Predictors of Neurological Outcome Following Infant Cardiac Surgery Without Deep Hypothermic Circulatory Arrest

2021 ◽  
Author(s):  
Agnieszka Kosiorek ◽  
Mary T. Donofrio ◽  
David Zurakowski ◽  
Justus G. Reitz ◽  
Lauren Tague ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Neurological Outcome ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest

scholarly journals Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

2020 ◽  
Author(s):  
Ludmila Khailova ◽  
Justin Robison ◽  
James Jaggers ◽  
Richard Ing ◽  
Scott Lawson ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Intestinal Alkaline Phosphatase

Abstract Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor post-operative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.

Cerebral Oxygenation during Pediatric Cardiac Surgery Using Deep Hypothermic Circulatory Arrest 

1995 ◽  
Vol 82 (1) ◽  
pp. 74-82 ◽  
Author(s):  
Dean C. Kurth ◽  
James M. Steven ◽  
Susan C. Nicolson
Keyword(s):  
Cardiac Surgery ◽  
Half Life ◽  
Cerebral Oxygenation ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Pediatric Cardiac Surgery ◽  
Brain Oxygenation ◽  
Neurologic Status ◽  
Cerebral Dysfunction

Background Deep hypothermic circulatory arrest is a widely used technique in pediatric cardiac surgery that carries a risk of neurologic injury. Previous work in neonates identified distinct changes in cerebral oxygenation during surgery. This study sought to determine whether the intraoperative changes in cerebral oxygenation vary between neonates, infants, and children and whether the oxygenation changes are associated with postoperative cerebral dysfunction. Methods The study included eight neonates, ten infants, and eight children without preexisting neurologic disease. Cerebrovascular hemoglobin oxygen saturation (SCO2), an index of brain oxygenation, was monitored intraoperatively by near-infrared spectroscopy. Body temperature was reduced to 15 degrees C during cardiopulmonary bypass (CPB) before commencing circulatory arrest. Postoperative neurologic status was judged as normal or abnormal (seizures, stroke, coma). Results Relative to preoperative levels, the age groups experienced similar changes in SCO2 during surgery: SCO2 increased 30 +/- 4% during deep hypothermic CPB, it decreased 62 +/- 5% by the end of arrest, and it increased 20 +/- 5% during CPB recirculation (all P < 0.001); after rewarming and removal of CPB, SCO2 returned to preoperative levels. During arrest, the half-life of SCO2 was 9 +/- 1 min in neonates, 6 +/- 1 min in infants, and 4 +/- 1 min in children (P < 0.001). Postoperative neurologic status was abnormal in three (12%) patients. The SCO2 increase during deep hypothermic CPB was less in these patients than in the remaining study population (3 +/- 2% versus 33 +/- 4%, P < 0.001). There were no other significant SCO2 differences between outcome groups. Conclusions Brain oxygenation changed at distinct points during surgery in all ages, reflecting fundamental cerebral responses to hypothermic CPB, ischemia, and reperfusion. However, the changes in SCO2 half-life with age reflect developmental differences in the rate of cerebral oxygen utilization during arrest, consistent with experimental work in animals. Certain intraoperative cerebral oxygenation patterns may be associated with postoperative cerebral dysfunction and require further study.

scholarly journals Foley catheter and deep hypothermic circulatory arrest to control bleeding in redo cardiac surgery

2004 ◽  
Vol 51 (3) ◽  
pp. 117-119
Author(s):  
Dusko Nezic ◽  
S. Borovic ◽  
Milan Cirkovic ◽  
Ljiljana Lausevic-Vuk ◽  
A. Kenkovski ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Foley Catheter ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
The Right ◽  
Right Atria ◽  
Combined Technique ◽  
Uncontrolled Bleeding

Two cases with catastrophic hemorrhage in redo cardiac surgery are described. In the first one tearing of right ventricle with uncontrolled bleeding occurred during sternal reentry. In the second one, tearing of the right atria occurred while the patient was on cardiopulmonary bypass. In both cases we were able to control bleeding using Foley catheter, which enabled us to proceed to deep hypothermic circulatory arrest to repair heart chambers (due to dense adhesions it was impossible to m?nage it in any other way). We have found this combined technique to be extremely useful tool to control catastrophic hemorrhage during redo cardiac surgery.

scholarly journals Plasma prohepcidin as a negative acute phase reactant after large cardiac surgery with a deep hypothermic circulatory arrest

2009 ◽  
pp. 827-833
Author(s):  
P Maruna ◽  
J Lindner ◽  
J Kunštýř ◽  
K Kubzová ◽  
J Hubáček
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Acute Phase ◽  
Iron Metabolism ◽  
Circulatory Arrest ◽  
Acute Phase Reactant ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Pulmonary Endarterectomy ◽  
Phase Reactant

Hepcidin is a key regulator of iron metabolism and a mediator of anemia in inflammation. Recent in vitro studies recognized prohepcidin as a type II acute phase protein regulating via interleukin-6. The aim of the present study was to investigate the time course of plasma prohepcidin after a large cardiac surgery in relation to IL-6 and other inflammatory parameters. Patients with chronic thromboembolic hypertension (n=22, males/females 14/8, age 51.9±10.2 years) underwent pulmonary endarterectomy using cardiopulmonary bypass and deep hypothermic circulatory arrest were included into study. Arterial concentrations of prohepcidin, IL-1β, IL-6, IL-8, tumor necrosis factor-α, and C-reactive protein were measured before/after sternotomy, after circulatory arrest, after separation from bypass, and then 12, 18, 24, 36, 48 h and 72 h after the separation from bypass. Hemodynamic parameters, hematocrit and markers of iron metabolism were followed up. Pulmonary endarterectomy induced a 48 % fall in plasma prohepcidin; minimal concentrations were detected after separation from cardiopulmonary bypass. Prohepcidin decline correlated with an extracorporeal circulation time (p<0.01), while elevated IL-6 levels were inversely associated with duration of prohepcidin decline. Postoperative prohepcidin did not correlate with markers of iron metabolism or hemoglobin concentrations within a 72-h period after separation from CPB. Prohepcidin showed itself as a negative acute phase reactant during systemic inflammatory response syndrome associated with a cardiac surgery. Results indicate that the evolution of prohepcidin in postoperative period implies the antagonism of stimulatory effect of IL-6 and contraregulatory factors inhibiting prohepcidin synthesis or increasing prohepcidin clearance.

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