scholarly journals Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 748
Author(s):  
Thomas Poschner ◽  
Anne-Kristin Schaefer ◽  
Doris Hutschala ◽  
Georg Goliasch ◽  
Julia Riebandt ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Negative Impact ◽  
Ecmo Support ◽  
Blood Samples ◽  
Postoperative Course ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Vienna General Hospital ◽  
Va Ecmo

(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1–7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days—this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; p = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; p = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; p = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality.

scholarly journals Relationships of Adiponectin with Markers of Systemic Inflammation and Insulin Resistance in Infants Undergoing Open Cardiac Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Yukun Cao ◽  
Ting Yang ◽  
Shiqiang Yu ◽  
Guocheng Sun ◽  
Chunhu Gu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Systemic Inflammation ◽  
Insulin Requirement ◽  
Glycaemic Index ◽  
Repeated Measurements ◽  
Inverse Association ◽  
Necrosis Factor Alpha ◽  
Blood Samples

Background. Insulin resistance and systemic inflammation frequently occur in infants undergoing cardiac surgery with cardiopulmonary bypass, while adiponectin has been demonstrated to have insulin-sensitizing and anti-inflammatory properties in obesity and type 2 diabetes mellitus. In this prospective study, we aimed to investigate the association of adiponectin with insulin resistance and inflammatory mediators in infants undergoing cardiac surgery with cardiopulmonary bypass.Methods and Results. From sixty infants undergoing open cardiac surgery, blood samples were taken before anesthesia, at the initiation of cardiopulmonary bypass and at 0, 6, 12, 24, and 48 hours after the termination of cardiopulmonary bypass. Plasma interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and adiponectin levels were assessed in blood samples. Insulin resistance was measured by assessment of the insulin requirement to maintain euglycaemia and repeated measurements of an insulin glycaemic index. Insulin glycaemic index, IL-6, and TNF-αincreased up to 3–8-fold 6 h after the operation. Adiponectin is negatively correlated with markers of systemic inflammation 6 h after CPB.Conclusions. Although the level of serum adiponectin decreased significantly, there was a significant inverse association of adiponectin with markers of systemic inflammation and insulin resistance in infants undergoing open cardiac surgery.

scholarly journals Venoarterial extracorporeal membrane oxygenation for cardiogenic shock: a retrospective analysis based on the etiology of shock

2017 ◽  
Author(s):  
Andrew Burchett ◽  
Thomas Tribble ◽  
Richard Charnigo ◽  
Susan Smyth ◽  
Maya Guglin
Keyword(s):  
Pulmonary Embolism ◽  
Cardiogenic Shock ◽  
Retrospective Analysis ◽  
Hospital Discharge ◽  
Reference Group ◽  
Ecmo Support ◽  
Uniform System ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Significant Difference ◽  
Va Ecmo

Background We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies. Methods We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated and Fisher’s exact tests were performed to compare each other group to the reference. Results Patients supported with VA-ECMO due to PE and CHF had better survival to hospital discharge (83.3% and 54.2%, with p = 0.003 and p = 0.011, respectively) versus the PCS group (7.7%). The PE, CHF, and AMI groups had statistically improved survival to VA-ECMO discontinuation. There was no statistically significant difference in survival to VA-ECMO discontinuation or hospital discharge in four subgroup analyses. Conclusions Patients supported with VA-ECMO in cardiogenic shock due to PE or CHF demonstrated increased rates of survival to hospital discharge when compared to the PCS group. This study also highlights the need for a more uniform system of categorizing etiologies of cardiogenic shock.

scholarly journals Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

2020 ◽  
Author(s):  
Ludmila Khailova ◽  
Justin Robison ◽  
James Jaggers ◽  
Richard Ing ◽  
Scott Lawson ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Intestinal Alkaline Phosphatase

Abstract Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor post-operative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.

Recombinant Factor VIIa Combined with Fibrinogen Corrects the Coagulopathy Associated with Cardiopulmonary Bypass Surgery Ex Vivo

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4097-4097
Author(s):  
Pall T. Onundarson ◽  
Hanna S. Asvaldsdottir ◽  
Brynja R. Gudmundsdottir ◽  
Benny Sorensen
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Tissue Factor ◽  
Whole Blood ◽  
Ex Vivo ◽  
Maximum Velocity ◽  
Rank Test ◽  
Protamine Sulphate ◽  
Blood Samples ◽  
Increased Risk

Abstract Major cardiac surgery and use of cardiopulmonary bypass (CPB) is often associated with the development of a severe coagulopathy, hyperfibrinolysis and increased risk of bleeding. The present ex vivo study challenged the hypotheses that whole blood thrombelastometry, activated with minute amounts of tissue factor, can reveal the development of a coagulopathy following cardiac surgery, and that supplementation with fibrinogen and rFVIIa, alone or in combination, can improve the ex vivo clotting pattern. In total, 22 patients with a median age of 68, undergoing coronary artery bypass grafting or valve surgery with use of CPB were included in the study. Dynamic thrombelastometric clotting profiles were recorded using citrated whole blood activated with dilute tissue factor (Innovin®, final dilution 1:17000). Blood samples were collected before surgery (control) and immediately following in vivo neutralization of heparin with protamine sulphate. All blood samples for thrombelastometry were treated with heparinase to ensure neutralization of residual heparin. Standard coagulation laboratory parameters and platelet function confirmed the development of a significant coagulopathy following CPB. The post-operative blood samples were spiked with buffer, rFVIIa (2 μg/mL), fibrinogen (1mg/mL), or the combination of rFVIIa+fibrinogen. The post-operative coagulopathy was evident by thromboelastometry as a statistically significant derangements (Wilcoxon signed rank test). There was prolongation of the onset of clotting (CT, from a median value of 183 seconds pre-op to 385 sec post-op), reduced maximum velocity of clot formation (MaxVel, from 17.5 mm*100/sec pre-op to 15.1 post-op) and reduced maximum clot firmness (MCF, from 6234 mm pre-op to 5527 post-op). Ex vivo spiking with rFVIIa shortened the post-operative clot initiation phase (CT) to a median of 232 sec. Fibrinogen also shortened the post-operative clotting time to a median of 246 sec, and additionally increased the MCF to 5839 mm. Finally, the combination of rFVIIa and fibrinogen together corrected the abnormal thromboelastometric findings associated with CPB-coagulopathy into the pre-operative range, i.e. median CT decreased to 155 sec, MaxVel increased to 16.8 mm*100/sec and MCF increased to 5808 mm. In conclusion, the experiments suggest a potential role of fibrinogen supplementation during control of bleeding following CPB, either alone or in combination with rFVIIa, since the combination corrected the CPB-associated coagulopathy remaining following neutralization of heparin.

Effects of conventional CPB and mini-CPB on neutrophils CD162, CD166 and CD195 expression

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 141-150 ◽  
Author(s):  
Drahomira Holmannova ◽  
Martina Kolackova ◽  
Jiri Mandak ◽  
Pavel Kunes ◽  
Zdenka Holubcova ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Fluorescence Intensity ◽  
Study Groups ◽  
Median Fluorescence Intensity ◽  
The Other ◽  
Blood Samples ◽  
Post Surgery ◽  
The Impact

Objective: Cardiac surgery is known to trigger a systemic inflammatory response. While the use of conventional cardiopulmonary bypass (CPB) results in profound inflammation, modified mini-CPB is considered less harmful. We evaluated the impact of cardiac surgery on the expression of CD162, CD166, CD195 molecules and their association with the type of CPB used. Methods and Results: Twenty-four patients were enrolled in our study. Twelve of them were operated using conventional CPB while the other twelve patients underwent surgery with mini-CPB. Blood samples were analysed by flow cytometry. We observed a significant increase in median fluorescence intensity of CD162 and CD195 that peaked instantly after surgery and normalized to the baseline value on the 1st day post surgery, whereas CD166 was initially down-regulated and its median fluorescence intensity (MFI) value increased to the baseline in the next few days. Conclusion: We observed immediate changes in the expression of CD162, CD166, and CD195 molecules on the neutrophils after surgery in both study groups of patients. The intensity of the observed changes was significantly greater in the group of patients who underwent conventional CPB compared to patients who underwent mini-CPB cardiac surgery.

scholarly journals Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry

2019 ◽  
Vol 29 (5) ◽  
pp. 670-677 ◽  
Author(s):  
Gonzalo Barge-Caballero ◽  
María A Castel-Lavilla ◽  
Luis Almenar-Bonet ◽  
Iris P Garrido-Bravo ◽  
Juan F Delgado ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Ecmo Support ◽  
Control Group ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Iabp Support ◽  
Va Ecmo

Abstract OBJECTIVES To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). RESULTS There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02–4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56–1.58). CONCLUSIONS In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.

Predictors of Poor Outcomes in Pediatric Venoarterial Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 9 (3) ◽  
pp. 297-304 ◽  
Author(s):  
Maanasi S. Mistry ◽  
Sara M. Trucco ◽  
Timothy Maul ◽  
Mahesh S. Sharma ◽  
Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Ecmo Support ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Poor Outcomes ◽  
Va Ecmo ◽  
Elevated Lactate

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides respiratory and hemodynamic support to pediatric patients in severe cardiac failure. We aim to identify risk factors associated with poorer outcomes in this population. Methods: A retrospective chart review was conducted of pediatric patients requiring VA-ECMO support for cardiac indications at our institution from 2004 to 2015. Data were collected on demographics, indication, markers of cardiac output, ventricular assist device (VAD) insertion, heart transplantation, or left atrial (LA) decompression. Univariate Cox proportional hazards models were used to calculate hazard ratios (HRs) for variables associated with the composite primary outcome of transplant-free survival (TFS). Results: Of the 68 reviewed patients, 65% were male, 84% were white, 38% had a prior surgery, 13% had a prior transplant, 10% had a prior ECMO support, and 87.5% required vasoactive support within six hours of cannulation. The ECMO indications included congenital heart disease repaired >30 days prior (12%), cardiomyopathy (41%), posttransplant rejection (7%), and cardiorespiratory failure (40%). The TFS was 54.5% at discharge and 47.7% at one year. Predictors of transplant and/or death include epinephrine use (hazard ratio [HR] = 2.269, P = .041), elevated lactate (HR = 1.081, P = 0005), and elevated creatinine (HR = 1.081, P = .005) within six hours prior to cannulation. Sixteen (23.6%) patients underwent LA decompression. Placement of VAD occurred in 16 (23.5%) patients, for which nonwhite race (HR = 2.94, P = .034) and prior ECMO (HR = 3.42, P = .053) were the only identified risk factors. Conclusions: Need for VA-ECMO for cardiac support carries high inpatient morbidity and mortality. Epinephrine use and elevated lactate and creatinine were associated with especially poor outcomes. Patients who survived to discharge had good short-term follow-up results.

Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: part II - must samples be spun within 30 min?

Perfusion ◽  
1997 ◽  
Vol 12 (3) ◽  
pp. 167-169 ◽  
Author(s):  
S Sapsed-Byrne ◽  
F Gao ◽  
D N F Harris
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Levels ◽  
Room Temperature ◽  
Cerebral Damage ◽  
Blood Samples ◽  
Before And After ◽  
S 100

Sangtec 100 (S-100) (Sangtec Medical, Sweden) and neurone-specific enolase (NSE) assays are showing promise in the assessment of cerebral damage following cardiopulmonary bypass (CBP). The manufacturer’s instructions state, however, that samples must be spun and frozen within 30 min, which is inconvenient for serial studies. We, therefore, investigated whether storing blood samples at room temperature (RT) or 4°C for up to 48 h affected the measured levels. Blood samples were taken before and after CBP in six patients and stored for 15 min, 4, 8, 24 or 48 h at RT or 4°C. S-100 and NSE levels did not alter in either ‘before surgery’ or CPB samples when stored for up to 48 h at 4°C. There was a small, nonsignificant rise when stored at RT. Samples may, therefore, be collected throughout long operations or stored overnight without affecting NSE or S-100 plasma levels.

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