Leukocyte filtration of the cardiotomy suction. Does it affect systemic leukocyte activation or pulmonary function?

Background: Cardiopulmonary bypass is thought to propagate a global systemic response through contact with the non-physiological surfaces of the extracorporeal circuit, leading to the stimulation of leukocytes, their adherence to endothelial cells and the release of cytotoxic molecules. This, in turn, has been shown to accelerate pulmonary injury. This study tested a new leukocyte-filtration system (RemoweLL) against a conventional system with no leukocyte-depleting capacity to determine the efficacy of the filtration system and its effects on pulmonary function. Methods: Thirty patients underwent coronary artery bypass graft surgery using either the RemoweLL filtration system (15 patients) or a conventional cardiopulmonary bypass circuit (15 patients). Data were collected on the total number of leukocytes, their differentiation and activation, using the leukocyte adhesion integrin CD11b as a surrogate marker. Pulmonary function was assessed using the Alveolar-arterial Oxygenation Index (AaOI) and patients were categorized using the Berlin definition of acute respiratory distress syndrome (ARDS). Results: Both groups showed significant increases in leukocyte numbers during CPB (p<0.001), with no differences noted between the groups. CD11b showed a significant increase in both groups, with peak activation occurring at the end of CPB, but no difference between the groups (p=0.8). There was a trend towards lower AaOI increases in the filtration group, but this did not reach significance (p=0.075) and there was no difference in ARDS definitions (p=0.33). Conclusions: Leukocyte filtration of cardiotomy suction did not influence total leukocyte counts or activation as measured by CD11b upregulation. Furthermore, no evidence could be found to suggest improved pulmonary function.

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Do lipid microemboli induce acute kidney injury during cardiopulmonary bypass?

Perfusion ◽

10.1177/0267659117705194 ◽

2017 ◽

Vol 32 (6) ◽

pp. 466-473

Author(s):

Richard Issitt ◽

Tim James ◽

Bronagh Walsh ◽

David Voegeli

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiopulmonary Bypass ◽

Serum Creatinine ◽

Cystatin C ◽

Bypass Graft ◽

Surrogate Marker ◽

Kidney Injury ◽

Renal Vasculature ◽

Filtration System

Background: Acute kidney injury (AKI) following cardiopulmonary bypass affects 5% of patients, representing significant postoperative morbidity and mortality. Animal models have shown an increased uptake of lipid microemboli (LME) into the renal vasculature, potentially indicating ischaemic causation. This study tested a new lipid filtration system (RemoweLL) against a conventional system with no lipid-depleting capacity to determine the efficacy of the filtration system and its effects on renal function. Methods: Thirty consecutive patients underwent coronary artery bypass graft surgery using either the RemoweLL filtration system (15 patients) or a conventional cardiopulmonary bypass circuit (15 patients). Renal function was assessed using cystatin C concentrations as a surrogate marker of glomerular injury, as well as perioperative glomerular filtration rate (GFR) and serum creatinine concentrations. Patients were defined as having acute renal injury if there was an increase in absolute serum creatinine ⩾3 mg/dL (26.4 µmol/L) or 1.5-fold increase from baseline as categorised using the AKIN criteria. Results: Postoperative differences in LME count between the two groups were highly significant [p<0.001]. Analysis of peak cystatin C concentrations showed significantly lower levels in the LME filtration group on the 2nd postoperative morning [p=0.04]. Two-factor ANOVA revealed a trend towards interaction, but this failed to reach significance [p=0.06]. There were no differences throughout the study period in serum creatinine or GFR [p>0.05]. There were no differences in any of the serum or urinary electrolytes. Conclusions: This study has shown a trend towards improved cystatin C removal with LME filtration; with significantly lower peak concentrations, although no further evidence of renoprotection could be demonstrated. Further research is warranted to establish possible renal benefits of LME filtration in patients undergoing cardiac surgery.

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Abstract 222: Combination of Blood Cardioplegic and Strategic Reperfusion Period Leucodepletion During Cardiopulmonary Bypass Preserves the Cardiac and Pulmonary Function: A Prospective Randomized Controlled Study

Circulation Research ◽

10.1161/res.111.suppl_1.a222 ◽

2012 ◽

Vol 111 (suppl_1) ◽

Author(s):

Qiang Chen ◽

Amir Sheikh ◽

Stuart Sheppard ◽

Roslyn Gibbs ◽

David Smith ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Pulmonary Function ◽

Artery Bypass ◽

Oxygenation Index ◽

Controlled Study ◽

Chest Drain ◽

Cell Counts ◽

Group 6 ◽

Reperfusion Period ◽

Group 1

Objectives: Leucocytes activation during cardiopulmonary bypass (CPB) contributes to postoperative organ dysfunction. We compared the outcomes of various leucodepletion strategies in patients undergoing coronary artery bypass grafting (CABG). Methods: One hundred-twenty low-risk patients undergoing first time CABG were prospectively randomized to six groups: 1 non-leucodepletion arterial filtration; 2 continuous arterial leucodepletion; 3 reperfusion period leucodepletion; 4 leucodepletion of blood cardioplegia; 5 combination of continuous arterial and blood cardioplegic leucodepletion; 6 combination of blood cardioplegic and reperfusion period leucodepletion. Blood samples were taken 5 min before CPB, 5 and 30 min on CPB, 5, 60 min after aortic X-clamp removal and 6 h post-CPB. Activated leucocytes were identified with Nitroblue Tetrazolium staining. Exhaled nitro oxide (NO) was measured pre- and post-CPB using real-time chemiluminescense analyzer. Respiratory index (alveolar-arterial oxygenation index, AaOI) was calculated 5 min before CPB and 5 min on CPB, 1, 2, 4, 8 and 18 h post-CPB. Results: Activated white cell counts were similar before CPB in all groups, but reduced significantly 5, 60 min following aortic X-clamp removal, and 6 h post-CPB in groups 2, 3, 5 and 6, compared with group 1 (ANOVA p=0.02). Post-CPB, NO increased in all groups (p<0.05) except in Group 6 (3.17±0.64 vs. 3.63±0.79 ppb/s, p=0.22). Group 6 exhibited a lower AaOI than group 1 over all time points post-CPB (ANOVA, p=0.02). Postoperatively, there was a significant reduction in inotropic requirement, ventilation time and atrial fibrillation in group 6 (p=0.045, 0.04 and 0.043, respectively). There was no difference in chest drain output, length of ICU and hospital stay among all groups. Conclusions: Combination of blood cardioplegic and reperfusion period leucodepletion appeared to be most effective in attenuating activated leucocytes during CPB, which was associated with better preservation of cardiac and pulmonary function compared with other leucodepletion strategies.

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The effect of pulsatile blood flow during proximal graft in facilitation weaning from cardiopulmonary bypass pump in coronary artery bypass graft surgery

Chirurgia ◽

10.23736/s0394-9508.19.05039-3 ◽

2020 ◽

Vol 33 (4) ◽

Author(s):

Seyed M. Amouzegarzavareh ◽

Marzieh Lak

Keyword(s):

Blood Flow ◽

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Pulsatile Blood Flow

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Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-020-04809-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Thiago Augusto Azevedo Maranhão Cardoso ◽

Gudrun Kunst ◽

Caetano Nigro Neto ◽

José de Ribamar Costa Júnior ◽

Carlos Gustavo Santos Silva ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Controlled Trial ◽

Artery Bypass ◽

Bypass Graft ◽

Volatile Anesthetic ◽

Serum Levels ◽

Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

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