scholarly journals Impact of Alternative Routes and Timing of Dopamine and Mannitol Administrations to Reduce Negative Properties of Extended Cardiopulmonary Bypass on Renal Function in Coronary Artery Operations

2021 ◽  
pp. 307-312
Author(s):  
Iqra Ejaz ◽  
Salwa Naeem ◽  
Mian Seher Munir ◽  
Muhammad Usman ◽  
Sohail Zafar ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Group Iv ◽  
Anesthetic Induction ◽  
Group Iii ◽  
Urine Production ◽  
Alternative Routes ◽  
Actual Method ◽  
Substantial Rise

Objectives: To analyze impact of alternative routes and timing of dopamine and mannitol administrations to reduce negative properties of extended cardiopulmonary bypass on renal function in coronary artery operations. Methods: Set I (n: 26 individual): Mannitol (1 g/kg) has been introduced to the CPB priming solution. Set II (n: 25 patients): Even during interval among anesthetic induction and operation, 3 g/kg/min of IV dopamine was delivered. Group III (n = 25 patients): 2 g/kg/min IV dopamine was provided among anesthesia initiation and operation conclusion, and 1 g/kg mannitol were added to priming solution for CPB. Furosemide was administered to Group IV (n = 26 cases) when urine production was poor. Results: There would be a substantial rise in the post-operative urine microalbumin/creatinine ratios over all classes (p 0.06), as well as a rise in cystatin-c in Set 1, 2, and 3 (p 0.02). Conclusions: Researchers suggest that combining dopamine infusion (1 g/kg/min) and mannitol (2 g/kg) throughout CPB seems to be the more actual method for preventing detrimental possessions of CPB on renal functioning.

Renal effects of cardiopulmonary bypass in the elderly

Perfusion ◽  
2002 ◽  
Vol 17 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Marius G Dehne ◽  
Armin Sablotzki ◽  
Jörg Mühling ◽  
Karl-Lorenz Dehne ◽  
Rainer Röhrig ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiopulmonary Bypass ◽  
Creatinine Clearance ◽  
The Elderly ◽  
Tubular Damage ◽  
Group Iii ◽  
Group I ◽  
Marker Proteins ◽  
Male Patients ◽  
Excretion Rates

Cardiopulmonary bypass is widely believed to be injurious to renal function. The unknown consequences of renal dysfunction with modern techniques of bypass in the elderly caused us to examine creatinine clearance and the excretion of sensitive marker proteins in older adult patients undergoing CABG. Thirty male patients were divided into three groups: group I with an age up to 60 years, group II with an age between 61 and 70 years, inclusive and group III 71 years and over. Serum creatinine and urea, creatinine clearance, and α1-micro-globulin (α1-MG), N-acetyl-β-D-glucosaminidase (NAG), Tamm -Horsfall protein (TH) and immunoglobulin G (IgG) were all measured daily, pre- and postoperatively. Creatinine clearance remained lower in the older patients without significant differences. Raised excretion rates of α1-MG, and IgG were seen after CPB. The increase in α1- MG and NAG during the postoperative period revealed tubular damage in all elderly patients. Measurements of α1-MG, NAG and IgG represent useful supplements to standard clinical tests for recognizing early and differentiated changes in renal function.

scholarly journals Comparison of intravenous bolus injection or continuous infusion of recombinant single chain urokinase-type plasminogen activator (saruplase) for thrombolysis. A canine model of combined coronary arterial and femoral venous thrombosis

Blood ◽  
1990 ◽  
Vol 76 (8) ◽  
pp. 1558-1563 ◽  
Author(s):  
HJ Rapold ◽  
ZM Wu ◽  
T Stassen ◽  
F Van de Werf ◽  
D Collen
Keyword(s):  
Coronary Artery ◽  
Continuous Infusion ◽  
Bolus Injection ◽  
Group Iv ◽  
Clot Lysis ◽  
Intravenous Bolus ◽  
Single Chain ◽  
Group Iii ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator

Abstract The thrombolytic efficacy of recombinant unglycosylated full length single chain urokinase-type plasminogen activator (rscu-PA, saruplase), applied either as single intravenous bolus or as a continuous infusion over 60 minutes, was studied in 5 randomized blinded groups of 5 dogs with combined copper coil induced coronary artery thrombosis and 125I- fibrin labeled femoral vein clots. Infusion of 1 mg/kg recu-PA (group I) induced coronary recanalization in 4 of 5 dogs and 98 +/- 1% (mean +/- SEM) venous clot lysis. Bolus injection of 1 mg/kg recu-PA (group II) caused reflow in 3 of 5 dogs and 88 +/- 5 percent venous clot lysis. Infusion of 0.5 mg/kg rescu-PA (group III) achieved reflow in 3 of 5 dogs and 52 +/- 6% venous clot lysis. Bolus injection of 0.5 mg/kg rscu-PA (group IV) induced reflow in 4 of 5 dogs and 48 +/- 12% venous clot lysis. Placebo infusion (group V) was associated with late recanalization in 1 of 5 dogs and 18 +/- 8% venous clot lysis. Coronary artery reocclusion after reflow was not observed in groups I and II, but occurred in 2 of 3 animals in group III and in 3 of 4 animals in group IV (P = .02). The time to reflow in responsive animals was 22 +/- 5 minutes with infusion of 0.5 or 1 mg/kg rscu-PA and 14 +/- 1 minute with bolus injection of 0.5 or 1 mg/kg (P = .14). Depletion of fibrinogen and alpha 2-antiplasmin to less than 25% of baseline levels was observed in the 5 dogs given 1 mg/kg rscu-PA by bolus and in 3 of the 5 dogs given 1 mg/kg rscu-PA via infusion, but in none of the dogs that received 0.5 mg/kg rscu-PA (P less than .001). Plasma clearance rates were 170 +/- 44 and 230 +/- 30 mL/minute after bolus injection and 190 +/- 47 and 310 +/- 56 mL/minute during infusion of rscu-PA for the 1 mg/kg and 0.5 mg/kg doses respectively. Thus, intravenous bolus injection of rscu-PA (saruplase) appears to be equipotent to an infusion over 60 minutes for both coronary and venous thrombolysis. This animal model of combined arterial and venous thrombolysis may be useful for the evaluation of new thrombolytic strategies.

scholarly journals Comparison of intravenous bolus injection or continuous infusion of recombinant single chain urokinase-type plasminogen activator (saruplase) for thrombolysis. A canine model of combined coronary arterial and femoral venous thrombosis

Blood ◽  
1990 ◽  
Vol 76 (8) ◽  
pp. 1558-1563
Author(s):  
HJ Rapold ◽  
ZM Wu ◽  
T Stassen ◽  
F Van de Werf ◽  
D Collen
Keyword(s):  
Coronary Artery ◽  
Continuous Infusion ◽  
Bolus Injection ◽  
Group Iv ◽  
Clot Lysis ◽  
Intravenous Bolus ◽  
Single Chain ◽  
Group Iii ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator

The thrombolytic efficacy of recombinant unglycosylated full length single chain urokinase-type plasminogen activator (rscu-PA, saruplase), applied either as single intravenous bolus or as a continuous infusion over 60 minutes, was studied in 5 randomized blinded groups of 5 dogs with combined copper coil induced coronary artery thrombosis and 125I- fibrin labeled femoral vein clots. Infusion of 1 mg/kg recu-PA (group I) induced coronary recanalization in 4 of 5 dogs and 98 +/- 1% (mean +/- SEM) venous clot lysis. Bolus injection of 1 mg/kg recu-PA (group II) caused reflow in 3 of 5 dogs and 88 +/- 5 percent venous clot lysis. Infusion of 0.5 mg/kg rescu-PA (group III) achieved reflow in 3 of 5 dogs and 52 +/- 6% venous clot lysis. Bolus injection of 0.5 mg/kg rscu-PA (group IV) induced reflow in 4 of 5 dogs and 48 +/- 12% venous clot lysis. Placebo infusion (group V) was associated with late recanalization in 1 of 5 dogs and 18 +/- 8% venous clot lysis. Coronary artery reocclusion after reflow was not observed in groups I and II, but occurred in 2 of 3 animals in group III and in 3 of 4 animals in group IV (P = .02). The time to reflow in responsive animals was 22 +/- 5 minutes with infusion of 0.5 or 1 mg/kg rscu-PA and 14 +/- 1 minute with bolus injection of 0.5 or 1 mg/kg (P = .14). Depletion of fibrinogen and alpha 2-antiplasmin to less than 25% of baseline levels was observed in the 5 dogs given 1 mg/kg rscu-PA by bolus and in 3 of the 5 dogs given 1 mg/kg rscu-PA via infusion, but in none of the dogs that received 0.5 mg/kg rscu-PA (P less than .001). Plasma clearance rates were 170 +/- 44 and 230 +/- 30 mL/minute after bolus injection and 190 +/- 47 and 310 +/- 56 mL/minute during infusion of rscu-PA for the 1 mg/kg and 0.5 mg/kg doses respectively. Thus, intravenous bolus injection of rscu-PA (saruplase) appears to be equipotent to an infusion over 60 minutes for both coronary and venous thrombolysis. This animal model of combined arterial and venous thrombolysis may be useful for the evaluation of new thrombolytic strategies.

P4375Value of echocardiography to diagnose coronary arteries patterns in transposition of great arteries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Galoin Bertail ◽  
T Perouse De Montclos ◽  
M Bakloul ◽  
O Metton ◽  
J Mitchell ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Intraoperative Complications ◽  
Survival Rates ◽  
Group Iv ◽  
Perioperative Mortality ◽  
Transposition Of Great Arteries ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Abstract The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries (CA) anatomy in transposition of the great arteries (TGA) and determine impact on outcomes. Material and methods Retrospective analysis of data in neonates diagnosed with TGA (isolated or associated with VSD). Preoperative echocardiographic (TTE) coronary artery pattern and surgical intraoperative reports (SURG) were compared. Mismatch between TTE and SURG, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I= normal CA, II= CA with intramural course, III= CA loop, IV= CA loop and intramural segment. Results 108 neonates who underwent arterial switch operation (ASO) for isolated TGA (67 cases) or TGA+VSD (41) were included in the study: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group IV. Five patients died (4.6%), from coronary cause in 3. Survival rates were 96% at 1-month and 95.2% beyond. Intraoperative complications occurred in 10 cases. TTE and SURG CA diagnosis differed in 19 cases = 17.6% (mismatch). Diagnosis of CA anatomy differed in 4.4%, 42.8%, 37.5% and 100% of respectively groups I, II, III and IV. Mortality was 28.6% in group II (intramural CA) compared to 2.9% in group I, 3.1% in group III and 0% in group IV (p=0.002). Death rates was 15.8% if TTE/SURG mismatch and 2.2% if TTE and SURG were concordant (p=0.0108). Mortality in group II (intramural CA) increased up to 50% in case of mismach TTE/SURG versus 0% if concordance, and was similar in the other groups. Survival rates were 84.2% in TTE misdiagnosed CA anomalies compared to 97.6% if TTE assessment correlated with surgical reports. By multivariate analysis, groups II and III coronary anatomy were risk factors for mismatch between TTE and SURG (respectively p=0.008 and p=0.0005), and mismatch TTE/SURG was the only risk factor for perioperative mortality (p=0.045). Conclusion Echocardiography can accurately assess coronary artery anatomy in neonates with TGA. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.

Prediction of Prolonged Ventilation after Coronary Artery Bypass Grafting: Data from an Artificial Neural Network

2017 ◽  
Vol 20 (1) ◽  
pp. 007 ◽  
Author(s):  
Eric Stephen Wise ◽  
David P. Stonko ◽  
Zachary A. Glaser ◽  
Kelly L. Garcia ◽  
Jennifer J. Huang ◽  
...  
Keyword(s):  
Neural Network ◽  
Mechanical Ventilation ◽  
Artificial Neural Network ◽  
Logistic Regression ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Early Identification ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Prolonged Ventilation

Objectives: The need for mechanical ventilation 24 hours after coronary artery bypass grafting (CABG) is considered a morbidity by the Society of Thoracic Surgeons. The purpose of this investigation was twofold: to identify simple preoperative patient factors independently associated with prolonged ventilation and to optimize prediction and early identification of patients prone to prolonged ventilation using an artificial neural network (ANN).Methods: Using the institutional Adult Cardiac Database, 738 patients who underwent CABG since 2005 were reviewed for preoperative factors independently associated with prolonged postoperative ventilation. Prediction of prolonged ventilation from the identified variables was modeled using both “traditional” multiple logistic regression and an ANN. The two models were compared using Pearson r2 and area under the curve (AUC) parameters.Results: Of 738 included patients, 14% (104/738) required mechanical ventilation ≥ 24 hours postoperatively. Upon multivariate analysis, higher body-mass index (BMI; odds ratio [OR] 1.10 per unit, P < 0.001), lower ejection fraction (OR 0.97 per %, P = 0.01) and use of cardiopulmonary bypass (OR 2.59, P = 0.02) were independently predictive of prolonged ventilation. The Pearson r2 and AUC of the multivariate nominal logistic regression model were 0.086 and 0.698 ± 0.05, respectively; analogous statistics of the ANN model were 0.159 and 0.732 ± 0.05, respectively.BMI, ejection fraction and cardiopulmonary bypass represent three simple factors that may predict prolonged ventilation after CABG. Early identification of these patients can be optimized using an ANN, an emerging paradigm for clinical outcomes modeling that may consider complex relationships among these variables.

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