scholarly journals Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

2020 ◽  
Vol 68 (8) ◽  
pp. 754-761
Author(s):  
Hayato Ise ◽  
Hiroto Kitahara ◽  
Kyohei Oyama ◽  
Keiya Takahashi ◽  
Hirotsugu Kanda ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Circulatory Arrest ◽  
Operation Time ◽  
Hypothermic Circulatory Arrest ◽  
Anesthesia Induction ◽  
Rotational Thromboelastometry ◽  
Elective Cardiac Surgery ◽  
Group 12 ◽  
Perioperative Bleeding ◽  
Before And After

Abstract Objectives Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). Methods We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. Results Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. Conclusion Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

scholarly journals Pulmonary effects of dexmedetomidine infusion in thoracic aortic surgery under hypothermic circulatory arrest: a randomized placebo-controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seongsu Kim ◽  
Soo Jung Park ◽  
Sang Beom Nam ◽  
Suk-Won Song ◽  
Yeonseung Han ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Controlled Trial ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Hypothermic Circulatory Arrest ◽  
Lung Mechanics ◽  
Anesthesia Induction ◽  
Protective Agent ◽  
Thoracic Aortic Surgery ◽  
Dexmedetomidine Infusion

AbstractDexmedetomidine has emerged as a promising organ protective agent. We performed prospective randomized placebo-controlled trial investigating effects of perioperative dexmedetomidine infusion on pulmonary function following thoracic aortic surgery with cardiopulmonary bypass and moderate hypothermic circulatory arrest. Fifty-two patients were randomized to two groups: the dexmedetomidine group received 1 µg/kg of dexmedetomidine over 20 min after induction of anesthesia, followed by 0.5 µg/kg/h infusion until 12 h after aortic cross clamp (ACC)-off, while the control group received the same volume of normal saline. The primary endpoints were oxygenation indices including arterial O2 partial pressure (PaO2) to alveolar O2 partial pressure ratio (a/A ratio), (A–a) O2 gradient, PaO2/FiO2 and lung mechanics including peak inspiratory and plateau pressures and compliances, which were assessed after anesthesia induction, 1 h, 6 h, 12 h, and 24 h after ACC-off. The secondary endpoints were serum biomarkers including interleukin-6, tumor necrosis factor-α, superoxide dismutase, and malondialdehyde (MDA). As a result, dexmedetomidine did not confer protective effects on the lungs, but inhibited elevation of serum MDA level, indicative of anti-oxidative stress property, and improved urine output and lower requirements of vasopressors.

Clinical neurologic and developmental studies after cardiac surgery utilizing hypothermic circulatory arrest and cardiopulmonary bypass

1993 ◽  
Vol 3 (3) ◽  
pp. 308-316 ◽  
Author(s):  
Gil Wernovsky ◽  
Richard A. Jonas ◽  
Paul R. Hickey ◽  
Adré J. du Plessis ◽  
Jane W. Newburger
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Neurodevelopmental Outcome ◽  
Hypothermic Circulatory Arrest ◽  
Cerebral Injury ◽  
Profound Hypothermia ◽  
The Central Nervous System

The dramatic reduction in surgical mortality associated with repair of congenital heart anomalies in recent decades has been accompanied by a growing recognition of adverse neurologic sequels in some of the survivors. Abnormalities of the central nervous system may be a function of coexisting cerebral abnormalities or acquired events unrelated to surgical management (such as paradoxical embolus, cerebral infection, or effects of chronic cyanosis), but insults to the central nervous system appear to occur most frequently during or immediately after surgery. In particular, techniques of support used during neonatal and infant cardiac surgery—cardiopulmonary bypass, profound hypothermia and circulatory arrest—have been implicated as important causes of cerebral injury. This paper will review the effects of bypass and deep hypothermic circulatory arrest on neurodevelopmental outcome.

scholarly journals Mild Systemic Hypothermic Circulatory Arrest Using a Frozen Elephant Trunk Graft with Endo-Balloon Occlusion for Total Arch Replacement

2020 ◽  
Vol 23 (5) ◽  
pp. E673-E676
Author(s):  
Yoshihiro Goto ◽  
Soh Hosoba ◽  
Yuichiro Fukumoto ◽  
Sho Takagi ◽  
Junji Yanagisawa
Keyword(s):  
Cerebral Perfusion ◽  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Operation Time ◽  
Balloon Occlusion ◽  
Hypothermic Circulatory Arrest ◽  
Hospital Length Of Stay ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Bladder Temperature

Background: Stroke and paraplegia are serious complications of total aortic arch replacement (TAR). Hypothermic circulatory arrest and cerebral perfusion reduce the risk of neurologic complications, but longer circulatory arrest time remains a risk factor for such complications. We utilized a frozen elephant trunk (FET) with endo-balloon occlusion under mild systemic hypothermia, which allowed us to shorten circulatory arrest time. Methods: Between April 2007 and May 2020, 72 patients underwent elective TAR using antegrade cerebral perfusion (ACP). They were divided into 2 groups. 64 patients received conventional TAR with moderate systemic hypothermic (bladder temperature, 25–28°C) circulatory arrest (group C). We used a FET with endo-balloon occlusion and retrograde perfusion through the femoral artery for the newest 8 patients who had mild hypothermic (bladder temperature of 30°C) circulatory arrest (group B). Results: The mean operation time (257.5 ± 42.1 versus 327.8 ± 84.9 min, P = .023), CPB time (144.4 ± 28.1 versus 178.2 ± 26.4 min, P = .003), cardiac arrest time (75.5 ± 21.2 versus 95.7 ± 56.4 min, P < .001), SCP time (100.8 ± 25.5 versus 124 ± 23.2 min, P < .001), lower body circulation arrest time (17.2 ± 4.2 versus 62.5 ± 19.3 min, P < .001) were significantly shorter in the endo-balloon occlusion group. There were no perioperative neurological and renal complications or mortality in FET group. The new technique enabled a decrease in mechanical ventilation time (8.6 ± 1.4 versus 13.9 ± 5.7 min, P = .015) and hospital length of stay (9.7 ± 1.8 versus 18.3 ± 4.6 min, P = .005). Conclusion: FET using an endo-balloon occlusion with mild hypothermia is a safe and an effective approach in TAR.

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