scholarly journals Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

2022 ◽  
Vol 8 ◽  
Author(s):  
Güclü Aykut ◽  
Halim Ulugöl ◽  
Uğur Aksu ◽  
Sakir Akin ◽  
Hasan Karabulut ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Inflammatory Response ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Systemic Inflammatory Response ◽  
Bypass Grafting ◽  
Blood Cardioplegia ◽  
Artery Bypass Grafting

Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5).Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01].Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.

scholarly journals Inflammatory Response in Patients under Coronary Artery Bypass Grafting Surgery and Clinical Implications: A Review of the Relevance of Dexmedetomidine Use

2014 ◽  
Vol 2014 ◽  
pp. 1-28 ◽  
Author(s):  
Neusa Maria Heinzmann Bulow ◽  
Elisângela Colpo ◽  
Marta Frescura Duarte ◽  
Eduardo Francisco Mafassioly Correa ◽  
Rochelle Silveira Schlosser ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Inflammatory Response ◽  
Coronary Artery Bypass ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Anti Inflammatory

Despite the fact that coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) prolongs life and reduces symptoms in patients with severe coronary artery diseases, these benefits are accompanied by increased risks. Morbidity associated with cardiopulmonary bypass can be attributed to the generalized inflammatory response induced by blood-xenosurfaces interactions during extracorporeal circulation and the ischemia/reperfusion implications, including exacerbated inflammatory response resembling the systemic inflammatory response syndrome (SIRS). The use of specific anesthetic agents with anti-inflammatory activity can modulate the deleterious inflammatory response. Consequently, anti-inflammatory anesthetics may accelerate postoperative recovery and better outcomes than classical anesthetics. It is known that the stress response to surgery can be attenuated by sympatholytic effects caused by activation of central (α-)2-adrenergic receptor, leading to reductions in blood pressure and heart rate, and more recently, that they can have anti-inflammatory properties. This paper discusses the clinical significance of the dexmedetomidine use, a selective (α-)2-adrenergic agonist, as a coadjuvant in general anesthesia. Actually, dexmedetomidine use is not in anesthetic routine, but this drug can be considered a particularly promising agent in perioperative multiple organ protection.

Pre-Operative Atorvastatin Therapy to Decrease the Systemic Inflammatory Response after Coronary Artery Bypass Grafting

2008 ◽  
Vol 36 (6) ◽  
pp. 1248-1254 ◽  
Author(s):  
Y Dereli ◽  
E Ege ◽  
S Kurban ◽  
C Narin ◽  
A Sarigül ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Inflammatory Response ◽  
Coronary Artery Bypass ◽  
Ldl Cholesterol ◽  
Artery Bypass ◽  
Systemic Inflammatory Response ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Group I

The effect of pre-operative atorvastatin on systemic inflammatory response syndrome (SIRS), often seen after coronary artery bypass grafting (CABG) was evaluated in 40 patients undergoing elective CABG. Patients were divided into two groups: group I (pre-operative LDL cholesterol ≤ 100 mg/dl; n = 20) received 20 mg/day atorvastatin for at least 15 days pre-operatively; group II (pre-operative LDL cholesterol < 100 mg/dl; n = 20) did not receive antihyperlipidaemic agents. All patients underwent CABG with cardiopulmonary bypass. Blood samples were taken pre-operatively and 24 h post-operatively. There were no significant differences between the two groups in terms of demographic, pre-operative or operative parameters. At 24 h post-operatively, median high-sensitivity C-reactive protein and mean interleukin-6 levels were significantly lower in group I compared with group II. There were no other significant differences in postoperative parameters between the two groups, except for duration of stay in the intensive care unit, which was shorter in group I patients. In conclusion, pre-operative atorvastatin treatment in patients undergoing elective CABG decreased inflammation parameters and could be effective in preventing SIRS.

scholarly journals Postoperative interleukin-8 levels are related to the duration of coronary artery bypass grafting surgery and predict in-hospital postsurgical complications

2018 ◽  
Vol 26 (3) ◽  
pp. 293-303
Author(s):  
Zsombor Mathe ◽  
Razvan Constantin Serban ◽  
Irina Pintilie ◽  
Cristina Somkereki ◽  
Adina Hutanu ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Inflammatory Response ◽  
Coronary Artery Bypass ◽  
Inflammatory Marker ◽  
Artery Bypass ◽  
Postoperative Phase ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Introduction: The magnitude of the very early coronary artery bypass grafting (CABG)-related inflammatory response has been shown to influence post-CABG outcomes. However, the dynamics of the systemic inflammatory response to CABG beyond the very early postoperative phase and its relevance to clinical outcomes are not fully understood. Methods: Circulating levels of several inflammatory markers were determined in 30 consecutive patients undergoing elective isolated on-pump CABG one day prior (D0-1), and 2 (D2) and 5 days post-CABG. Results: CABG was associated with a significant increase in all studied inflammatory marker levels (all p<0.05 for D2 versus D0-1). D2 post-CABG IL-6 and IL-8 levels were both significantly positively correlated with extracorporeal circulation (ECC) and aortic clamping (AC) times (all p<0.05), whereas a weaker correlation was observed between D2 post-CABG IL-8 levels and total surgery time (r=0.42, p=0.02). In multiple regression analysis, D2 IL-8 levels independently predicted post-CABG kidney (p= 0.02) and liver (p = 0.04) dysfunction, as well as a sum of post-CABG major complications ≥2 (p = 0.04). Conclusions: In this prospective study, longer duration of cardiopulmonary bypass caused a larger post-CABG inflammatory surge, whereas the duration of total CABG surgery had a less significant effect. IL-8 hyperresponders had greater risk of developing kidney and liver dysfunction and presented more major post-CABG complications. These data suggest that targeting the IL-8 pathway using antiinflammatory agents, or simply by shortening the duration of cardiopulmonary bypass could improve the in-hospital post-CABG outcomes in this population.

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