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke,AF,and MI.The meta-analysis was performed using RevMan 5 software.Results Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references,with 8104 patients in the OPCAB group and 8724 cases in the CCABG group.The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80,95% confidence interval (CI)=0.52-1.22,P=0.30) and MI (OR=0.73,95%CI=0.52-1.02,P=0.06).However,we found a significantly reduced risk of AF (OR=0.65,95%CI =0.52-0.82,P=0.0002)in off-pump patients.Conclusions Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG,but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.

  1. [Simplified laparoscopic gastric bypass. Initial experience].

    Science.gov (United States)

    Hernández-Miguelena, Luis; Maldonado-Vázquez, Angélica; Cortes-Romano, Pablo; Ríos-Cruz, Daniel; Marín-Domínguez, Raúl; Castillo-González, Armando

    2014-01-01

    Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.

  2. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Science.gov (United States)

    ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  3. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  4. Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    Science.gov (United States)

    ... for people with coronary heart disease is called "percutaneous coronary intervention" (PCI), or "stenting." This involves using a flexible ... artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention Coronary artery bypass grafting in patients with cerebrovascular ...

  5. Cardiopulmonary Exercise Testing in Children and Adolescents With Dystrophinopathies : A Pilot Study

    NARCIS (Netherlands)

    Bartels, Bart; Takken, Tim; Blank, A. Christian; van Moorsel, Huib; van der Pol, W. Ludo; de Groot, Janke F.

    2015-01-01

    Purpose: To determine exercise response during cardiopulmonary exercise testing in children and adolescents with dystrophinopathies. Methods: Exercise response on the cardiopulmonary exercise test (CPET) was compared with a standard care test protocol. Results: Nine boys (aged 10.8 +/- 4.7 years) wi

  6. Does Cardiopulmonary Resuscitation Cause Rib Fractures in Children? A Systematic Review

    Science.gov (United States)

    Maguire, Sabine; Mann, Mala; John, Nia; Ellaway, Bev; Sibert, Jo R.; Kemp, Alison M.

    2006-01-01

    Background: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in…

  7. Potential wrist ligament injury in rescuers performing cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Robert Curran

    2013-01-01

    Full Text Available Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim′s chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers′ wrists of less than 10% of those seen during the performance of chest compressions significantly strain the scapholunate ligament. Biomechanical research should be performed to further evaluate this possible correlation. Compensation for worker injury maybe involved.

  8. A method of automatic control procedures cardiopulmonary resuscitation

    Science.gov (United States)

    Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.

    2015-11-01

    The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.

  9. 46 CFR 154.550 - Excess flow valve: Bypass.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Excess flow valve: Bypass. 154.550 Section 154.550... and Process Piping Systems § 154.550 Excess flow valve: Bypass. If the excess flow valve allowed under § 154.532(b) has a bypass, the bypass must be of 1.0 mm (0.0394 in.) or less in diameter. Cargo Hose...

  10. 21 CFR 870.3545 - Ventricular bypass (assist) device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular bypass (assist) device. 870.3545... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3545 Ventricular bypass (assist) device. (a) Identification. A ventricular bypass (assist) device is a device that...

  11. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob;

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera...... analgesic treatment in LRYGB surgery....

  12. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... completely endoscopic coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic ... scrub nurse, also a lot of experience with robotics now. And Dr. Atiq Rahman, fellow here for ...

  13. Bypassing BDD Construction for Reliability Analysis

    DEFF Research Database (Denmark)

    Williams, Poul Frederick; Nikolskaia, Macha; Rauzy, Antoine

    2000-01-01

    In this note, we propose a Boolean Expression Diagram (BED)-based algorithm to compute the minimal p-cuts of boolean reliability models such as fault trees. BEDs make it possible to bypass the Binary Decision Diagram (BDD) construction, which is the main cost of fault tree assessment....

  14. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G;

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  15. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... is in place right now. There’s usually some slack or redundancy in the balloon once we initially ... go on bypass, and then it’s without any slack in the right position, and we can inflate ...

  16. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  17. Post-Bypass Extensive Ascites due to Splanchnic Bypass and the Effectiveness of Hyperalimentation Treatment

    Directory of Open Access Journals (Sweden)

    Veysel Temizkan

    2013-04-01

    Full Text Available Reperfusion edema may develop in the early periods of chronic ischemic tissue reperfusion. Reperfusion edema may be represented after the splanchnic bypass with ascites, abdominal distension, and liver and kidney function impairment. In this article, we are reporting the hyperalimentation treatment and its results for the common ascites and hepatorenal syndrome, after a coeliac and superior mesenteric artery bypass. [Arch Clin Exp Surg 2013; 2(2.000: 124-128

  18. Gravity and the evolution of cardiopulmonary morphology in snakes.

    Science.gov (United States)

    Lillywhite, Harvey B; Albert, James S; Sheehy, Coleman M; Seymour, Roger S

    2012-02-01

    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse - significantly longer heart-head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart-to-head distance and length of vascular lung are co-adaptive cardiopulmonary features of snakes.

  19. Age-related changes in chest geometry during cardiopulmonary resuscitation.

    Science.gov (United States)

    Dean, J M; Koehler, R C; Schleien, C L; Michael, J R; Chantarojanasiri, T; Rogers, M C; Traystman, R J

    1987-06-01

    We studied alterations of chest geometry during conventional cardiopulmonary resuscitation in anesthetized immature swine. Pulsatile force was applied to the sternum in increments to determine the effects of increasing compression on chest geometry and intrathoracic vascular pressures. In 2-wk- and 1-mo-old piglets, permanent changes in chest shape developed due to incomplete recoil of the chest along the anteroposterior axis, and large intrathoracic vascular pressures were generated. In 3-mo-old animals, permanent chest deformity did not develop, and large intrathoracic vascular pressures were not produced. We propose a theoretical model of the chest as an elliptic cylinder. Pulsatile displacement along the minor axis of an ellipse produces a greater decrease in cross-sectional area than displacement of a circular cross section. As thoracic cross section became less circular due to deformity, greater changes in thoracic volume, and hence pressure, were produced. With extreme deformity at high force, pulsatile displacement became limited, diminishing pressure generation. We conclude that changes in chest geometry are important in producing intrathoracic intravascular pressure during conventional cardiopulmonary resuscitation in piglets. PMID:3610916

  20. Cardiopulmonary Circuit Models for Predicting Injury to the Heart

    Science.gov (United States)

    Ward, Richard; Wing, Sarah; Bassingthwaighte, James; Neal, Maxwell

    2004-11-01

    Circuit models have been used extensively in physiology to describe cardiopulmonary function. Such models are being used in the DARPA Virtual Soldier (VS) Project* to predict the response to injury or physiological stress. The most complex model consists of systemic circulation, pulmonary circulation, and a four-chamber heart sub-model. This model also includes baroreceptor feedback, airway mechanics, gas exchange, and pleural pressure influence on the circulation. As part of the VS Project, Oak Ridge National Laboratory has been evaluating various cardiopulmonary circuit models for predicting the effects of injury to the heart. We describe, from a physicist's perspective, the concept of building circuit models, discuss both unstressed and stressed models, and show how the stressed models are used to predict effects of specific wounds. *This work was supported by a grant from the DARPA, executed by the U.S. Army Medical Research and Materiel Command/TATRC Cooperative Agreement, Contract # W81XWH-04-2-0012. The submitted manuscript has been authored by the U.S. Department of Energy, Office of Science of the Oak Ridge National Laboratory, managed for the U.S. DOE by UT-Battelle, LLC, under contract No. DE-AC05-00OR22725. Accordingly, the U.S. Government retains a non-exclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purpose.