scholarly journals Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate

2000 ◽  
Vol 119 (2) ◽  
pp. 347-357 ◽  
Author(s):  
Robert R. Clancy ◽  
Susan A. McGaurn ◽  
Gil Wernovsky ◽  
Thomas L. Spray ◽  
William I. Norwood ◽  
...  
Keyword(s):  
Prediction Model ◽  
Heart Surgery ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Preoperative Risk ◽  
Risk Of Death

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

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.

Risk of Seizures in Survivors of Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest

PEDIATRICS ◽  
2003 ◽  
Vol 111 (3) ◽  
pp. 592-601 ◽  
Author(s):  
R. R. Clancy ◽  
S. A. McGaurn ◽  
G. Wernovsky ◽  
J. W. Gaynor ◽  
T. L. Spray ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest

Desflurane Confers Neurologic Protection for Deep Hypothermic Circulatory Arrest in Newborn Pigs

2001 ◽  
Vol 95 (4) ◽  
pp. 959-964 ◽  
Author(s):  
C. Dean Kurth ◽  
Margaret Priestley ◽  
H. Marc Watzman ◽  
John McCann ◽  
Jeff Golden
Keyword(s):  
Tissue Damage ◽  
Heart Surgery ◽  
Brain Temperature ◽  
Circulatory Arrest ◽  
Neuronal Cell ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Cell Counts ◽  
Cardiovascular Variables ◽  
Fentanyl Group

Background Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), as used for infant heart surgery, carry a risk of ischemic neurologic injury. Volatile anesthetics have neuroprotective properties against both global and focal ischemia at normothermia. The authors examined the hemodynamic and neuroprotective effects of desflurane in a piglet CPB-DHCA model. Methods Twenty piglets aged 5-10 days received a desflurane- (6-9% expired) or fentanyl-based anesthetic before and during CPB (before and after DHCA). DHCA lasted 90 min at 19 degrees C brain. Cardiovascular variables (heart rate, arterial pressure, blood gases, glucose, brain temperature) were monitored. On postoperative day 2, neurologic and histologic outcomes were determined. Results Cardiovascular variables before, during, and after CPB were physiologically similar between groups. The desflurane group had better neurologic performance (P = 0.023) and greater postoperative weight gain (P = 0.04) than the fentanyl group. In neocortex, the desflurane group had less tissue damage (P = 0.0015) and fewer dead neurons (P = 0.0015) than the fentanyl group. Hippocampal tissue damage was less in the desflurane group (P = 0.05), but overall, neuronal cell counts in the CA1 sector of the right hippocampus were similar to those in the fentanyl group. Conclusions Desflurane-based anesthesia yields hemodynamics during CPB with DHCA that are similar to those with fentanyl-based anesthesia. However, desflurane-based anesthesia improves neurologic and histologic outcomes of CPB-DHCA in comparison with outcomes with fentanyl-based anesthesia.

Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

2015 ◽  
Vol 18 (4) ◽  
pp. 124
Author(s):  
Mehmet Kaplan ◽  
Bahar Temur ◽  
Tolga Can ◽  
Gunseli Abay ◽  
Adlan Olsun ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Distal Anastomosis ◽  
Ascending Aortic Aneurysm ◽  
Aortic Aneurysm Surgery ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

<p><strong>Background</strong><strong>: </strong>This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.</p><p><strong>Methods: </strong>Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.</p><p><strong>Results</strong><strong>: </strong>Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.<strong></strong></p><p><strong>Conclusion: </strong>These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.</p><p> </p>

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