Effects of Duraflo II Heparin-Coated Cardiopulmonary Bypass Circuits on the Coagulation System, Endothelial Damage, and Cytokine Release in Patients with Cardiac Operation Employing Aprotinin and Steroids

Background There are few detailed descriptions of the inflammatory response to cardiac surgery with cardiopulmonary bypass (CPB) in children beyond 24 h postoperatively. This is especially true for the antiinflammatory cytokines and the extent of tissue injury. The aim of the current study was to describe the inflammatory and injury responses in uncomplicated pediatric cardiac surgery with CPB, where methylprednisolone and modified ultrafiltration (MUF) were used. Methods Blood samples were collected up to 48 h postoperatively. Cytokines (tumor necrosis factor-alpha and interleukin-6, -1beta, -10, and -1ra), complement (C3d and C4d) and coagulation system (prothrombin activation fragments 1 and 2 and antithrombin III) activation, neutrophil elastase, and the resulting tissue injury (creatine kinase, lactate dehydrogenase, alanine transaminase, amylase, and gamma-glutamyl transferase) were measured. Results The proinflammatory cytokine release varied widely, in contrast to a clear-cut antiinflammatory response. Cytokine concentrations did not decrease immediately after MUF, and no rebound increases later in the postoperative period were observed. The coagulation system, but not complement, was activated. There was a late release of C-reactive protein. Tissue injury could be quantified biochemically without evidence of hepatic or pancreatic dysfunction. Conclusion In this group of uncomplicated subjects, the antiinflammatory cytokine and tissue injury responses were well defined, in contrast to a variable proinflammatory cytokine release. This was accompanied by activation of the coagulation system but not of complement. Concentrations of inflammatory mediators did not decrease immediately after MUF, and there was no evidence for rebound release later in the postoperative period.

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A systematic review of the evidence supporting post-operative medication use in congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951121001463 ◽

2021 ◽

pp. 1-27

Author(s):

Elizabeth J. Thompson ◽

Henry P. Foote ◽

Caitlin E. King ◽

Sabarish Srinivasan ◽

Elizabeth C. Ciociola ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Adverse Events ◽

Drug Development ◽

Drug Disposition ◽

Controlled Vocabulary ◽

Coagulation System ◽

Future Research ◽

Pulmonary Vasodilators ◽

Post Operative Period ◽

Operative Care

Abstract Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

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COVID-19 AND STROKE: POSSIBLE CAUSES AND PATHOGENESIS (REVIEW)

Vestnik ◽

10.53065/kaznmu.2021.22.87.024 ◽

2021 ◽

pp. 103-106

Author(s):

А.Е. Кожашева ◽

С.О. Белесбек ◽

Д.Ж. Абдимитова ◽

Б.М. Сакен ◽

А.П. Бориходжаева ◽

...

Keyword(s):

Preventive Measures ◽

Cerebrovascular Disorders ◽

Endothelial Damage ◽

Cytokine Release ◽

Contributing Factors ◽

Acute Cerebrovascular Accident ◽

Von Willebrand ◽

The Relationship ◽

Willebrand Factor ◽

D Dimer

Появляются доказательства того, что COVID-19 может вызывать выброс цитокинов, состояние гиперкоагуляции и повреждение эндотелия, которое может привести к острому нарушению мозгового кровообращения (ОНМК). В данной статье авторы обсуждают взаимосвязь между COVID-19 и ОНМК, и о возможных факторах, способствующих возникновению инсульта. Как свидетельствует увеличение D-димера, фибриногена, фактора VIII и фактора фон Виллебранда, инфекция SARS-CoV-2 вызывает коагулопатию, нарушает функцию эндотелия и способствует состоянию гиперкоагуляции. В совокупности это предрасполагает пациентов к цереброваскулярным нарушениям. Механизм, лежащий в основе COVID-19 и инсульта, требует дальнейшего изучения, равно как и разработка эффективных терапевтических или профилактических мер. Evidence is emerging that COVID-19 can cause cytokine release, hypercoagulable states, and endothelial damage that can lead to acute cerebrovascular accident (ACVI). In this article, the authors discuss the relationship between COVID-19 and stroke and the possible contributing factors to stroke. As evidenced by an increase in D-dimer, fibrinogen, factor VIII and von Willebrand factor, SARS-CoV-2 infection causes coagulopathy, disrupts endothelial function and hypercoagulability. Collectively, this predisposes patients to cerebrovascular disorders. The mechanism underlying COVID-19 and stroke requires further study, as does the development of effective therapeutic or preventive measures.

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Femoro-axillary cardiopulmonary bypass for giant abdominal aortic aneurysm repair prior to staged cardiac operation for ischaemic cardiomyopathy

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2009.09.033 ◽

2010 ◽

Vol 37 (4) ◽

pp. 972-974 ◽

Cited By ~ 2

Author(s):

Marco Pocar ◽

Andrea Moneta ◽

Davide Passolunghi ◽

Francesco Donatelli

Keyword(s):

Abdominal Aortic Aneurysm ◽

Cardiopulmonary Bypass ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Cardiac Operation ◽

Ischaemic Cardiomyopathy ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Effect of Cardiopulmonary Bypass on Cytokine Release and Adhesion Molecule Expression in Alveolar Macrophages

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.156.3.9611055 ◽

1997 ◽

Vol 156 (3) ◽

pp. 932-938 ◽

Cited By ~ 23

Author(s):

MASANORI TSUCHIDA ◽

HIROSHI WATANABE ◽

TAKEHIRO WATANABE ◽

HIROYUKI HIRAHARA ◽

MANABU HAGA ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Adhesion Molecule ◽

Alveolar Macrophages ◽

Adhesion Molecule Expression ◽

Cytokine Release

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Direct evidence of endothelial injury during cardiopulmonary bypass by demonstration of circulating endothelial cells

Perfusion ◽

10.1191/0267659106pf860oa ◽

2006 ◽

Vol 21 (3) ◽

pp. 133-137 ◽

Cited By ~ 11

Author(s):

Franz-Xaver Schmid ◽

Bernhard Floerchinger ◽

Nalini Kumar Vudattu ◽

Günther Eissner ◽

Marion Haubitz ◽

...

Keyword(s):

Endothelial Cells ◽

Cardiopulmonary Bypass ◽

Direct Evidence ◽

Artery Bypass ◽

Endothelial Activation ◽

Endothelial Damage ◽

Endothelial Injury ◽

Circulating Endothelial Cells ◽

Whole Body ◽

Maximum Increase

Endothelial activation is considered a key process in the development of a whole body inflammatory response secondary to cardiopulmonary bypass (CPB). Increased levels of a multitude of soluble mediators have been described as being released during and after cardiac surgery. Circulating endothelial cells have recently been established as a novel marker of endothelial damage in a variety of vascular disorders. Blood samples from 20 patients undergoing elective coronary artery bypass surgery were obtained preoperatively and 1, 6, 12, 24, and 48 h after termination of CPB. Control samples were obtained from ten healthy volunteers. Circulating endothelial cells (CEC) were isolated with immunomagnetic anti-CD146-coated Dynabeads, and counted in a Nageotte chamber. Low numbers of CEC were observed in healthy control volunteers (12±6 cells/mL; median: 9 cells/mL). CEC numbers were already significantly elevated in all patients before CPB, and there was a further significant increase after weaning from CPB (maximum increase at 6 h after CPB: 73±30 cells/mL; range: 30-153 cells/mL, p < 0.001). The number of CEC provides further and direct evidence that CPB is associated with a pronounced endothelial injury and/or damage. CEC appear to be most useful markers for vascular endothelial activation because they are specific, stable, and circulating components of injured vessel wall.

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