Prospective randomized trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery.
Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery. This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A nonparametric multivariate analysis of variance for repeated measurements and small sample sizes was performed. In a total of 54 patients (25% Hct, n = 28; 20% Hct, n = 26), calculated oxygen delivery (p = 0.11), oxygen consumption (p = 0.06) and blood lactate (p = 0.60) were not significantly different between groups. Clinical outcomes
TY - JOUR. T1 - Phenylephrine increases cerebral blood flow during low-flow hypothermic cardiopulmonary bypass in baboons. AU - Schwariz, Arthur E.. AU - Minanov, Oktavijan. AU - Stone, J. Gilbert. AU - Adams, David C.. AU - Sandhu, Aqeel A.. AU - Pearson, Mark E.. AU - Kwiatkowski, Pawel. AU - Young, William L.. AU - Michler, Robert E.. PY - 1996/8/23. Y1 - 1996/8/23. N2 - Background: Although low-flow cardiopulmonary bypass (CPB) has become a preferred technique for the surgical repair of complex cardiac lesions in children, the relative hypotension and decrease in cerebral blood flow (CBF) associated with low flow may contribute to the occurrence of postoperative neurologic injury. Therefore, it was determined whether phenylephrine administered to increase arterial blood pressure during low-flow CPB increases CBF. Methods: Cardiopulmonary bypass was initiated in seven baboons during fentanyl, midazolam, and isoflurane anesthesia. Animals were cooled at a pump flow rate of 2.5 1 · min -1 · m ...
TY - JOUR. T1 - Cerebral blood flow during low-flow hypothermic cardiopulmonary bypass in baboons. AU - Schwartz, A. E.. AU - Kaplon, R. J.. AU - Young, W. L.. AU - Sistino, J. J.. AU - Kwialkowski, P.. AU - Michler, R. E.. PY - 1994/1/1. Y1 - 1994/1/1. N2 - Background: Neurologic injury after cardiopulmonary bypass (CPB) is a frequent and devastating complication of cardiothoracic surgery. Disordered cerebral hemodynamics during CPB has been implicated as an important factor in the etiology of these injuries. Evidence of disordered cerebral hemodynamics includes reports of a progressive time-dependent decrease in cerebral blood flow (CBF) during stable full-flow CPB. Low-flow hypothermic CPB has become a preferred technique for the management of pediatric patients undergoing surgical repair of complex cardiac lesions. Because CBF is already substantially reduced with the onset of low-flow CPB, we determined if a similar progressive decline in CBF occurs during the low-flow state. Methods: After ...
TY - JOUR. T1 - Effects of coronary revascularization with or without cardiopulmonary bypass on plasma levels of asymmetric dimethylarginine. AU - Cziráki, Attila. AU - Ajtay, Zénó. AU - Németh, Ádám. AU - Lenkey, Zsófia. AU - Sulyok, Endre. AU - Szabados, Sándor. AU - Alotti, Nasri. AU - Martens-Lobenhoffer, Jens. AU - Szabó, Csaba. AU - Bode-Böger, Stefanie M.. PY - 2011/6/1. Y1 - 2011/6/1. N2 - Objectives: We measured and compared serum asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and L-arginine levels in patients undergoing coronary artery revascularization. Methods: Two groups of patients with coronary artery disease were subjected to coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB; n=20) or with off-pump CABG surgery (OPCABG; n=21). Blood samples for measurements of ADMA, SDMA, and L-arginine were withdrawn and determined by liquid chromatography-tandem mass spectrometry from the coronary sinus (CS) and from the peripheral ...
TY - JOUR. T1 - Nonpulsatile cardiopulmonary bypass disrupts the flow-metabolism couple in the brain. AU - Andersen, K.. AU - Waaben, J.. AU - Husum, B.. AU - Voldby, B.. AU - Bødker, A.. AU - Hansen, A. J.. AU - Gjedde, A.. PY - 1985. Y1 - 1985. N2 - The effect of cardiopulmonary bypass on the relationship between brain glucose consumption and regional blood flow is unknown. We measured this relationship in pigs subjected to 3 hours of pulsatile or nonpulsatile cardiopulmonary bypass at normothermia and compared the results to the relationship established in a control group of pigs. A total of 10 regions were sampled in both hemispheres of the porcine brain. In control pigs, cerebral blood flow averaged 46 ml/100 gm and the glucose consumption, 21 μmol/100 gm/min. The ratio between blood flow and glucose consumption was close to 2 ml/μmol in all regions. In pulsatile cardiopulmonary bypass both the whole-brain average and the regional values declined, so that the ratio remained the same, ...
Data & statistics on Carbon dioxide transfer rate in relation to cardiopulmonary bypass times: Carbon dioxide transfer rate in relation to cardiopulmonary bypass times, Shown in piglets undergoing deep hypothermic circulatory arrest (DHCA) with or without selective cerebral perfusion (SCP). Cerebral tissue oxygenation (Pbto2) is shown as relative units (RU), normalized to before cardiopulmonary bypass baseline (BL; mm Hg). Measurements are shown at the following times: BL, before cardiopulmonary bypass baseline; Cool, cooling; CA30, 30 minutes of DHCA; eCA, end DHCA; ..., Intraoperative SctO2 course of a patient undergoing aortic arch surgery with hypothermic circulatory arrest. Note dependency of SctO2 to CO2. Insufflation of CO2 during endoscopic vein harvesting leading to increase in SctO2 as well as decline in SctO2 once mechanical ventilation was started. CPB = cardiopulmonary bypass; DHCA = deep hypothermic circulatory arrest....
The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%
Objective: We assessed the causes of imbalance of oxygen transport by continuously measuring oxygen consumption (VO2) during hypothermic cardiopulmonary bypass (CPB) in pigs. Methods: Six pigs (17.2±1.6 kg) underwent hypothermic (32°C) CPB for 180 min with 120 min of aortic crossclamping (ACC). An AMIS 2000 mass spectrometer was adapted for the on-line measurement of VO2. Arterial lactate was measured at the beginning of CPB, the end of hypothermia, before and 10 min after ACC release, 20 min later, and at the end of CPB. Results: Arterial lactate increased from 1.8±0.7 to 5.1±1.8 mmol/L during CPB. Hypothermia reduced VO2 by 0.63±0.29 ml/min/kg per °C, but lactate increased to 4.2±1.5 mmol/L ( ...
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Measurements and results: Subjects were observed for 24 hours; during surgery, 6 and 24 hours after aortic clamp removed. During July 2012 - December 2013, there were 52 patients who became subjects. There were proportion differences between cardiac lactate and cardiac output change after cardiac surgery. Increase of cardiac lactate has a correlation with increasing levels of sTNFR-1 and IL-6 and decreasing index of Tc, ScvO2 and cardiac output. There were correlations among low index of ScvO2, high index of cardiac lactate and decrease of cardiac output. High sTNFR-1 and IL-6 were correlated to low cardiac output. Cardiac lactate, ScvO2 and MAP can be used as predictors of cardiac output change in patients with cardio-pulmonary bypass. sTNFR-1 and IL-6 levels were correlated with cardiac output changes after cardiac surgery ...
Over a three year period we have used haemodialysis and haemofiltration in parallel with cardiopulmonary bypass in 26 patients. Impaired renal function and excessive fluid retention have been the main indications. Patients on haemodialysis programmes for end stage renal failure did not require further dialysis until at least the third postoperative day, when they could tolerate the haemodynamic disturbance of dialysis. In the other patients these techniques proved valuable in reversing the effects of haemodilution and in controlling the concentration of serum potassium. Our experience has confirmed that haemodialysis and haemofiltration in parallel with cardiopulmonary bypass are useful adjuncts in the perioperative management of patients with impaired renal function undergoing open heart surgery. The techniques are also effective in correcting the fluid retention and biochemical imbalance in patients with congestive cardiac failure, including those with heart transplants.. ...
Established as the standard reference on cardiopulmonary bypass, Dr. Gravlees text is now in its Third Edition. This comprehensive, multidisciplinary text covers all aspects of cardiopulmonary bypass including sections on equipment, physiology and pathology, hematologic aspects, and clinical applications. This edition features a new section on cardiopulmonary bypass in neonates, infants, and children and a new chapter on circulatory support for minimally invasive cardiac surgery. Other highlights include state-of-the-art information on low-volume circuits and other new equipment and discussions of outcomes data for on-pump and off-pump surgeries ...
Acute kidney injury, a prevalent complication of cardiac surgery performed on cardiopulmonary bypass (CPB), is thought to be driven partly by hypoxic damage in the renal medulla. To determine the causes of medullary hypoxia during CPB, we modeled its impact on renal hemodynamics and function, and thus oxygen delivery and consumption in the renal medulla. The model incorporates autoregulation of renal blood flow and glomerular filtration rate and the utilization of oxygen for tubular transport. The model predicts that renal medullary oxygen delivery and consumption are reduced by a similar magnitude during the hypothermic (down to 28°C) phase of CPB. Thus, the fractional extraction of oxygen in the medulla, an index of hypoxia, is increased only by 58% from baseline. However, during the rewarming phase (up to 37°C), oxygen consumption by the medullary thick ascending limb increases 2.3-fold but medullary oxygen delivery increases only by 33%. Consequently, the fractional extraction of oxygen in ...
BACKGROUND: After cardiac surgery with cardiopulmonary bypass (CPB), acquired coagulopathy often leads to post-CPB bleeding. Though multifactorial in origin, this coagulopathy is often aggravated by deficient fibrinogen levels. OBJECTIVE: To assess whether laboratory and thrombelastometric testing on CPB can predict plasma fibrinogen immediately after CPB weaning. PATIENTS / METHODS: This prospective study in 110 patients undergoing major cardiovascular surgery at risk of post-CPB bleeding compares fibrinogen level (Clauss method) and function (fibrin-specific thrombelastometry) in order to study the predictability of their course early after termination of CPB. Linear regression analysis and receiver operating characteristics were used to determine correlations and predictive accuracy. RESULTS: Quantitative estimation of post-CPB Clauss fibrinogen from on-CPB fibrinogen was feasible with small bias (+0.19 g/l), but with poor precision and a percentage of error |30%. A clinically usefu
Summary. Background: Bleeding after cardiopulmonary bypass (CPB) is a major cause of morbidity and mortality and consumes large amounts of blood. Identifying patients at increased risk of bleeding secondary to hemostatic impairment may improve clinical outcomes by allowing early intervention. Methods: This present study recruited 77 patients undergoing CPB and measured coagulation screens, coagulation factors, TEG®, Rotem® and thrombin generation (TG) before surgery and 30 min after heparin reversal. The tests were analyzed to investigate whether they identified patients at increased risk of excess bleeding (defined as , 1000 mL) in the first 24 h postoperatively. Results: Patients who bled , 1000 mL had a lower: platelet count (P , 0.02), factors (F)IX, X and XI (P , 0.005), endogenous thrombin potential (ETP) and an initial rate of TG (P , 0.02) and higher activated partial thromboplastin time (aPTT) (P , 0.001) than patients who bled , 1000 mL. Receiver operating characteristic (ROC) ...
Click the title to purchase the article.. Abstract:. "Femoro-femoral cardiopulmonary bypass (CPB) followed by deep hypothermic circulatory arrest is one of the modalities used for ascending aortic pseudoaneurysmrepair to achieve cardiac unloading and to avoid severe hemorrhage due to the risk of rupture during the sternal entry. However, due to the limited size of the cannulas, it can be challenging to achieve total cardiopulmonary support. Therefore, despite the achievement of total cardiopulmonary support, the heart may still be able to eject antegrade blood flow that meets the retrograde blood flow from the arterial side of the CPB. The point where the blood flow meets in the aorta is called the watershed area. If the antegrade blood flow is large due to a left ventricular ejection, the watershed area will be located in the descending aorta. Therefore, if ventilation is stopped, deoxygenated blood will be ejected to the cerebral circulation. Cerebral near-infrared spectroscopy (NIRS) may be ...
TY - JOUR. T1 - Enhancement of brain pO2 during cardiopulmonary bypass using a hyperosmolar oxygen carrying solution. AU - Runge, T. M.. AU - McGinity, J. W.. AU - Frisbee, S. E.. AU - Briceno, J. C.. AU - Ottmers, S. E.. AU - Calhoon, John H. AU - Hantler, C. B.. AU - Korvick, D. L.. AU - Ybarra, J. R.. PY - 1997/5. Y1 - 1997/5. N2 - During the past decade a new syndrome has been recognized: cerebral hypoxia secondary to cardiopulmonary bypass, resulting in impairment of cognitive memory. The incidence of the syndrome appears to be no less that 30% in patients over 65 years of age undergoing cardiac surgery. There are several factors contributing to hypoxia produced by cardiopulmonary bypass. One of these factors is crystalloid pump prime and replacement solutions devoid of (1) oxygen carrying capacity and (2) devoid of protein and its colloid osmotic pressure. This shortcoming of cardiopulmonary crystalloid solutions is partially responsible for two of the three major pathologic effects of ...
To the best of our knowledge, this is the first prospective study evaluating cognitive function before and after cardiopulmonary bypass in children. We found that the relatively short period of mildly hypothermic cardiopulmonary bypass was not associated with any change in cognitive function. The results of this study differ from the findings of a previous study that showed a 9.5-point deficit in full IQ and a deficit in nonverbal information processing in subjects who underwent surgical repair of an ASD compared with subjects who underwent ASD repair via a catheter-delivered device.15 Furthermore, although the previous study showed group differences in visual-spatial skills,15 we found no evidence to indicate that visual-spatial skills deteriorate after surgical repair of an ASD. Specifically, comparisons of nonverbal and spatial information processing in our sample suggest consistency of performance over time. In fact, a small increase was seen in the postoperative test scores. Although these ...
During conventional cardiopulmonary bypass (CPB) there is no active perfusion of the pulmonary circulation and the mechanical ventilation is ceased leaving the lungs exposed to warm ischemia. Pulmonary dysfunction is seen in varying degrees after major surgery, but more severe in cardiac surgery patients probably due to the effects of CPB. The evidence for effect and safety are limited, but active pulmonary artery perfusion during CPB could be beneficial for the patients postoperative oxygenation. Our aim was in a randomised clinical trial to assess primarily the effect of pulmonary artery perfusion during CPB on postoperative oxygenation in patients diagnosed with chronic obstructive pulmonary disease (COPD), secondarily to assess other possible benefits and harms. Furthermore, we wanted in a systematic review with meta-analyses of all randomised clinical trials to investigate the pooled effects of pulmonary artery perfusion during CPB. We planned and conducted a randomised, partly blinded, ...
Michael Manning, MD, PhD, Research Fellow and Medical Instructor in the Division of Cardiothoracic Anesthesiology was awarded a two-year $50,000 Society of Cardiovascular Anesthesiologists (SCA) Starter Grant entitled "Atrial Fibrillation Following Cardiopulmonary Bypass: The Role of Angiotensin II".. Post-operative atrial fibrillation (POAF) occurs in 30-60% of cardiac surgical patients, and is associated with increased morbidity and mortality. Preventative treatment options for this significant problem are lacking, with most therapy instituted after onset of POAF when associated risks, including stroke, are highest. Evidence suggests a key role for inflammation in the genesis and perpetuation of POAF through structural changes in the atrial wall; this may serve as a point for intervention and prevention, thereby decreasing overall morbidity and mortality.. Patients who undergo cardiac surgery with cardiopulmonary bypass (CPB) experience a significant inflammatory reaction, which has been ...
Epinephrine-induced lactic acidosis following cardiopulmonary bypass. Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia. To determine if lactic acidosis occurring after cardiopulmonary bypass could be attributed to the metabolic or other effects of epinephrine administration. Posts
OBJECTIVES A meta-analysis was conducted to investigate the effects of ulinastatin treatment on adult patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). METHODS Seven electronic databases were searched for reports of randomized, controlled trials conducted up to February 2014 in which patients undergoing cardiac surgery with CPB were administered ulinastatin in the perioperative period. RESULTS Fifty-two studies with 2025 patients were retained for analysis. The results showed that the ulinastatin can attenuate the plasma levels of pro-inflammatory cytokines and enhance the anti-inflammatory cytokine levels in patients undergoing cardiac surgery with CPB. Meanwhile, the ulinastatin had a significant beneficial effect on myocardial injury. The mean differences (MD) and 95% confidence intervals (95% CI) of biochemical markers were -63.54 (-79.36, -47.72) for lactate dehydrogenase, -224.99 (-304.83, -145.14) for creatine kinase, -8.75 (-14.23, -3.28) for creatine kinase-MB, and -0
Cardiac surgery with cardiopulmonary bypass (CPB) may cause inflammatory responses, which can deteriorate the outcomes. Inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6,-8 and -10, can act as both the effector and the predictor for post-operative inflammatory responses. Plasma mitochondrial DNA (mtDNA) was found as a pro-inflammatory agent recently, which was released when cells were insulted. In the present study, we included 38 patients undergoing coronary artery bypass graft (CABG) to analyze their perioperative plasma mtDNA and levels of inflammatory cytokines. Blood samples were collected before aortic cross-clamping (T1), at the end of CPB (T2), 6 h post-CPB (T3), 12 h post-CPB (T4), and 24 h post-CPB (T5). Rt-PCR and specific ELISA kits were used to quantify the plasma mtDNA and inflammatory cytokines, respectively. Bivariate correlations analysis was used to check the correlations between plasma mtDNA and inflammatory cytokines respectively. Results shown that
TY - JOUR. T1 - S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB). AU - Varrica, Alessandro. AU - Satriano, Angela. AU - Gavilanes, Antonio D W. AU - Zimmermann, Luc J. AU - Vles, Hans J S. AU - Pluchinotta, Francesca. AU - Anastasia, Luigi. AU - Giamberti, Alessandro. AU - Baryshnikova, Ekaterina. AU - Gazzolo, Diego. PY - 2019/4. Y1 - 2019/4. N2 - AIMS: S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO2).METHODS: We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B ...
The modern era of myocardial revascularization with cardiopulmonary bypass began in 1954 when Dr. John Gibbon reported the development of the cardiopulmonary bypass machine.6 An additional seminal advance occurred with the development of coronary angiography by Mason Sones at the Cleveland Clinic in 1957, which opened the door to the elective treatment of coronary atherosclerosis by means of direct revascularization.7 Initial reports by Rene Favaloro and Donald B. Effler on their techniques to treat clinical events associated with stenotic lesions of the coronary arteries culminated in the first large series of aorto-to-coronary artery venous grafts reported in 1969.8 Simultaneously Dudley Johnson of Milwaukee published a series of 301 patients in 1969.9 The success of these techniques was soon demonstrated in larger series initiating the modern era of coronary artery surgery. ...
This study is a multi-institutional randomized double-blind placebo controlled trial of the use of glucocorticoids to improve the clinical course of neonates following cardiac surgery. Cardiopulmonary bypass (CPB) is critical to cardiac surgery, but the pathophysiologic processes engendered by CPB play an important role in post-operative recovery. The use, doses and schedule of glucocortiocoid administration to ameliorate these CPB induced processes is highly variable and without clear data to provide direction. The Primary Aim of this study is to compare the effects of intraoperative methylprednisolone to placebo on a composite morbidity-mortality outcome following neonatal CPB. Secondary Endpoints include: inotropic requirements, incidence of low cardiac output syndrome, fluid balance, ICU stay parameters, levels of inflammatory molecules, neuro-developmental outcomes, and safety parameters. The study will focus on neonates because their post-CPB clinical course is typically more severe, and ...
xml version=1.0?,,rfc1807,,datestamp,2018-06-04T14:57:38.6619335,/datestamp,,bib-version,v2,/bib-version,,id,39473,/id,,entry,2018-04-18,/entry,,title,Heart rate dynamics during cardio-pulmonary exercise testing are associated with glycemic control in individuals with type 1 diabetes,/title,,swanseaauthors,,author,,sid,f5da81cd18adfdedb2ccb845bddc12f7,/sid,,ORCID,0000-0002-6986-6449,/ORCID,,firstname,Richard,/firstname,,surname,Bracken,/surname,,name,Richard Bracken,/name,,active,true,/active,,ethesisStudent,false,/ethesisStudent,,/author,,/swanseaauthors,,date,2018-04-18,/date,,deptcode,STSC,/deptcode,,abstract,IntroductionThis study investigated the degree and direction (kHR) of the heart rate to performance curve (HRPC) during cardio-pulmonary exercise (CPX) testing and explored the relationship with diabetes markers, anthropometry and exercise physiological markers in type 1 diabetes (T1DM).Material and methodsSixty-four people with T1DM (13 females; age: 34 ± 8 years; HbA1c: 7.8 ...
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Website. Interests: The effect of venodilation-based constant preload volume loading on hemodynamic variability in surgical patients. Crisis Management and Team Training for hospital-based resuscitation.Mechanism of radial arterial pressure changes following cardiopulmonary bypass. ...
Lacza, Zsombor and Csordás, Attila and Horváth, Eszter Mária and Pankotai, Eszter and Szabó, Csaba (2009) Mitokondriális eredetű nitrogén szabadgyökök és ATP-függő K-csatornák szerepe az organellum működésében = The involvement of mitochondrial-derived nitrogen radicals and mitoK-ATP channels in the regulation of organelle function. Project Report. OTKA. Rőth, Erzsébet and Alotti, Nasri and Lantos, János and Csordás, Attila and Papp, Lajos (1999) Oxidative stress following cardiopulmonary bypass. Journal of Molecular and Cellular Cardiology, 31. A56. ISSN 0022-2828 ...
The most common neurological deficits in children after surgery for congenital heart disease are fine and gross motor deficits. Recent magnetic resonance imaging studies have demonstrated a significant number of newly developed white matter (WM) lesions in infants after surgery. The present study describes region-specific WM development in the juvenile porcine brain, which is similar in developmental stage to the human newborn. Acute and long-term cellular responses to cardiopulmonary bypass in oligodendrocyte lineages and neuron-axonal elements, which are the most prominent cell populations in WM, have been observed. A uniquely susceptible cellular target of cardiopulmonary bypass-induced WM injury in the oligodendrocyte lineage, as well as maturation-dependent vulnerability of developing WM, was found. Oligodendrocyte progenitor cells, which mediate WM recovery function, are highly resistant to cardiopulmonary bypass-induced injury. Interestingly, oligodendrocyte progenitor cell number ...
The significance of acanthrocytes and red cell fragmentation was evaluated in 31 patients undergoing cardiopulmonary bypass. Seven patients served as controls, and 24 patients with valvular prosthesis were observed for a period of at least 2 weeks. In the control group minimal red cell fragmentation (2-3/10 hpf) was seen, while acanthrocytes were present only during and immediately after cardiopulmonary bypass. In seven patients with valvular replacement the results were similar to the control group. Six other patients showed increased red cell fragmentation (15/10 hpf). In three of these, red cell fragmentation disappeared by the third postoperative week, in two by ...
OBJECTIVE To investigate whether generation and liberation of bradykinin and histamine contribute to generalized edema formation in pediatric cardiopulmonary bypass surgery. DESIGN Prospective observational study. SETTING Pediatric heart surgery of a university hospital. PATIENTS Forty-one neonates, infants, and children undergoing cardiopulmonary bypass to correct congenital cardiac anomalies. INTERVENTIONS Plasma concentrations of bradykinin and histamine were determined before, during, and after cardiopulmonary bypass. Fluid balance was evaluated by control of fluid intake and output. MEASUREMENTS AND MAIN RESULTS The susceptibility to generalized edema formation increased significantly (r = -.457; p |.005) with decreasing age. Approximately three times higher plasma concentrations of bradykinin (p |.001) were found at the onset of anesthesia and during the total observation period in patients with a fluid retention of |6% of body weight compared with patients with a lower retention rate.
Extracorporeal circulation (ECC) methods are being increasingly used for mechanical support of respiratory and cardio-circulatory failure. Especially, cardiopulmonary bypass (CPB) during cardiovascular surgery, sustenance of the patient’s life by providing an appropriate blood flow and oxygen supply to principal organs. On the other hand, systemic inflammatory responses in patients undergoing cardiovascular surgery supported by CPB contribute significantly to CPB-associated mortality and morbidity. Our previous research showed that CPB causes a systemic inflammatory response and organ damage in a small animal CPB model. We have been studying the effects of hyperoxia and blood plasma substitute on CPB. In this review, we present a study focusing on the systemic inflammatory response during CPB, along with our findings.
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Coronary artery bypass grafting with extracorporal circulation is established as the golden standard. The conventional cardiopulmonary bypass (CPB) system is associated with inflammatory reaction, hemolysis, hemodilution an disturbances of the blood coagulation system. Also its well known that neurological disturbances caused by embolic material and air bubbles are potential risks of CPB. The new minimized perfusion circuit ROCsafeTM is a closed, reservoir-less, reduced prime, surface coated circuit, with optimized safety features in effectively eliminate both macro and micro air bubbles and should optimize the clinical outcome after CABG using cardiopulmonary bypass. ...
A countrys healthcare needs change over time, and as our population gets older, its healthcare needs become more complex.1 Nothing demonstrates this more than the increase seen in recent years in the number of cardiac surgeries. There are now more than one million cardiac surgeries annually across the world, and it is likely that this number will continue to rise.2. Cardiopulmonary Bypass (CPB) is a technique that temporarily takes over heart and lung function during surgery, maintaining the circulation and oxygenation of the patients blood.. Whilst patients are on Cardiopulmonary Bypass, they are most vulnerable and highly dependent on the skill of the clinical team and the technology that assists that team. During a typical cardiac surgery using Cardiopulmonary Bypass, patients will undergo a high number of tests, such as haemoglobin, haematocrit, blood gases and electrolytes. From induction of anesthesia until the immediate post-operative period, patients will typically have their blood ...
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Koşuyolu Kalp Dergisi, Kosuyolu Heart Journal, Increased Remnant Cholesterol Blood Concentration Associated with First Acute Coronary Syndrome, Negative Correlation Between Body Mass Index and Chest Tube Out-put After Coronary Artery Bypass Graft Surgery, Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery, Effect of Pulmonary Function Tests on Mortality and Morbidity Associated with Open Heart Surgery Performed with Cardiopulmonary Bypass, Education of Perfusionists in Turkey, Decreased Arterial Elasticity Assessed by Pulse Wave Velocity in Patients with Behçets Disease, Assessment of the Relationship Between C-Reactive Protein to Albumin Ratio and New-Onset Atrial Fibrillation in Patients with ST Elevation Myocardial Infarction, Reproducibility of Tilt-Table Test Potentiated with Double Dose Sublingual Nitroglycerin in Patients with Suspected Recurrent Syncopal Episodes, Impact of Left Ventricular Mass Index on Early Outcomes After
Recent data independently linking allogeneic blood use to increased morbidity and mortality after cardiopulmonary bypass (CPB) warrants the study of new methods to employ unique and familiar technology to reduce allogeneic blood exposure. The Hemobag® allows the open-heart team to concentrate residual CPB circuit contents and return a high volume of autologous clotting factors and blood cells to the patient. Fifty patients from all candidates were arbitrarily selected to receive the Hemobag® (HB) therapy. A retrospective control group of 50 non-Hemobag® (NHB) patients were matched to the HB group patient-by-patient for comparison according to surgeon, type of procedure, age, body surface area (BSA), body weight and CPB time. Many efforts to conserve blood (Cell Saver® and ANH) were employed in both groups. Post-CPB cell washing of circuit contents was additionally employed in the control group. There were no significant differences between the HB and NHB groups in regard to patient ...
|p||italic|Study aim:|/italic| the aim of study was assessment somatic features and selected cardio-ventilatory indices in men above 50 years old with different physical activity levels.|/p||p| |italic|Materials and methods:|/italic| the study included 55 men on average aged 54.5 ± 4.32, classified to the trained group (T), n = 33, and not trained group (NT), n = 22. Total physical activity was assessed using the SDPAR Questionnaire. Measurements: anthropometric indices, ventilatory indices and VO2 peak, hemodynamic indices and fatigue using Borg scale during exercise maximal test.|/p||p| |italic|Results:|/italic| daily energy expenditures for sport and recreation differ significantly between T and NT groups, 6.82 METs vs. 0.2 METs, respectively (p < 0.001). Men in T and NT groups significantly differ in somatic features, and cardio-pulmonary indices including: time of physical tests effort (s) 1103 ± 193 vs. 681 ± 328; max speed (km/h) 14 ± 1.5 vs. 10 ± 1.4, VE peak 135.9 ± 21.17 l
Visiting faculty- Dr Deepak Tempe- Director, Prof of Anaesthesia, GB Pant Hospital, New Delhi, at Dr K G. Deshpande memorial Centre, Gokulpeth, Nagpur,. At the out set, a Short history and demonstration of Trans-thoracic ECHO was shown by don Dr. Anil Modak, Cardiologist. A Lecture on Basic TEE views-was discussed by Dr. Deepak Tempe. It was followed by Live TEE views demonstration from OT directly with interactive discussion and Discussion with Dr Tempe regarding difficulties while the patient is on Cardio-pulmonary bypass(CPB ) and Post-CPB TEE views. A panel discussion was arranged at the concluding session in which Dr. Arvind Joshi (President CTS), Dr. P.K.Deshpande, Dr. S.K. Deshpande. Dr. Snadeep Khnazode and Dr. Deepak Tempe & Dr. Ritesh Borkar (Secretary CTS) participated and answered queries of select participants and audience comprising of Anaesthesiologists, Perfusionists and Cardiac surgeons.. ...
Objectives: The profile of patients referred for coronary artery bypass grafting (CABG) is continuously changing to include older patients with multiple comorbidities. We assessed the safety and efficacy of a biocompatible perfusion strategy (BPS) in a contemporary series of patients undergoing isolated CABG.. Methods: The BPS consisted of a membrane oxygenator, tip-to-tip closed-system heparin-bonded cardiopulmonary bypass circuits without a cardiotomy reservoir, low systemic anticoagulation (target activated clotting time 300 s) using heparin titration curves, low prime volume, avoidance of systemic cooling, and routine use of cell saver and anti-fibrinolytics. Data were prospectively collected using the American Society of Thoracic Surgeons database definitions.. Results: Nine-hundred and sixty-four consecutive patients (mean age 66 ± 11 years, 83% male) undergoing CABG between 2008 and 2012 were enrolled. Thirty-day mortality was 1.4%. Rates of postoperative stroke, myocardial infarction, ...
The portable and modular cardiopulmonary bypass apparatus has met the above mentioned needs. The apparatus consists of (i) a first cannula assembly means for withdrawing blood from a patient, (ii) a pump means connected to the first cannula assembly means for receiving the withdrawn blood and for moving the blood through the apparatus, and (iii) a first tubing means connected to the pump means to transport the patients blood away from the pump means. The apparatus further comprises (iv) oxygenator means for receiving blood from the first tubing means and for oxygenating the blood and (v) second cannula assembly means connected to the oxygenator means for returning the oxygenated blood to the patient. The apparatus is portable so that it can be used by medical personnel anywhere. In addition, the apparatus is adapted to include one or more modules for conditioning the blood, such as modules that include a heat exchanger, blood purifier, plasma and blood cell apheresis device and others. An aortic
(HealthDay)-Five years after coronary-artery bypass grafting (CABG) surgery, patients whose operation was performed with cardiopulmonary bypass (on pump) lived longer than those whose surgeons performed the procedure without ...
|h2|Introduction|/h2| |p class=p9|The provision of cardiopulmonary bypass (CPB) equipment and cardiothoracic (CT) surgical back-up during transcathet ...
Pappas, G and Starzl, TE (1970) Retrograde False Channel Perfusion: A Complication of Cardiopulmonary Bypass during Repair of Dissecting Aneurysms. Annals of Thoracic Surgery, 9 (3). 263 - 266. ISSN 0003-4975 ...
Differential cardiac gene expression during cardiopulmonary bypass: ischemia-independent upregulation of proinflammatory genes.s profile, publications, research topics, and co-authors