scholarly journals Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

2014 ◽  
Vol 3 ◽  
Author(s):  
Vladimir Pichugin ◽  
Nikolay Melnikov ◽  
Farkhad Olzhayev ◽  
Alexander Medvedev ◽  
Sergey Jourko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Lung Compliance ◽  
Beating Heart ◽  
Low Flow ◽  
Control Group ◽  
Coronary Perfusion ◽  
The Third

Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB) is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP) and the “beating heart” in combination with pulmonary artery perfusion (PAP) and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients), the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients), the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients), the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level), oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and  47.7%, respectively. 24 hours after surgery, CK-MB levels were lower in the second and third groups by 42.0% and  42.6%, respectively, and lower by 29.7% and 27.4% 48 hours after surgery, respectively. Normalization of CK-MB levels were registered earlier in second and third groups (within 24 hours) than the control group. Oxygenation index and lung compliance were significantly higher in the third group after CPB.Conclusion. Our technique improved myocardial and lung function in patients, but larger prospective randomized trials are needed to definitively assess the protective effects of this technique.

scholarly journals Respiratory tactics during cardiopulmonary bypass in cardiac surgery

2021 ◽  
Vol 18 (2) ◽  
pp. 40-47
Author(s):  
A. Yu. Kirillov ◽  
A. G. Yavorovskiy ◽  
M. A. Vyzhigina ◽  
R. N. Komarov ◽  
P. V. Nogtev ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Positive Airway Pressure ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Respiratory Support ◽  
Favorable Effect ◽  
Positive End Expiratory Pressure ◽  
Important Place ◽  
Volume Ventilation

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 826-832
Author(s):  
Tomomi Hasegawa ◽  
Yoshihiro Oshima ◽  
Shinji Yokoyama ◽  
Asuka Akimoto ◽  
Yusuke Misaka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Interleukin 6 ◽  
Patient Characteristics ◽  
Serum Levels ◽  
Pediatric Cardiac Surgery ◽  
Interleukin 8 ◽  
Control Group ◽  
Platelet Counts

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

scholarly journals Performance of Lactate and CO2-Derived Parameters in Predicting Major Postoperative Complications After Cardiac Surgery With Cardiopulmonary Bypass: Protocol of a Diagnostic Accuracy Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiao-Fen Zhou ◽  
Rong-Guo Yu ◽  
Qian Chen ◽  
Yi-Min Xue ◽  
Han Chen
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Postoperative Complications ◽  
Diagnostic Accuracy ◽  
Partial Pressure ◽  
Low Flow ◽  
Diagnostic Accuracy Study ◽  
Operating Characteristics ◽  
Content Ratio ◽  
Accuracy Study

Background: CO2-derived parameters are increasingly used to identify either low-flow status or anaerobic metabolism in shock resuscitation. However, the performance of CO2-derived parameters in cardiac surgical patients is poorly understood. This study aims to compare the performance of lactate and CO2-derived parameters in predicting major postoperative complications after cardiac surgery with cardiopulmonary bypass.Methods: This is a prospective, single-center, diagnostic accuracy study. All patients who receive elective cardiac surgery involving cardiopulmonary bypass will be screened for study eligibility. Blood samples will be taken for the calculation of CO2-derived parameters, including the venous-arterial difference in CO2 partial pressure (PCO2 gap), venous-arterial difference in CO2 content to arterial-venous O2 content ratio (Cv-aCO2/Ca-vO2), and venous-arterial difference in CO2 partial pressure to arterial-venous O2 content ratio (Pv-aCO2/Ca-vO2) at ICU admission, and 3, 6, and 12 h later. Baseline, perioperative data will be collected daily for 7 days; patients will be followed up for 28 days to collect outcome data. The primary endpoint is the occurrence of major postoperative complications. Receiver-operating characteristics (ROC) curve analysis will be carried out to assess the predictive performance of lactate and CO2-derived parameters. The performance of the ROC curves will be compared.Discussion: The performance of lactate and CO2-derived parameters in predicting major postoperative complications will be investigated in the non-sepsis population, which has not been extensively investigated. Our study will compare the two surrogates of respiratory quotient directly, which is an important strength.Trial Registration: ChiCTR, ChiCTR2000029365. Registered January 26th, 2020, http://www.chictr.org.cn/showproj.aspx?proj=48744.

Trillium™ Biopassive Surface: A New Biocompatible Treatment for Extracorporeal Circulation Circuits

2000 ◽  
Vol 23 (5) ◽  
pp. 319-324 ◽  
Author(s):  
A. Cazzaniga ◽  
M. Ranucci ◽  
G. Isgrò ◽  
G. Soro ◽  
D. De Benedetti ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Cardiopulmonary Bypass ◽  
Blood Cell ◽  
Control Group ◽  
Biochemical Profile ◽  
Leukocyte Activation ◽  
Blood Cell Count ◽  
To Receive ◽  
Protamine Administration

139 patients undergoing cardiac surgery were included in a prospective, randomized trial. Patients were randomly allocated to receive cardiopulmonary bypass (CPB) with Trillium™ Biopassive Surface (TBS Group) coated oxygenators or conventional circuits (control group). 112 patients were studied with respect to postoperative biochemical profile; a subgroup of 27 patients was studied with respect to perioperative complement (C3a) activation. Patients in the TBS group demonstrated a significantly lower white blood cell count at the end of the operation (p=0.036) and a significantly higher platelet count the day after the operation (p=0.023) when compared to the control group. C3a was significantly higher (p=0.02) in the TBS group after 30 minutes of CPB, but the C3a increase after protamine administration was significantly less pronounced in the TBS group vs. the control group. Further studies involving platelet and leukocyte activation are required to better elucidate the action of this new coating in the setting of routine CPB.

HIGH FIDELITY BEATING HEART PORCINE MODEL FOR CARDIAC SURGERY AND CARDIOPULMONARY BYPASS TRAINING

2016 ◽  
Vol 32 (10) ◽  
pp. S188
Author(s):  
I.B. Ribeiro ◽  
J. Ngu ◽  
K. Tardioli ◽  
S. Folch ◽  
G. Gill ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Porcine Model ◽  
Beating Heart ◽  
High Fidelity

Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis

Perfusion ◽  
2008 ◽  
Vol 23 (6) ◽  
pp. 323-327 ◽  
Author(s):  
E Sirvinskas ◽  
J Andrejaitiene ◽  
L Raliene ◽  
L Nasvytis ◽  
A Karbonskiene ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Urine Output ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Lung Ventilation ◽  
Early Postoperative Period

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.

Chronically Administered Acetaminophen and the Ischemia/Reperfused Myocardium

2003 ◽  
Vol 228 (6) ◽  
pp. 674-682 ◽  
Author(s):  
R. Golfetti ◽  
T. Rork ◽  
G. Merrill
Keyword(s):  
Creatine Kinase ◽  
Tap Water ◽  
Chronic Administration ◽  
Left Ventricular ◽  
Low Flow ◽  
Control Group ◽  
Coronary Perfusion ◽  
In Vitro Production

Male and female Hartley strain guinea pigs weighing 280 ± 10 g were given acetaminophen-treated water ad libitum for 10 days. Sham-treated control animals were given similar quantities of untreated tap water (vehicle-treated control group). On Day 10, hearts were extracted, instrumented, and exposed to an ischemia (low-flow, 20 min)/reperfusion protocol. Our objective was to compare and contrast ventricular function, coronary circulation, and selected biochemical and histological indices in the two treatment groups. Left ventricular developed pressure in the early minutes of reperfusion was significantly greater in the presence of acetaminophen, e.g., at 1 min, 40 ± 4 vs 21 ± 3 mmHg ( P < 0.05). Coronary perfusion pressure was significantly less from 3 to 40 min of reperfusion in the presence of acetaminophen. Creatine kinase release in vehicle-treated hearts rose from 42 ± 14 (baseline) to 78 ± 25 units/liter by the end of ischemia. Corresponding values in acetaminophen-treated hearts were 36 ± 8 and 44 ± 14 units/liter. Acetaminophen significantly ( P < 0.05) attenuated release of creatine kinase. Chemiluminescence, an indicator of the in vitro production of peroxynitrite via the in vivo release of superoxide and nitric oxide, was also significantly attenuated by acetaminophen. Electron microscopy indicated a well-preserved myofibrillar ultrastructure in the postischemic myocardium of acetaminophen-treated hearts relative to vehicle-treated hearts (e.g., few signs of contraction bands, little or no evidence of swollen mitochondria, and well-defined light and dark bands in sarcomeres with acetaminophen; opposite with vehicle). We conclude that chronic administration of acetaminophen provides cardioprotection to the postischemic, reperfused rodent myocardium.

Effect of Therapeutic Hypercapnia on Inflammatory Responses to One-lung Ventilation in Lobectomy Patients

2015 ◽  
Vol 122 (6) ◽  
pp. 1235-1252 ◽  
Author(s):  
Wei Gao ◽  
Dong-Dong Liu ◽  
Di Li ◽  
Guang-xiao Cui
Keyword(s):  
Carbon Dioxide ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Inflammatory Responses ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Lung Compliance ◽  
Carbon Dioxide Partial Pressure ◽  
One Lung Ventilation ◽  
Necrosis Factor

Abstract Background: One-lung ventilation (OLV) can result in local and systemic inflammation. This prospective, randomized trial was to evaluate the effect of therapeutic hypercapnia on lung injury after OLV. Method: Fifty patients aged 20 to 60 yr undergoing lobectomy were randomly provided with air or carbon dioxide (partial pressure of carbon dioxide: 35 to 45 mmHg or 60 to 70 mmHg). Peak pressure, plateau pressure, and lung compliance were recorded. Bronchoalveolar lavage fluid (BALF) and blood samples were collected. Adverse events were monitored. The primary outcome was the concentration of BALF tumor necrosis factor, and the secondary outcomes were serum cytokine concentrations. Results: The BALF tumor necrosis factor was lower in the carbon dioxide group than in the air group (median [range], 51.1 [42.8 to 76.6] vs. 71.2 [44.8 to 92.7]; P = 0.034). Patients in the carbon dioxide group had lower concentrations of serum and BALF interleukin (IL)-1, IL-6, and IL-8, but higher serum concentrations of IL-10, accompanied by reduced numbers of cells and neutrophils as well as lower concentrations of protein in the BALF. Also, patients in the carbon dioxide group had lower peak (mean ± SD, 22.2 ± 2.9 vs. 29.8 ± 4.6) and plateau pressures (20.5 ± 2.4 vs. 27.1 ± 2.9), but higher dynamic compliance (46.6 ± 5.8 vs. 38.9 ± 6.5). Furthermore, patients in the carbon dioxide group had higher postoperation oxygenation index values. Ten patients experienced slightly increased blood pressure and heart rate during OLV in the carbon dioxide group. Conclusion: Under intravenous anesthesia, therapeutic hypercapnia inhibits local and systematic inflammation and improves respiratory function after OLV in lobectomy patients without severe complications.

Absence of Beneficial Effect of Acute Normovolemic Hemodilution Combined with Aprotinin on Allogeneic Blood Transfusion Requirements in Cardiac Surgery

2002 ◽  
Vol 96 (2) ◽  
pp. 276-282 ◽  
Author(s):  
Laurent Höhn ◽  
Alexandre Schweizer ◽  
Marc Licker ◽  
Denis R. Morel
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Blood Transfusion ◽  
Allogeneic Blood ◽  
Surgical Patients ◽  
Control Group ◽  
Acute Normovolemic Hemodilution ◽  
Normovolemic Hemodilution ◽  
Normal Cardiac Function

Background The efficacy of acute normovolemic hemodilution (ANH) in decreasing allogeneic blood requirements remains controversial during cardiac surgery. Methods In a prospective, randomized study, 80 adult cardiac surgical patients with normal cardiac function and no high risk of ischemic complications were subjected either to ANH, from a mean hematocrit of 43% to 28%, or to a control group. Aprotinin and intraoperative blood cell salvage were used in both groups. Blood (autologous or allogeneic) was transfused when the hematocrit was less than 17% during cardiopulmonary bypass, less than 25% after cardiopulmonary bypass, or whenever clinically indicated. Results The amount of whole blood collected during ANH ranged from 10 to 40% of the patients' estimated blood volume. Intraoperative and postoperative blood losses were not different between control and ANH patients (total blood loss, control: 1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36). Allogeneic blood was given in 29% of control patients (median, 2; range, 1-3 units of packed erythrocytes) and in 33% of ANH patients (median, 2; range, 1-5 units of packed erythrocytes; P = 0.219). Preoperative and postoperative platelet count, prothrombin time, and partial thromboplastin time were similar between groups. Perioperative morbidity and mortality were not different in both groups, and similar hematocrit values were observed at hospital discharge (33.7 +/- 3.9% in the control group and 32.6 +/- 3.7% in the ANH group; nonsignificant) Conclusions Hemodilution is not an effective means to lower the risk of allogeneic blood transfusion in elective cardiac surgical patients with normal cardiac function and in the absence of high risk for coronary ischemia, provided standard intraoperative cell saving and high-dose aprotinin are used.

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