The effect of oral triiodothyronine supplementation on lactate and pyruvate after paediatric cardiac surgery

2020 ◽  
pp. 1-7
Author(s):  
Eva M. Marwali ◽  
Putri Caesa ◽  
Muhammad Rayhan ◽  
Poppy S. Roebiono ◽  
Dicky Fakhri ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Pyruvate Metabolism ◽  
Aortic Cross Clamp ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Glucose Levels ◽  
Lactate And Pyruvate ◽  
Induction Of Anaesthesia

Abstract Objective: To determine if triiodothyronine alters lactate, glucose, and pyruvate metabolism, and if serum pyruvate concentration could serve as a predictor of low cardiac output syndrome in children after cardiopulmonary bypass procedures. Methods: This study was ancillary to the Oral Triiodothyronine for Infants and Children undergoing Cardiopulmonary bypass (OTICC) trial. Serum pyruvate was measured in the first 48 patients and lactate and glucose were measured in all 208 patients enrolled in the OTICC study on the induction of anaesthesia, 1 and 24 hours post-aortic cross-clamp removal. Patients were also defined as having low cardiac output syndrome according to the OTICC trial protocol. Result: Amongst the designated patient population for pyruvate analysis, 22 received placebo, and 26 received triiodothyronine (T3). Lactate concentrations were nearly 20 times greater than pyruvate. Lactate and pyruvate levels were not significantly different between T3 and placebo group. Glucose levels were significantly higher in the placebo group mainly at 24-hour post-cross-clamp removal. Additionally, lactate and glucose levels peaked at 1-hour post-cross-clamp removal in low cardiac output syndrome and non-low cardiac output syndrome patients, but subsequently decreased at a slower rate in low cardiac output syndrome. Lactate and pyruvate concentrations correlated with glucose only prior to surgery. Conclusion: Thyroid supplementation does not alter systemic lactate/pyruvate metabolism after cardiopulmonary bypass and reperfusion. Pyruvate levels are not useful for predicting low cardiac output syndrome. Increased blood glucose may be regarded as a response to hypermetabolic stress, seen mostly in patients with low cardiac output syndrome.

scholarly journals Clinical and Laboratory Predictors for the Development of Low Cardiac Output Syndrome in Infants Undergoing Cardiopulmonary Bypass: A Pilot Study

2021 ◽  
Vol 10 (4) ◽  
pp. 712
Author(s):  
Sarah E. Drennan ◽  
Kathryn Y. Burge ◽  
Edgardo G. Szyld ◽  
Jeffrey V. Eckert ◽  
Arshid M. Mir ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Characteristic Curve ◽  
Perioperative Period ◽  
Interleukin 10 ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

Cardiac surgery employing cardiopulmonary bypass exposes infants to a high risk of morbidity and mortality. The objective of this study was to assess the utility of clinical and laboratory variables to predict the development of low cardiac output syndrome, a frequent complication following cardiac surgery in infants. We performed a prospective observational study in the pediatric cardiovascular ICU in an academic children’s hospital. Thirty-one patients with congenital heart disease were included. Serum levels of nucleosomes and a panel of 20 cytokines were measured at six time points in the perioperative period. Cardiopulmonary bypass patients were characterized by increased levels of interleukin-10, -6, and -1α upon admission to the ICU compared to non-bypass cardiac patients. Patients developing low cardiac output syndrome endured longer aortic cross-clamp time and required greater inotropic support at 12 h postoperatively compared to bypass patients not developing the condition. Higher preoperative interleukin-10 levels and 24 h postoperative interleukin-8 levels were associated with low cardiac output syndrome. Receiver operating characteristic curve analysis demonstrated a moderate capability of aortic cross-clamp duration to predict low cardiac output syndrome but not IL-8. In conclusion, low cardiac output syndrome was best predicted in our patient population by the surgical metric of aortic cross-clamp duration.

Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome

2012 ◽  
Vol 25 (12) ◽  
pp. 2756-2761 ◽  
Author(s):  
Raul Abella ◽  
Angela Satriano ◽  
Alessandro Frigiola ◽  
Alessandro Varrica ◽  
Antonio DW Gavilanes ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiopulmonary Bypass ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals Combined use of phenoxybenzamine and dopamine for low cardiac output syndrome in children at withdrawal from cardiopulmonary bypass.

Heart ◽  
1980 ◽  
Vol 43 (4) ◽  
pp. 388-392 ◽  
Author(s):  
M Kawamura ◽  
O Minamikawa ◽  
H Yokochi ◽  
S Maki ◽  
T Yasuda ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiopulmonary Bypass ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Combined Use

scholarly journals Etiological factors and clinical value of metabolic acidosis after cardiac surgery with cardiopulmonary bypass

2019 ◽  
Vol 18 (3) ◽  
pp. 35-43
Author(s):  
A. O. Marichev ◽  
S. V. Datsenko ◽  
O. V. Deinega ◽  
E. A. Kabakova ◽  
E. S. Kurskova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Metabolic Acidosis ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Postoperative Period ◽  
Acid Base ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Lactate Acidosis

Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate significance of MetAc in an early postoperative period.Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inflammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inflammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inflammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality. 

Postoperative Hydrocortisone Infusion Reduces the Prevalence of Low Cardiac Output Syndrome After Neonatal Cardiopulmonary Bypass*

2015 ◽  
Vol 16 (7) ◽  
pp. 629-636 ◽  
Author(s):  
Stephen M. Robert ◽  
Santiago Borasino ◽  
Robert J. Dabal ◽  
David C. Cleveland ◽  
Kristal M. Hock ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiopulmonary Bypass ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals Changes in cardiac Aquaporin expression during aortic valve replacement surgery with cardiopulmonary bypass

2019 ◽  
Author(s):  
María Teresa Politi ◽  
Federico Ochoa ◽  
Vanina Netti ◽  
Raúl Ferreyra ◽  
Guillermo Bortman ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiopulmonary Bypass ◽  
Aquaporin 4 ◽  
Myocardial Oedema ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Aquaporin 1 ◽  
Replacement Surgery ◽  
Protein Levels ◽  
Valve Replacement Surgery

Abstract OBJECTIVES Cardiopulmonary bypass (CPB) use is an essential strategy for many cardiovascular surgeries. However, its use and duration have been associated with a higher rate of postoperative complications, such as low cardiac output syndrome due to myocardial oedema and dysfunction. Though Aquaporin water channels have been implicated in myocardial water balance, their specific role in this clinical scenario has not been established. METHODS In a consecutive study of 17 patients with severe aortic stenosis undergoing aortic valve replacement surgery, 2 myocardial biopsies of the left ventricle were taken: 1 before and 1 after CPB use. Sociodemographic, clinical and laboratory data were collected. Western blot and immunohistochemistry studies were performed. RESULTS After CPB use, there was a mean increase of ∼62% in Aquaporin 1 protein levels (P = 0.001) and a mean reduction of ∼38% in Aquaporin 4 protein levels (P = 0.030). In immunohistochemistry assays, Aquaporin 1 was found lining small blood vessels, while Aquaporin 4 formed a circular label in cardiomyocytes. There were no changes in the localization of either protein following CPB use. During the observed on-pump time interval, there was a 1.7%/min mean increase in Aquaporin 1 (P = 0.021) and a 2.5%/min mean decrease in Aquaporin 4 (P = 0.018). Myocardial interstitial oedema increased by 42% (95% confidence interval 31–54%) after CPB use. Patients who developed low cardiac output syndrome were in the upper half of the median percentage change of Aquaporin expression. CONCLUSION Time-dependent changes in cardiac Aquaporin expression may be associated with myocardial oedema and dysfunction related to CPB use.

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