scholarly journals Using reagent-supported thromboelastometry (ROTEM®) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest

2008 ◽  
Vol 34 (3) ◽  
pp. 641-647 ◽  
Author(s):  
Andreas Straub ◽  
Daniela Schiebold ◽  
Hans Peter Wendel ◽  
Carole Hamilton ◽  
Thomas Wagner ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Circulatory Arrest ◽  
Congenital Heart Surgery ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest

Glycoprotein IIb/IIIa inhibition reduces prothrombotic events under conditions of deep hypothermic circulatory arrest

2005 ◽  
Vol 94 (07) ◽  
pp. 115-122 ◽  
Author(s):  
Ruben Azevedo ◽  
Wolfram Beierlein ◽  
Hans P. Wendel ◽  
Klaus Dietz ◽  
Gerhard Ziemer ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Platelet Activation ◽  
Heart Surgery ◽  
Circulatory Arrest ◽  
Organ Damage ◽  
Congenital Heart Surgery ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Short Acting

SummaryDeep Hypothermic Circulatory Arrest (DHCA) is employed during thoracic aortic and congenital heart surgery, and can induce postoperative neurological damage probably caused by microthrombembolism. Hypothermia has been reported to induce platelet activation and aggregation. The platelet activation marker P-selectin mediates binding of platelets to leukocytes. Tirofiban and eptifibatide, short-acting inhibitors of the platelet fibrinogen receptor GP IIb/IIIa, have recently been shown to protect platelet function without increasing bleeding during heart surgery using cardiopulmonary bypass. The aim of this study was to investigate the effect of tirofiban and eptifibatide on platelets and platelet-leukocyte interaction under DHCA conditions in vitro.Platelet aggregation, binding of the GP IIb/IIIa activation specific antibody PAC-1, P-selectin expression as well as monocyte and granulocyte content of aggregates were investigated in un-stimulated and ADP-stimulated samples using flow cytometry. Tirofiban and eptifibatide inhibited massive platelet aggregation and PAC-1 binding which were induced by DHCA conditions. P-selectin expression was inhibited by tirofiban but increased by eptifibatide at hypothermia. Platelet-bound leukocytes were present in all samples. Eptifibatide increased granulocyte content of aggregates at hypothermia in ADP-stimulated samples. We conclude that under conditions of DHCA both tirofiban and eptifibatide inhibit platelet aggregation but have different effects on platelet P-selectin expression and platelet-leukocyte interaction. Application of a short-acting and non-activating GP IIb/IIIa inhibitor should be considered during DHCA in vivo to prevent occlusion of the microvasculature and subsequent organ damage.

Allopurinol Neurocardiac Protection Trial in Infants Undergoing Heart Surgery Using Deep Hypothermic Circulatory Arrest

PEDIATRICS ◽  
2001 ◽  
Vol 108 (1) ◽  
pp. 61-70 ◽  
Author(s):  
R. R. Clancy ◽  
S. A. McGaurn ◽  
J. E. Goin ◽  
D. G. Hirtz ◽  
W. I. Norwood ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest

scholarly journals Neurodevelopmental Outcome After Congenital Heart Surgery: Results From an Institutional Registry

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
Joseph M. Forbess ◽  
Karen J. Visconti ◽  
Camille Hancock-Friesen ◽  
Robert C. Howe ◽  
David C. Bellinger ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Single Ventricle ◽  
Circulatory Arrest ◽  
Neurodevelopmental Outcome ◽  
Velocardiofacial Syndrome ◽  
Congenital Heart Surgery ◽  
Critical Congenital Heart Disease ◽  
Iq Scores ◽  
And Performance

Objective Increased survival in children with critical congenital heart disease (CHD) has raised interest in the neurodevelopmental sequelae of these lesions. This investigation is part of an institutional effort to examine the neurodevelopment of 5-year-old children following repair or palliation of CHD. Methods We performed a battery of neuropsychological tests on a sample of 243 children between 1998 and 2001. Results In the sample as a whole, mean full-scale (FSIQ), verbal (VIQ), and performance (PIQ) IQ scores were in the normal range (96.8±15.9, 97.8±14.6, and 96.3±17.1, respectively). Anatomic, demographic, and perioperative factors were assessed for impact on neurodevelopment. In multiple regression analysis, lower socioeconomic status (SES) and the diagnosis of velocardiofacial syndrome (VCFS) predicted a lower FSIQ ( P =0.01, and P =0.001, respectively). A single ventricle diagnosis ( P =0.06), longer postoperative ICU stay ( P =0.08), and cumulative duration of hypothermic circulatory arrest (HCA) ( P =0.09) approached significance as predictors of lower FSIQ. Conclusion Children with CHD, on the whole, appear to be performing within the average range in terms of intellectual abilities. Lower SES and VCFS are associated with lower IQ scores. Trends toward worse outcomes were observed in single ventricle patients, biventricular patients with longer postrepair ICU stays, and patients subjected to longer periods of HCA.

Glucose, sodium and plasma protein levels during deep hypothermic circulatory arrest using a low volume, minimal glucose priming solution based on washed packed red cells

Perfusion ◽  
1991 ◽  
Vol 6 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Arne Lönnqvist ◽  
Jeri Dobbs
Keyword(s):  
Plasma Protein ◽  
Congenital Heart ◽  
Circulatory Arrest ◽  
Good Control ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Red Cells ◽  
Protein Levels ◽  
Glucose Levels ◽  
Low Volume

The effect of a low volume, minimal glucose priming solution based on washed packed red cells on glucose, sodium and plasma protein levels during deep hypothermic circulatory arrest (DHCA) was studied in six patients of less than six months of age undergoing repair of congenital heart disease. Glucose levels during DHCA were not significantly different from prebypass values (6.2mmol/l±2.7 vs 7.1 mmol/l±2.8; p = 0.518), whereas plasma protein levels were significantly decreased (51.0g/l±0.7 vs 20.0g/l± 0.3; P = 0.0001) and sodium levels slightly but significantly increased (142mmol/l±3.8 vs 150mmol±3.8; p = 0.0026). In summary, the priming solution used in this study achieved good control of glucose levels during DHCA, although it needs some modification in regard to sodium and plasma protein content. A discussion of the choice of priming solution and a hypothesis for potential calcium-mediated reperfusion injury are also presented.

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