Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery

Introduction:Cardiopulmonary bypass surgery is accompanied by an inflammatory response and pulmonary dysfunction that renders patients vulnerable to postoperative complications. The majority of studies investigating the inflammatory response in cardiopulmonary bypass focus on cytokine measurements. This study investigated the early response of peripheral blood cell types and early changes in lung tissue in on-pump versus off-pump cardiopulmonary bypass surgery.Methods:Landrace pigs were assigned to the following groups (n = 6 per group): 1. off-pump cardiopulmonary bypass, 2. conventional cardiopulmonary bypass, 3. heparin-coated cardiopulmonary bypass, 4. surface-reduced cardiopulmonary bypass, and 5. surface-reduced cardiopulmonary bypass plus lung perfusion. Surgery was performed under mild hyperthermia (32°C), with 90-minute ischemia and 180-minute reperfusion. Histological and flow cytometric analyses were performed.Results:Lung water content increased during reperfusion in heparin-coated (84.63 ± 2.99%) compared to conventional cardiopulmonary bypass (76.33 ± 4.56%, p = 0.04). Alveolar septal thickness increased during ischemia at heparin-coated (p < 0.01) and surface-reduced cardiopulmonary bypass plus lung perfusion (p = 0.05). Tumor necrosis factor expression increased significantly (p < 0.01) in peribronchial, perivascular, and peripheral lung areas in all on-pump groups, but not in off-pump cardiopulmonary bypass. The usage of heparin-coated cardiopulmonary bypass led to increased percentages of CD3+CD4+(p = 0.03) and CD3+CD8+(p = 0.01) T cells compared to an uncoated device. Natural killer and mature B lymphocytes decreased at conventional and surface-reduced cardiopulmonary bypass plus lung perfusion. Activated granulocytes and macrophages increased at conventional cardiopulmonary bypass and heparin-coated cardiopulmonary bypass.Conclusion:Off-pump cardiopulmonary bypass induces less immunological response and lung injury than on-pump surgery. The reduction of cardiopulmonary bypass surface reduces the inflammatory immune response induced by cardiopulmonary bypass. Lung perfusion of surface-reduced cardiopulmonary bypass diminished the extravasation caused by surface reduction of the cardiopulmonary bypass.

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Comparison between transcranial Doppler and Coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery

Perfusion ◽

10.1177/0267659111419033 ◽

2011 ◽

Vol 26 (6) ◽

pp. 519-523

Author(s):

A Eyjolfsson ◽

F Al-Rashidi ◽

M Dencker ◽

S Scicluna ◽

B Brondén ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Transcranial Doppler ◽

Bypass Surgery ◽

Coulter Counter ◽

Shed Blood ◽

Non Invasive ◽

Cardiopulmonary Bypass Surgery ◽

Short And Long Term

Introduction: Lipid micro embolization (LME) from re-transfused shed blood has been postulated to be a potential reason for short- and long-term cognitive dysfunction after cardiac surgery. The purpose of this investigation was to evaluate if transcranial Doppler (TCD) has the capacity to detect LME. Methods: Thirteen patients undergoing cardiopulmonary bypass surgery were investigated. Each patient’s cerebral circulation was monitored with transcranial Doppler during the first two minutes after re-transfusion of shed blood and blood was simultaneously sampled and characterised by a Coulter counter. Results: Strong correlation was found between embolic loads, as measured by transcranial Doppler and Coulter counter (r=0.79, P<0.005). Conclusions: This pilot study shows that non-invasive monitoring by transcranial Doppler could be a potential tool to monitor LME during cardiopulmonary bypass surgery.

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Effects of propofol and isoflurane on haemodynamics and the inflammatory response in cardiopulmonary bypass surgery

British Journal of Biomedical Science ◽

10.1080/09674845.2015.11666803 ◽

2015 ◽

Vol 72 (3) ◽

pp. 93-101 ◽

Cited By ~ 15

Author(s):

S. Sayed ◽

N. K. Idriss ◽

H. G. Sayyed ◽

A. A. Ashry ◽

D. M. Rafatt ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Bypass Surgery ◽

Cardiopulmonary Bypass Surgery

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Hemoglobin and Renal Replacement Therapy after Cardiopulmonary Bypass surgery: A predictive score from the Cardiac Surgery Registry of Puglia

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.08.003 ◽

2014 ◽

Vol 176 (3) ◽

pp. 866-873 ◽

Cited By ~ 7

Author(s):

Domenico Paparella ◽

Pietro Guida ◽

Valerio Mazzei ◽

Carmine Carbone ◽

Giuseppe Speziale ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Bypass Surgery ◽

Predictive Score ◽

Cardiopulmonary Bypass Surgery

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An evidence-based review of the use of vasoactive and inotropic medications in post-operative paediatric patients after cardiac surgery with cardiopulmonary bypass from 2000 to 2020

Cardiology in the Young ◽

10.1017/s1047951120004151 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1757-1771

Author(s):

Caitlin E. King ◽

Elizabeth J. Thompson ◽

Henry P. Foote ◽

Kanecia O. Zimmerman ◽

Kevin D. Hill ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Final Analysis ◽

High Risk Population ◽

Low Cardiac Output Syndrome ◽

Cardiopulmonary Bypass Surgery ◽

Childhood Morbidity ◽

Operative Care ◽

Meta Analyses

AbstractBackground:Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use.Methods:To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth – 18 years of age. Two reviewers independently reviewed studies to determine final eligibility.Results:The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses.Conclusion:Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.

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Hyperlactatemia and its adverse patient outcomes among patients who underwent cardiopulmonary bypass surgery at national cardiac centre Addis Ababa, Ethiopia 2021. Retrospective observational study

10.21203/rs.3.rs-651580/v1 ◽

2021 ◽

Author(s):

Tigist Tesfaye ◽

Getaneh Baye Mulu ◽

Bantalem Tilaye Atinafu ◽

Fetene Nigussie Tarekegn ◽

Worku Misganaw kebede

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Lactate Level ◽

Bypass Surgery ◽

Addis Ababa ◽

Multivariable Analysis ◽

Outcome Variable ◽

Significant Variable ◽

Cardiopulmonary Bypass Surgery ◽

Cardiac Center

Abstract Background: Hyperlactatemia and lactic acidosis are commonly encountered during and after cardiac surgery. Hyperlactatemia is highly suggestive of tissue ischemia and is associated with a prolonged intensive care unit stay, a prolonged requirement for respiratory and cardiovascular support, and increased postoperative mortality. Objective: To assess hyperlactatemia and adverse outcomes among patients who underwent cardiopulmonary bypass surgery at Cardiac Center Ethiopia, Addis Ababa, Ethiopia, 2021.Method: An institution-based retrospective cross-sectional study was employed among all patients who underwent cardiopulmonary bypass surgery from December to January 2020. Blood lactate samples were collected intraoperatively and postoperatively. We entered the collected data into Epidata version 4.2 and export it to SPSS 25 for analysis. We did descriptive statistics for categorical and continuous variables and chi-square to show an association between the outcome variable and independent variables. We entered variables fitted in bivariate analysis into multivariable analysis to show the strength of the association and the statistically significant variable.Result: The prevalence of hyperlactatemia in this study among patients who underwent cardiac surgery procedures at Cardiac Center Ethiopia was 37.5 %. A rise in lactate level prolongs ICU stay, prolongs intubation duration, and increases the need for Inotropes support. Lactate level was measured on the immediate postoperative day within 10 hours after the surgery and was defined as lactate level > 3 mmol/L in the first hour after surgery. Age > 40 years [AOR: 6.8 (95% CI 1.7-25), P=<0.008]. female gender [AOR: 1.8 (95% CI 1.1-3.8), P=0.048]. Variables statistically significant were declared at 95 % CI, p-value < 0.05.Conclusion and Recommended: An early rise in lactate levels in patients who underwent cardiopulmonary bypass surgery is a strong and robust predictor of morbidity. As a result, screening of patients in the preoperative period and strict follow-up management of those factors is recommended.

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