Neutrophil function and cardiopulmonary bypass in humans. The effects of glucose and non-glucose containing bypass pump priming fluids

Perfusion ◽  
1986 ◽  
Vol 1 (2) ◽  
pp. 103-116 ◽  
Author(s):  
PT Conroy ◽  
MJ Elliott ◽  
PN Platt ◽  
M. Holden
Keyword(s):  
Cardiopulmonary Bypass ◽  
Whole Blood ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Neutrophil Function ◽  
Polymorphonuclear Neutrophil ◽  
Blood Glucose Concentrations ◽  
Glucose Group

Defective polymorphonuclear neutrophil function during cardiopulmonary bypass (CPB) has been implicated as a cause of postoperative infection following open-heart surgery. Neutrophil function is known to be impaired in poorly controlled diabetics with elevations of blood glucose concentrations of the order which occur frequently during CPB when glucose containing priming fluids are used. Neutrophil function, as measured by bactericidal assay, and neutrophil and whole blood luminol dependent chemiluminescence, was studied in two groups of 1 2 patients undergoing coronary artery bypass graft surgery. Patients received either a glucose or non-glucose containing bypass pump-priming fluid. Postoperatively neutrophil luminol-dependent chemiluminescence was significantly increased in both groups (glucose prime groups p < 0.01, non-glucose prime group p < 0.01). Whole blood chemiluminescence was increased significantly intra and postoperatively in the glucose prime group ( p < 0.02, p < 0.02 respectively) but the increase was not significant in the non-glucose prime group. Bactericidal activity remained unchanged during and after surgery in both groups (mean bactericidal index intraoperatively 96.4 glucose group, 96.2 non-glucose group; postoperatively 99.7 glucose group, 99.7 non-glucose group). These data suggest that glucose containing bypass priming fluids do not modulate significantly the function of circulating neutrophils after CPB. Neutrophil function was not decreased after surgery, and other factors may be responsible for the reported higher incidence of bacterial infection after CPB.

Monitoring of r-Hirudin Anticoagulation during Cardiopulmonary Bypass – Assessment of the Whole Blood Ecarin Clotting Time

1997 ◽  
Vol 77 (05) ◽  
pp. 0920-0925 ◽  
Author(s):  
Bernd Pötzsch ◽  
Katharina Madlener ◽  
Christoph Seelig ◽  
Christian F Riess ◽  
Andreas Greinacher ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Whole Blood ◽  
Heart Surgery ◽  
Ex Vivo ◽  
Open Heart Surgery ◽  
Clotting Time ◽  
Blood Samples ◽  
Alternative Approach ◽  
Ecarin Clotting Time

SummaryThe use of recombinant ® hirudin as an anticoagulant in performing extracorporeal circulation systems including cardiopulmonary bypass (CPB) devices requires a specific and easy to handle monitoring system. The usefulness of the celite-induced activated clotting time (ACT) and the activated partial thromboplastin time (APTT) for r-hirudin monitoring has been tested on ex vivo blood samples obtained from eight patients treated with r-hirudin during open heart surgery. The very poor relationship between the prolongation of the ACT and APTT values and the concentration of r-hirudin as measured using a chromogenic factor Ila assay indicates that both assays are not suitable to monitor r-hirudin anticoagulation. As an alternative approach a whole blood clotting assay based on the prothrombin-activating snake venom ecarin has been tested. In vitro experiments using r-hirudin- spiked whole blood samples showed a linear relationship between the concentration of hirudin added and the prolongation of the clotting times up to a concentration of r-hirudin of 4.0 µg/ml. Interassay coefficients (CV) of variation between 2.1% and 5.4% demonstrate the accuracy of the ecarin clotting time (ECT) assay. Differences in the interindividual responsiveness to r-hirudin were analyzed on r-hirudin- spiked blood samples obtained from 50 healthy blood donors. CV- values between 1.8% and 6% measured at r-hirudin concentrations between 0.5 and 4 µg/ml indicate remarkably slight differences in r-hirudin responsiveness. ECT assay results of the ex vivo blood samples linearily correlate (r = 0.79) to the concentration of r-hirudin. Moreover, assay results were not influenced by treatment with aprotinin or heparin. These findings together with the short measuring time with less than 120 seconds warrant the whole blood ECT to be a suitable assay for monitoring of r-hirudin anticoagulation in cardiac surgery.

A Case of Organic Mania Associated with Open Heart Surgery

1994 ◽  
Vol 7 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Kathryn J. Kotrla ◽  
Ranjit C. Chacko ◽  
Shawn A. Barrett
Keyword(s):  
Heart Surgery ◽  
Single Photon ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Photon Emission ◽  
Open Heart Surgery ◽  
Brain Regions ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Single Photon Emission Computed

Organic mania has been reported to have multiple etiologies. A case is described of a patient who developed mania following a coronary artery bypass graft and mitral valve replacement. Cerebral abnormalities were not detected by computed tomographic or magnetic resonance imaging scans, but an area of dysfunction was found using single photon emission computed tomographic (SPECT) imaging. The lesion resolved when the patient became clinically asymptomatic. The area of decreased cerebral perfusion associated with the patient's mania was in an atypical location, raising questions about which brain regions can result in well-defined psychiatric syndromes.

Plasma Oxygen during Cardiopulmonary Bypass: A Comparison of Blood Oxygen Levels with Oxygen Present in Plasma Lipid

1998 ◽  
Vol 94 (1) ◽  
pp. 35-41 ◽  
Author(s):  
I. M. Petyaev ◽  
A. Vuylsteke ◽  
D. W. Bethune ◽  
J. V. Hunt
Keyword(s):  
Cardiopulmonary Bypass ◽  
Lipid Content ◽  
Whole Blood ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Plasma Lipid ◽  
Essential Element ◽  
Lipid Phase ◽  
Number Of Patients ◽  
Plasma Oxygen

1. Although not often appreciated, it is a fact that molecular oxygen is more soluble in lipids than in aqueous solution. We have recently developed a method to monitor oxygen within the lipid content of plasma. Monitoring plasma oxygen is one essential element during open heart surgery using a cardiopulmonary bypass pump and oxygenator. Currently oxygen is monitored electrochemically and is based upon monitoring the partial pressure of oxygen in a gas equilibrated with whole blood. 2. To determine the relative importance of lipid-associated oxygen in blood and assess the potential use of such a measurement we present comparisons of changes in oxygen associated with whole blood and lipid content of plasma before, during and after cardiac surgery. 3. In a limited number of patients studied (n = 28), aged between 34 and 86 years, oxygen in lipid increased with decreased extracorporeal blood temperature during cardiopulmonary bypass, increased in proportion to oxygen supplied and appeared to be a better monitor of oxygen than conventional electrochemical systems currently in use. Oxygen associated with whole blood and plasma lipid was markedly below normal on aortic declamping after cardiopulmonary bypass, suggesting an hypoxic episode at this point. Levels of oxygen in the lipid phase of plasma returned to normal presurgical values 6–8 h after surgery. 4. Calculation of the concentration of lipid-associated oxygen present in plasma suggests that plasma lipids contain up to 25% of that typically ascribed to haemoglobin. Thus, we suggest that monitoring lipid-associated oxygen may prove a better alternative to current methods of measuring oxygen status. Furthermore, we suggest that plasma lipid is a hitherto unsuspected pool of circulating oxygen which may play a significant role in tissue oxygen supply.

Comparison of a Duraflo II-coated cardiopulmonary bypass circuit and a trillium-coated oxygenator during open-heart surgery

Perfusion ◽  
2004 ◽  
Vol 19 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Tom N Hoel ◽  
Vibeke Videm ◽  
Svein T Baksaas ◽  
Tom E Mollnes ◽  
Frank Brosstad ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Complement Activation ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Activation Products ◽  
Risk Patients ◽  
Leukocyte Counts ◽  
Terminal Complement

Background: Cardiopulmonary bypass (CPB) evokes a systemic inflammatory response. In attempting to improve the biocompatibility of the equipment, various methods to coat the inner surfaces of the CPB systems have been developed. The present study compares a Trillium Biopassive surface-coated Affinity oxygenator with a Duraflo II totally heparin-coated CPB system. Methods: Low-risk patients admitted for primary coronary artery bypass grafting or aortic valve replacement were randomized to operation using the Trillium- or the Duraflo II-coated setups. Heparin concentration, complement activation (C3bc activation products and terminal complement complex (TCC)), platelet activation (platelet numbers and beta-thromboglobulin (BTG)), leukocyte activation (leukocyte numbers and myeloperoxidase (MPO)), coagulation (thrombin/antithrombin complexes (TAT)) and fibrinolytic activity (plasmin/a2-antiplasmin complexes (PAP)) were measured during CPB and two hours postoperatively. Results: Platelet counts decreased during CPB, without significant intergroup differences. The median BTG concentration increased moderately in both groups and were slightly higher in the Trillium group during CPB (p B-0.05), but not postoperatively. Complement activation products (C3bc and TCC), leukocyte counts, MPO, TAT and PAP activity showed no differences between the two groups. Conclusions: There were small differences in the inflammatory response between the two extracorporeal circulation devices compared in this study.

The role of N-acetylcystein administration on the oxidative response of neutrophils during cardiopulmonary bypass

Perfusion ◽  
1995 ◽  
Vol 10 (1) ◽  
pp. 21-26 ◽  
Author(s):  
LW Andersen ◽  
J. Thiis ◽  
A. Kharazmi ◽  
I. Rygg
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxidative Burst ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Radical Scavenger ◽  
Double Blind Study ◽  
Oxidative Response ◽  
Oxidative Burst Response

The role of N-acetylcystein (NAC) administration on the oxidative response of neutrophils during cardiopulmonary bypass (CPB) was evaluated in a double-blind study. Twenty-four adult patients undergoing coronary artery bypass were included in the study. Twelve patients received NAC as a bolus of 100 mg/kg followed by a continuous infusion of 20 mg/kg/h in the bypass circuit from the beginning to the end of bypass. A further 12 patients received placebo. Citrated blood samples for measurement of oxidative burst response of neutrophils were obtained at different time points during bypass. The oxidative burst response of neutrophils in the patients receiving NAC was significantly low at all times during bypass. Based on these findings NAC appears to act as an oxygen free radical scavenger during open-heart surgery.

Recent Developments in Myocardial Protection: Retrograde Cardioplegia

1997 ◽  
Vol 5 (1) ◽  
pp. 2-7
Author(s):  
Anthony L Panos ◽  
Salim Aziz
Keyword(s):  
Coronary Sinus ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Ease Of Use ◽  
Blood Cardioplegia ◽  
Catheter Design ◽  
Coronary Sinus Catheter ◽  
Recent Developments

In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.

scholarly journals Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Abdorasoul Anvaripour ◽  
Forouzan Yazdanian ◽  
Mohammad-Zia Totonchi ◽  
Houshang Shahryari
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Venous Catheter ◽  
Mitral Valve Stenosis ◽  
Artery Disease ◽  
Vessel Coronary Artery

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

Cardiac rehabilitation of older patients

2003 ◽  
Vol 13 (3) ◽  
pp. 241-255 ◽  
Author(s):  
Robert West
Keyword(s):  
Major Trauma ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Developed Countries ◽  
The Other ◽  
Co Morbidity ◽  
Life Threatening

Rehabilitation is a necessary step in the process of recovery from most serious illness and from many clinical interventions. The nature of rehabilitation, and the form of any programme of rehabilitation provided to help patients with this process, depends greatly on patient, illness, treatment or intervention, co-morbidity and on the availability of appropriate services. Heart disease is the leading cause of death in most developed countries and acute myocardial infarction (MI) is a major cause of acute medical admissions to hospitals, and revascularization by coronary artery bypass graft surgery (CABG) is a leading surgical intervention. Both MI and CABG involve a day or more in intensive care followed by several days recuperation in hospital. There is a fairly obvious case for rehabilitation for patients surviving the truly life-threatening experience of MI (20% sudden deaths and a further 10% die within 24 hours of onset of pain), and for patients following the major ‘trauma’ of open heart surgery (operative mortality about 1%). The specific needs of these two groups may differ because their experiences differ; one medical the other surgical, and, possibly more significantly, one unexpected, the other planned.

scholarly journals Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

2013 ◽  
Vol 46 (03) ◽  
pp. 538-542 ◽  
Author(s):  
Mohammad Abbasi Tashnizi ◽  
Mohammad Esmail Khayami ◽  
Hamid Reza Rahimi ◽  
Aliasghar Moeinipour ◽  
Ahmad Amouzeshi ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Heart Surgery ◽  
Platelet Rich Plasma ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Systemic Complications ◽  
Healing Wound ◽  
Life Threatening ◽  
Invasive Method

ABSTRACT Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG); but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

scholarly journals Coronary Artery Bypass Graft Surgery in Tanzania: 5 Years of Experience at Jakaya Kikwete Cardiac Institute

2020 ◽  
Author(s):  
Mohamed Yakubu Janabi ◽  
Evarist Nyawawa ◽  
Bashir Nyangasa ◽  
William Ramadhani Ramadhan ◽  
Ramadhani Hassan Hamis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
World Health

Abstract Cardiac surgery is not widely available in most developing countries, and most patients have no choice but to live in morbid conditions and managed conservatively or the few who are referred abroad for surgical procedures costs the respective countries millions of hard earned foreign currency. The World Health Organization projects that over the next ten years the continent of Africa will experience the largest increase in death rates from cardiovascular disease. The Jakaya Kikwete Cardiac Institute (JKCI) is a government owned National Specialized and Teaching Hospital that serves patients from all the regions of the United Republic of Tanzania with a population of nearly 60,000,000 people and also serves beyond the borders (Rwanda, Burundi, DR Congo, South Sudan, Comoro, Malawi and Zambia) for advanced cardiovascular medical, intervention, vascular and open heart surgery, the Institute was established in 2015. Methods: Here we report all patients who underwent coronary artery bypass surgery grafting only performed at the Centre since its inauguration in 2015- till 2019. Data were collected for basic demography, diagnosis, investigations, clinical and surgical outcome parameters. Results: A total of 85 patients with heart diseases and underwent coronary artery bypass surgery grafting (CABG) are analysed in this study. There were 64 (75%) male and 21 (25%) female patients. Their age ranged from 41–85 years old with almost half 42 (49%) of the cohort being between the age between 61–70 years old. Most of the patients had two or more grafts and an internal mammary artery graft was used over 80% of the procedures. The overall 30-day mortality was 7.1%, incidence of stroke 0.2%, duration of mechanical ventilation was an average of 9.98 hours and intensive care unit (ICU) stay post CABG was an average of 6.48 days and final discharge from the centre ranged from 10–16 days.Conclusion: This study has demonstrated that coronary artery bypass surgery grafting in low/middle income country is safe and feasible. A sustainable program demands highest level of governmental support as seen in this case, and a dedicated multidisciplinary team with profound know how in cardiac pathologies. Furthermore, a need for good local data to know the prevalence of coronary disease is mandatory to determine the magnitude of coronary artery disease in each country.

Sign in / Sign up

Export Citation Format

Share Document