Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

Introduction: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime. Method: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used. Results: Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg). Conclusions: Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1

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In Vivo Compliance of the Human Saphenous Vein Measured by Sonography: Comparison with Plethysmographic and in vitro Measurements

Phlebology The Journal of Venous Disease ◽

10.1177/026835559501000404 ◽

1995 ◽

Vol 10 (4) ◽

pp. 143-148 ◽

Cited By ~ 1

Author(s):

G. Lefthériotis ◽

Th. Pochet ◽

P. Abraham ◽

J. B. Subayi-Kamuanga ◽

A. Jardel ◽

...

Keyword(s):

Saphenous Vein ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

University Hospital ◽

Human Saphenous Vein ◽

Venous Compliance ◽

In Vitro Measurements

Objective: To evaluate a non-invasive and selective measurement of in vivo venous compliance of the human saphenous vein using sonography. Design: An experimental study in patients prior to coronary bypass surgery. Setting: Departments of Physiology and Cardiothoracic Surgery, University Hospital of Angers. Patients: Thirty patients investigated prior to coronary bypass surgery. Interventions: Simultaneous strain-gauge venous occlusion plethysmography (VOP) and measurements of the circumference of the great saphenous vein by sonography at four different occlusion pressures: 20, 30, 40 and 50 mmHg. In 10 of the same patients, in vitro determination of pressure–volume relationship during progressive inflation of excised saphenous vein samples. Main outcome measures: Venous compliance obtained with the three methods. Results: Weak correlation coefficients were found between in vitro measurements and VOP ( r=0.478, p<0.01) and sonography ( r=0.497, p<0.02). Although individual correlations between in vitro and VOP measurements ranged from 0.928 to 0.999, a wide heterogeneity was found with sonography (from 0.620 to 0.985). Conclusions: Sonography allows the selective measurement of in vivo venous compliance, although the measured compliances differ from other techniques.

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Heparin-coated Cardiopulmonary Bypass Circuits in Coronary Bypass Surgery

Artificial Organs ◽

10.1111/j.1525-1594.1996.tb04573.x ◽

1996 ◽

Vol 20 (8) ◽

pp. 936-940 ◽

Cited By ~ 10

Author(s):

Hitoshi Horimoto ◽

Keiichiro Kondo ◽

Kunio Asada ◽

Shinjiro Sasaki

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery

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Concomitant Carotid Endarterectomy and Coronary Bypass Surgery: Should Cardiopulmonary Bypass Be Used for the Carotid Procedure?

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2001.tb01220.x ◽

2008 ◽

Vol 17 (1) ◽

pp. 51-59 ◽

Cited By ~ 14

Author(s):

Massimo Bonacchi ◽

Edvin Prifti ◽

Giacomo Frati ◽

Marzia Leacche ◽

Gabriele Giunti ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Carotid Endarterectomy ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery

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Is Carotid Artery Stenting an Alternative to Simultaneous Carotid Endarterectomy Performed for Carotid Artery Stenosis in Patients Undergoing Isolated Coronary Bypass Surgery?

The Heart Surgery Forum ◽

10.1532/hsf.1290 ◽

2015 ◽

Vol 18 (5) ◽

pp. 211 ◽

Cited By ~ 1

Author(s):

Hüseyin Şaşkın ◽

Cagri Duzyol ◽

Kazım Serhan Ozcan ◽

Rezan Aksoy ◽

Mustafa Idiz

Keyword(s):

Myocardial Infarction ◽

Cardiopulmonary Bypass ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Group 2 ◽

Group 1

Background: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. Methods: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed. Group 1 (n = 71) had coronary artery bypass surgery under general anesthesia with carotid endarterectomy followed by cardiopulmonary bypass with heart team decision. Again with heart team decision, Group 2 (n=31), patients at high-risk for carotid endarterectomy (serious cardiac disease, severe chronic obstructive pulmonary disease, superiorly located lesions), received carotid artery stents in the interventional radiology department and a month later, coronary bypass surgery was performed with cardiopulmonary bypass under elective conditions. Results: Median of patient age was 67.5 (45-83) years. Twenty-two patients (31%) in Group 1 and 19 patients (56.3%) in Group 2 had neurological symptoms, which was statistically significant (P = .004). During the early postoperative term, three patients (4.2%) in Group 1 and two patients (6.5%) in Group 2 died (P = .64). Five patients (7.0%) in Group 1 and two patients (6.5%) in Group 2 developed neurological symptoms during the early postoperative term (P > .05). Likewise, two patients (2.8%) in Group 1 and five patients (16.1%) in Group 2 developed myocardial infarction following carotid intervention (P = .03). Conclusions: In patients with significant carotid artery stenosis undergoing coronary bypass surgery with cardiopulmonary bypass, in comparison to simultaneous carotid endarterectomy with coronary bypass technique and carotid artery stenting followed with coronary bypass technique showed no difference in combined endpoint (postoperative myocardial infarction, neurological events, and mortality). With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed.

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The Relationship between Low Intraoperative Hematocrit Levels during Cardiopulmonary Bypass and Postoperative Neurological Events

The Heart Surgery Forum ◽

10.1532/hsf98.2013133 ◽

2013 ◽

Vol 16 (5) ◽

pp. E243-E247

Author(s):

Metin Yılmaz ◽

Anıl Özen ◽

Kerem Yay ◽

Ertekin Utku Ünal ◽

Ömer Faruk Çiçek ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Pathological Finding ◽

Coronary Bypass ◽

Control Group ◽

Open Heart ◽

Left Hand ◽

The Mean ◽

The Relationship

Objective: The objective of our study is to analyzewhether low intraoperative hematocrit levels have an effectupon postoperative neurological events.Methods: Our study included 140 patients who underwentisolated coronary bypass under cardiopulmonary bypassbetween 2009 and 2012. The main group of the study was70 patients with intraoperative hematocrit levels lower than22%. These patients’ 30-day postoperative neurological (particularlystroke) follow up was registered as the main data ofthe study. Another group of 70 patients possessing the samedemographic features who underwent open heart surgerywith hematocrit levels remaining above 22% were registeredas the control group for perioperative neurological data.Results: The average age of the patients with hematocritlevels below and above 22% was 56.8 Â± 5.8 years and 54.1Â± 7.3 years, respectively. The mean follow-up period of thepatients was 37.2 Â± 8.6 days. None of the patients had anyneurological postoperative sequalae. No mortalities occurred.One patient who had mild paresthesia and motor weaknessof the left hand had no pathological finding on computedtomography and was diagnosed with peripheral neuropathydue to intraoperative sternal retraction.Conclusion: Because our study revealed no cerebrovascularevents, coronary bypass surgery under cardiopulmonarybypass may be safely conducted even in patients with hematocritlevels lower than 22%.

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Target Vessel Detection by Epicardial Ultrasound in Off-Pump Coronary Bypass Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a75e95 ◽

2013 ◽

Vol 8 (4) ◽

pp. 249-252 ◽

Cited By ~ 2

Author(s):

Masato Hayakawa ◽

Tohru Asai ◽

Takeshi Kinoshita ◽

Tomoaki Suzuki ◽

Shoichiro Shiraishi

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Arteries ◽

High Frequency ◽

Bypass Surgery ◽

Operation Time ◽

Coronary Bypass ◽

Postoperative Outcome ◽

Coronary Bypass Surgery ◽

Off Pump ◽

The Impact

Objective The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Methods Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. Results All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group ( P = 0.02). There were no significant differences in postoperative outcome between the two groups. Conclusions In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

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