scholarly journals The Effect of On-Pump and Off-Pump Bypass Operations on Oxidative Damage and Antioxidant Parameters

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Ayse Dogan ◽  
Fevzi Sarper Turker
Keyword(s):  
Enzyme Activity ◽  
Oxidative Damage ◽  
Postoperative Period ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Practices ◽  
Pump Operation ◽  
Off Pump ◽  
Antioxidant Parameters ◽  
Antioxidant Supplement

Objective. The aim of the study is to determine the oxidative status in on-pump and off-pump coronary artery surgery and contribute to possible surgical choices in clinical practices in accordance with the information obtained as a result of this study. Methods. 52 patients undergoing open heart surgery (26 patients in on-pump group and 26 patients in off-pump group) were included in the study. MDA, GPx, GSH, CAT, and SOD were investigated in blood samples. Results. In the on-pump group, it was determined that there were a significant increase in MDA level in the peroperative period compared to the preoperative and postoperative periods and a significant increase in GSH level in the postoperative period than in the preoperative period. Additionally, while there was a significant decrease in CAT activity in the postoperative period than in the peroperative period, there was a statistically significant increase in SOD enzyme activity in the postoperative period compared to the preoperative and peroperative periods. A statistically significant increase was observed in SOD enzyme activity in the postoperative period in on-pump compared to off-pump group. Conclusion. It is thought that this oxidative damage can be suppressed by administering a suitable antioxidant supplement in the preoperative and peroperative periods among patients undergoing the on-pump operation.

scholarly journals Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fevzi Sarper Türker ◽  
Ayşe Doğan ◽  
Gonca Ozan ◽  
Kurtuluş Kıbar ◽  
Mine Erışır
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxidative Damage ◽  
Postoperative Period ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Early Postoperative Period ◽  
Open Heart ◽  
Arterial Blood ◽  
Antioxidant Parameters ◽  
Antioxidant Supplements

Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods.Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined.Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period.Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed.

Off-Pump Coronary Artery Bypass Surgery May Produce a Hypercoagulable Patient

2005 ◽  
Vol 6 (2) ◽  
pp. 94 ◽  
Author(s):  
Robert L. Quigley ◽  
David W. Fried ◽  
John Pym ◽  
Richard Y. Highbloom
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
Platelet Activity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<P>Background: The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. </P><P>Methods: We prospectively studied 17 OPCAB and 6 on-pump patients over 4 days (hospital course) with daily thromboelastography. A coagulation index (CI) (reflecting R and K times, a angle, and maximum amplitude [MA]) was calculated for the patients, who served as their own controls. </P><P>Results: The OPCAB patients demonstrated 3 days postoperatively a 17% increase in coagulation compared with the baseline. Specifically, the CI consistently revealed an elevation in the a angle and the MA, both of which reflect increased fibrinogen and platelet activity. On the other hand, 3 days following surgery the CI of the CPB group was tightly clustered around their respective baseline CI values, which had recovered from a significant decrease immediately after surgery. </P><P>Conclusion: A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.</P>

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

Efficacy of a Proton Pump Inhibitor Given in the Early Postoperative Period to Relieve Symptoms of Hiatal Hernia After Open Heart Surgery

Surgery Today ◽  
2006 ◽  
Vol 36 (2) ◽  
pp. 131-134 ◽  
Author(s):  
Mitsumasa Hata ◽  
Motomi Shiono ◽  
Hisakuni Sekino ◽  
Hidekazu Furukawa ◽  
Akira Sezai ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Hiatal Hernia ◽  
Proton Pump ◽  
Postoperative Period ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Early Postoperative Period ◽  
Open Heart

Anesthetic management of an off-pump open-heart surgery in a dog

2009 ◽  
Vol 36 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Eva Rioja ◽  
Kim Beaulieu ◽  
David L Holmberg
Keyword(s):  
Heart Surgery ◽  
Anesthetic Management ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Off Pump

scholarly journals Off-pump myocardial revascularization using the octopus tissue stabilizer system

2003 ◽  
Vol 56 (1-2) ◽  
pp. 80-84 ◽  
Author(s):  
Predrag Milojevic ◽  
Vojislava Neskovic ◽  
Dragos Stojanovic ◽  
Miroslav Jakovljevic ◽  
Sava Nenic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Open Heart Surgery ◽  
Myocardial Revascularization ◽  
Arterial Grafts ◽  
Off Pump ◽  
Coronary Artery Revascularization ◽  
Pump Coronary Artery Bypass

Off-pump coronary artery bypass surgery (OPCAB) has changed the approach to contemporary coronary surgery. Development of new surgical devices and techniques has reduced morbidity and mortality during off-pump surgery. From March 2000 - April 2002, a total of 136 patients underwent open heart surgery using off-pump technique and fast-track anesthesia at Dedinje Cardiovascular Institute. Octopus Medtronic coronary stabilizer was used for stabilization of targeted vessel. Arterial grafts were used 169 times and saphenous vein 69 times. Average number of anastomoses was 1,830,73 per patient. One patient (0.74%) died. Three patients (2.21%) underwent surgery revision due to postoperative bleeding and one (0.74%) because of graft dysfunction Perioperative myocardial infarction was registered 2 times (1.47%) pneumothorax 3 times (2.21%), postoperative arrhythmias 11 times (8.09%) transitory ischemic attack once (0.74%) and deep wound infection once (0.74%). Twelve patients (8.82%) required prolonged inotropic support Angiographies early revealed patent grafts in 8 patients (5.88%). OPCAB is a safe and effective alternative approach to coronary artery revascularization Use of coronary stabilizer has improved the safety and quality of OPCAB surgery.

Management of anticoagulation and its reversal during paediatric cardiopulmonary bypass: a review of current UK practice

Perfusion ◽  
2000 ◽  
Vol 15 (3) ◽  
pp. 191-201 ◽  
Author(s):  
Massimiliano Codispoti ◽  
Pankaj S Mankad
Keyword(s):  
Cardiopulmonary Bypass ◽  
Great Britain ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Wide Distribution ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Telephone Interviews ◽  
Surgical Units ◽  
The Uk

Protocols for management of heparin and protamine administration in patients undergoing open-heart surgery have been developed from experience gained mainly in adult practice. However, it has been demonstrated that there are marked differences between paediatric and adult patients in their response to systemic anticoagulation and its reversal. The aim of this study was to obtain an overview of current practice of management of anticoagulation and its reversal from paediatric cardiac surgical units of Great Britain and Ireland. All centres performing paediatric cardiac surgery agreed to participate in the survey ( n = 16). Telephone interviews were carried out with the chief or a senior perfusionist from all participating institutions, which were based on a structured questionnaire compiled specifically for the purpose. The answers were anonymized. At present, in the UK and Ireland, unfractionated heparin is the anticoagulant of choice in all units, with a slight prevalence of porcine mucosal (9/16, 56.5%) versus bovine lung preparation (7/16, 44.0%). The policy for administration of heparin to the patient is uniform, with a dose of 300 IU/kg. However, there is great variability in the amount of heparin added to the prime and to the volume infused during cardiopulmonary bypass (CPB). Monitoring of anticoagulation is achieved by activated coagulation time alone in all but one centre, with lower limits varying between 400 and 750 s. Use of aprotinin is widely accepted, but clinical indications are highly variable. No centre adopts heparin-bonded or heparin-coated circuitry for CPB. Calculation of initial and additional protamine doses followed a variety of criteria, resulting in a very wide distribution of doses. The data obtained highlighted the lack of uniformity among paediatric cardiac surgical units of Great Britain and Ireland with regard to most of the issues related to the management of anticoagulation and its reversal. The striking heterogeneity of our cross-sectional observations clearly underlines the need for prospective, multicentre studies on a national basis to relate different clinical practices to outcome measures.

Breaking down the silos: Transcatheter aortic valve implant versus open heart surgery

2020 ◽  
Vol 33 (6) ◽  
pp. 277-281
Author(s):  
Hamid Sadri
Keyword(s):  
Aortic Valve ◽  
Heart Surgery ◽  
Budget Impact ◽  
Open Heart Surgery ◽  
Cost Of Care ◽  
Clinical Practices ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Department ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Valve

Budget silos innate to hospital global funding schemes tend to inhibit the adoption of innovative clinical practices. In contrast, budget fluidity can encourage initiatives that align with the Quadruple Aim. This article calculated the budget impact of Surgical Aortic Valve Replacement (SAVR) and Transcatheter Valve Implant (TAVI) in high-risk aortic stenosis to demonstrate the value of a full-cost accounting approach. The budget impact of TAVI was $4,000 more than SAVR ($52,576 vs $48,578). However, the cost of managing SAVR adverse events was higher than TAVI ($17,718 vs. $11,754) over 1 year. A scenario analysis demonstrated that the total cost of care for a cohort of 100 patients at baseline ratio of 30% TAVI versus 70% SAVR was similar to a future scenario, with reverse proportions. While TAVI may seem expensive upfront, when considered as a surgical department budget item, the overall cost to the hospital is comparable to the SAVR.

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