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1.
JAMA ; 328(1): 38-47, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35759691

RESUMO

Importance: In children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation). Objective: To determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease. Design, Setting, and Participants: Double-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between July 2017 and April 2021, with 28-day follow-up of the last participant completed on May 24, 2021. Interventions: Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n = 679) or standard care cardiopulmonary bypass without nitric oxide (n = 685). Main Outcomes and Measures: The primary end point was the number of ventilator-free days from commencement of bypass until day 28. There were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the intensive care unit; length of stay in the hospital; and postoperative troponin levels. Results: Among 1371 patients who were randomized (mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%) completed the trial. The number of ventilator-free days did not differ significantly between the nitric oxide and standard care groups, with a median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2), respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to 0.22; P = .92). A total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28, for an adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary outcomes were not significantly different between the groups. Conclusions and Relevance: In children younger than 2 years undergoing cardiopulmonary bypass surgery for congenital heart disease, the use of nitric oxide via cardiopulmonary bypass did not significantly affect the number of ventilator-free days. These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery. Trial Registration: anzctr.org.au Identifier: ACTRN12617000821392.


Assuntos
Ponte Cardiopulmonar , Cardiopatias Congênitas , Óxido Nítrico , Respiração Artificial , Insuficiência Respiratória , Medicamentos para o Sistema Respiratório , Austrália , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Ponte Cardiopulmonar/métodos , Método Duplo-Cego , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Nova Zelândia , Óxido Nítrico/administração & dosagem , Óxido Nítrico/uso terapêutico , Oxigenadores , Recuperação de Função Fisiológica , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/prevenção & controle , Insuficiência Respiratória/terapia , Medicamentos para o Sistema Respiratório/administração & dosagem , Medicamentos para o Sistema Respiratório/uso terapêutico , Síndrome
2.
Blood Purif ; 51(1): 31-37, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34107477

RESUMO

AIM: This study aimed to evaluate the efficacy of the resin hemoperfusion device (HA380 hemoperfusion cartridge) on inflammatory responses during adult cardiopulmonary bypass (CPB). METHODS: Sixty patients undergoing surgical valve replacement were randomized into the HP group (n = 30) with an HA380 hemoperfusion cartridge in the CPB circuit or the control group (n = 30) with the conventional CPB circuit. The results of routine blood tests, blood biochemical indexes, and inflammatory factors were analyzed at V0 (pre-CPB), V1 (CPB 30 min), V2 (ICU 0 h), V3 (ICU 6 h), and V4 (ICU 24 h). RESULTS: The HP group had significantly lower levels of IL-6, IL-8, and IL-10. Significant estimation of group differences in the generalized estimating equation (GEE) models was also observed in IL-6 and IL-10. The HP group had significantly lower levels of creatinine (Cr), aminotransferase (AST), and total bilirubin (TBil) compared to the control group. The estimation of differences of Cr, AST, and TBil all reached statistical significance in GEE results. The HP group had significantly less vasopressor requirement and shorter mechanical ventilation time and ICU stay time as compared to the control group. CONCLUSION: The HA380 hemoperfusion cartridge could effectively reduce the systemic inflammatory responses and improve postoperative recovery of patients during adult CPB.


Assuntos
Ponte Cardiopulmonar/instrumentação , Hemoperfusão/instrumentação , Inflamação/etiologia , Adulto , Feminino , Hemodinâmica , Humanos , Inflamação/sangue , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade
3.
Clin Appl Thromb Hemost ; 27: 1076029620982374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571008

RESUMO

Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.


Assuntos
Plaquetas/metabolismo , Ponte Cardiopulmonar/instrumentação , Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Transtornos Hemostáticos/etiologia , Oxigenadores de Membrana , Implantação de Prótese/instrumentação , Animais , Plaquetas/patologia , Ponte Cardiopulmonar/efeitos adversos , Micropartículas Derivadas de Células/metabolismo , Micropartículas Derivadas de Células/patologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemólise , Transtornos Hemostáticos/sangue , Humanos , Ativação Plaquetária , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Medição de Risco , Fatores de Risco , Estresse Mecânico , Resultado do Tratamento
4.
Lasers Med Sci ; 36(4): 783-790, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32651700

RESUMO

The optical properties of hemoglobin could indicate the degree of hemolysis. We aimed to utilize this to develop a real-time blood damage monitoring device for cardiopulmonary bypass (CPB) systems. The real-time blood damage monitoring device comprised a near-infrared spectroscopy optical module with a fiber spectrometer and monitoring platform and computer software developed using LabVIEW 2017. The fiber spectrometer operated at wavelengths of 545, 660, and 940 nm and contained a detector fiber bundle (source-detector distance = 1.0-2.5 cm). CPB operation was simulated using an artificial heart-lung machine with a flow rate of 3, 4, or 5 L/min. Four hundred milliliter of anticoagulated porcine blood was continuously rotated for 4 h. The transmittance, reflectivity, and absorbance of the blood were measured using the optical device at a frequency of 25 Hz and then digitally averaged into 1-s interval. Samples of damaged blood were collected at regular intervals for in vitro hemolysis tests to calculate the normalized index of hemolysis (NIH). All experiments were repeated three times. We prepared 28 blood bags containing 400 ml of anticoagulant. Paired t test was used to examine the test-retest reliability of the differences between the three methods and control samples. Statistical tests revealed significant differences in the mean values between the test and control groups over time (P < 0.01). Relationship was established between the real-time monitoring results and the NIH values. An effective blood damage detection method that combined in vitro hemolysis tests and near-infrared spectroscopy was achieved. The results demonstrate the clinical potential of a real-time, low-cost, and reliable blood damage monitoring device to improve the safety of CPB operation.


Assuntos
Ponte Cardiopulmonar/instrumentação , Espectroscopia de Luz Próxima ao Infravermelho , Máquina Coração-Pulmão , Hemoglobinas/metabolismo , Hemólise , Humanos , Reprodutibilidade dos Testes
5.
Artif Organs ; 45(1): 22-28, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32737900

RESUMO

Our objective was to assess the effect of nitric oxide added to the sweep gas of the oxygenator during cardiopulmonary bypass (CPB) in infants on platelet count, platelet function, clinical outcomes, and safety. A randomized, double-blinded, placebo-controlled clinical trial in infants less than a year of age undergoing cardiac surgery requiring CPB was undertaken. Nitric oxide at a dose of 20 ppm was added to the sweep gas in the treatment group. Blood was collected at baseline and prior to separation from CPB to measure platelet count and function as determined by responsiveness to specific agonists. Clinical outcomes were observed through hospital discharge. Methemoglobin levels were measured preoperatively, at the conclusion of CPB, and upon admission to the ICU. Forty patients consented and were randomized in the trial. Eighteen patients were randomized to the treatment group and 22 were included in the placebo group. The groups were similar in terms of age, weight, gender, and surgical complexity. No significant differences were found in measures of platelet count, platelet response to agonist, or clinical outcomes. Patients in the treatment group had higher methemoglobin levels after receiving nitric oxide, but no levels approached toxicity (maximum 2.4%). Nitric oxide added to the sweep gas of the oxygenator during CPB in infants did not have an appreciable effect on the preservation of platelet count, platelet responsiveness to agonist, or clinical outcomes. Methemoglobin levels were increased after receiving nitric oxide but were far below a toxic level of 15%.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Óxido Nítrico/administração & dosagem , Oxigenadores/efeitos adversos , Agregação Plaquetária/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/instrumentação , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Metemoglobina/análise , Projetos Piloto , Testes de Função Plaquetária , Resultado do Tratamento
6.
Artif Organs ; 45(1): 46-54, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32619302

RESUMO

Hemolysis in cardiac surgery is often related to the contact of blood with air or artificial surfaces. Variations of negative pressure in the suction cannulas may represent an additional factor. Limited data exist on the contribution of a roller pump-assisted (RPA) cardiotomy suction unit to hemolysis. Elevation of free hemoglobin (fHb) following air suction (AS) or suction tip occlusion (STO) events of a pump-assisted cardiotomy suction unit was investigated in a mock circuit filled with blood from slaughtered domestic pigs. AS-associated hemolysis was measured over 240 minutes with 2 minutes of AS occurring every 10 minutes. STO-associated hemolysis was analyzed over 80-minute periods: configuration 1 (c1) comprised a cycle of 20 minutes (min) occlusion and 60 minutes RPA flow (20/60 minutes); c2 comprised 20 cycles of 1/3 minutes; c3 comprised 40 cycles of 0.5/1.5 minutes; and c4 comprised 80 cycles of 0.25/0.75 minutes. The AS setup did not lead to significant hemolysis after 2 (P = .97), 3 (P = .40) or 4 (P = .11) hours. The STO setup showed the greatest hemolysis (ΔfHb of 30 mg/dL) in c1 after 20 minutes. ΔfHb was different in c1 from all other configurations at 20 minutes (P < .0001) and 80 minutes (P < .05). Ex vivo generation of large negative pressures by STO events is the main cause of cardiotomy suction-associated hemolysis. The clinical relevance of this mechanism needs further investigations.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Hemólise , Sucção/efeitos adversos , Animais , Ponte Cardiopulmonar/instrumentação , Desenho de Equipamento , Hemodinâmica , Sucção/instrumentação , Sus scrofa
8.
PLoS One ; 15(10): e0240144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045000

RESUMO

OBJECTIVES: Direct true lumen cannulation (DTLC) of the aorta is an alternative cardiopulmonary bypass cannulation technique in the context of type A acute aortic dissection (A-AAD). DTLC has been reported to be effective in restoring adequate perfusion to jeopardized organs. This study reports and compares operative outcomes with DTLC or alternative cannulation techniques in a large cohort of patients with A-AAD. METHODS: All patients who underwent surgery for A-AAD between January 2006 and January 2017 in Mainz university hospital were reviewed. The choice of cannulation technique was left to the operating surgeon, however DTLC was our preference in patients who were in state of shock or showed signs of tamponade or hypoperfusion, in cases of potential cerebral malperfusion, as well as in patients who were under resuscitation. RESULTS: A total of 528 patients (63% males, mean age 64±13.8 years) underwent emergency surgery for A-AAD. The DTLC technique was used in 52.4% of patients. The DTLC group of patients had worse clinical status at the time of presentation with more shock, tamponade, true lumen collapse, cerebral and other malperfusion states. New neurologic events were diagnosed in around 8% of patients in each group following surgery, but there was a trend for quicker neurological recovery in the DTLC-group. Early mortality rates, short-term and long-term survival rates did not differ between the two groups. CONCLUSIONS: DTLC is a safe cannulation technique that enables effective antegrade true lumen perfusion in complicated A-AAD scenarios, and is an advantageous addition to the aortic surgeons' armamentarium.


Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Ponte Cardiopulmonar/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Dissecção Aórtica/mortalidade , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/mortalidade , Cânula/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Angiografia por Tomografia Computadorizada , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
9.
J Cardiothorac Surg ; 15(1): 313, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054852

RESUMO

BACKGROUND: Minimally invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass. Conventional external aortic clamping (exoclamping) is not always feasible, so endoaortic clamping (endoclamping) has evolved as a viable alternative. The aim of this study is to compare endoclamping (Intraclude™, Edwards Lifesciences) with exoclamping (Chitwood) during minimally invasive mitral valve procedures. METHODS: This single-centre study included 822 consecutive patients undergoing minimally invasive mitral valve procedures. The endoclamp was used in 64 patients and the exoclamp in 758. Propensity-score (PS) matching was performed resulting in 63 patients per group. Outcome measures included procedural variables, length of intensive care unit (ICU) and hospital stay, major adverse cardiac and cerebrovascular events (MACCE) and repeat surgery. RESULTS: The mean age was similar in the two group (62.2 [endoclamp] vs. 63.5 [exoclamp] years; p = 0.554), as were the cardiopulmonary bypass (145 vs. 156 min; p = 0.707) and the procedure time (203 vs. 211 min; p = 0.648). The X-clamp time was significantly shorter in the endoclamp group (88 vs. 99 min; p = 0.042). Length of ICU stay (25.0 vs. 23.0 h) and length of hospital stay (10.0 vs. 9.0 days) were slightly longer in the endoclamp group, but without statistical significance. There were nominal but no statistically significant differences between the groups in the rates of stroke, vascular complications, myocardial infarction or repeat mitral valve surgery. The conversion rate to open sternotomy approach was 2.4% without difference between groups. The estimated 7-year survival rate was similar for both groups (89.9% [endoclamp]; 84.0% [exoclamp]) with a hazard ratio of 1.291 (95% CI 0.453-3.680). CONCLUSIONS: Endoaortic clamping is an appropriate and reasonably safe alternative to the conventional Chitwood exoclamp for patients in which the exoclamp cannot be used because the ascending aorta cannot be safely mobilised.


Assuntos
Ponte Cardiopulmonar/instrumentação , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Pontuação de Propensão , Resultado do Tratamento
10.
PLoS One ; 15(7): e0235604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645079

RESUMO

BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response (SIRS) and affects the organ vascular bed. Experimentally, the lack of pulsatility alters myogenic tone of resistance arteries and increases the parietal inflammatory response. The purpose of this study was to compare the vascular reactivity of the internal thoracic arteries (ITAs) due to the inflammatory response between patients undergoing coronary artery bypass grafting (CABG) under CPB with a roller pump or with a centrifugal pump. METHODS: Eighty elective male patients undergoing CABG were selected using one or two internal thoracic arteries under CPB with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples were collected before starting CPB (Time 1) and before the last coronary anastomosis during aortic cross clamping (Time 2). The primary endpoint was the endothelium-dependent relaxation of ITAs investigated using wire-myography. The secondary endpoint was the parietal inflammatory response of arteries defined by the measurements of superoxide levels, leukocytes and lymphocytes rate and gene expression of inflammatory proteins using. Terminal complement complex activation (SC5b-9) and neutrophil activation (elastase) analysis were performed on arterial blood at the same times. RESULTS: Exposure time of ITAs to the pump flow was respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP group. Acetylcholine-dependent relaxation was conserved in the two groups whatever the time. Gene expression of C3 and C4a in the artery wall decreased from Time 1 to Time 2. No oxidative stress was observed in the graft. There was no difference between the groups concerning the leukocytes and lymphocytes rate. SC5b-9 and elastase increased between Time 1 and Time 2. CONCLUSION: Endothelium-dependent relaxation of the internal thoracic arteries was preserved during CPB whatever the type of pump used. The inflammatory response observed in the blood was not found in the graft wall within this time frame. TRIAL REGISTRATION: Name of trial study protocol: IPITA Registration number (ClinicalTrials.gov): NCT04168853.


Assuntos
Ponte Cardiopulmonar/instrumentação , Ponte de Artéria Coronária/métodos , Coração Auxiliar/efeitos adversos , Artéria Torácica Interna/cirurgia , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiologia , Feminino , Humanos , Elastase de Leucócito/metabolismo , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Complicações Pós-Operatórias/epidemiologia , Transplantes/fisiologia , Transplantes/cirurgia , Vasoconstrição , Vasodilatação
11.
J Card Surg ; 35(8): 2039-2040, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652821

RESUMO

Condensation and water loss from gas output of the cardiopulmonary bypass (CPB) oxygenator has been the study object of several research. However, little is known about the propagation of the condensation formed at the level of oxygenator and how potentially it can contaminate the surrounding environment. We aimed to document the moment of formation of the 'gas steam' derived from the CPB oxygenator during cardiac surgery with thermography imaging. Thermographic camera is a device that creates an image using infrared radiation, similar to a common camera that forms an image using visible light. The brightest (warmest) parts of the image are customarily colored white, the intermediate temperatures reds and yellows, and the dimmest (coolest) parts black. Thermal image captures the condensation phenomenon around the oxygenator perimeter with the same color/temperature code (yellow) of gas outlet. The use of aspiration at the level of the gas outlet could also favor the elimination of the condensation, improve gas exchanges, and potentially reduce the spread of hazardous substances in the operating room.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar/instrumentação , Falha de Equipamento , Oxigenadores , Água , Salas Cirúrgicas , Temperatura , Termografia , Volatilização
13.
Heart Surg Forum ; 23(2): E187-E192, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32364913

RESUMO

BACKGROUND: The aim of this study is to compare the effects of tubing length on systemic inflammatory response syndrome and myocardial protection in a rat model of cardiopulmonary bypass (CPB) from a histological standpoint. METHODS: Twelve adult male Wistar Albino rats weighing >180 g were randomly selected and divided into 2 groups. In 1 group, the pump lines were kept 1 m shorter than standard. The right jugular vein and tail artery were cannulated using a 16-gauge catheter. Animals received 500 IU/kg intravenous heparin. Cardiac index and rectal temperature were set at 2.4 mL and 36°C, respectively. Total line volume was maintained at 8 mL. A roller pump was adjusted to supply a blood flow of 6 to 28 mL/min (mean 10 mL/min), similar to the typical cardiac output of rats. CPB duration was 15 minutes throughout the experiment. After sacrifice, tissue samples were collected from heart, liver, and kidney for histomorphologic examination. RESULTS: All histochemical and histomorphologic analyses, performed by 2 blinded researchers, revealed band loss in cardiomyocytes, mononuclear (MNL) cell infiltration, and impaired fibrillar organization in the standard-line group. Additionally in that group, sinusoidal dilatation in the liver, low-level congestion, focal necrosis, and periportal MNL infiltration were noted. In the shorter-line group, on the other hand, MNL cell infiltration, band loss in myofibrils, and cardiomyocyte degeneration were rarely observed. Higher liver congestion and lower MNL cell infiltration were observed in the shorter-line group. No significant differences were found in kidney samples. CONCLUSION: In a shorter-line roller pump test model, less multiorgan damage and fewer systemic inflammatory responses were observed. It may be applicable to keep CPB lines as close to the table as possible, especially in pediatric cardiac surgery cases.


Assuntos
Ponte Cardiopulmonar/instrumentação , Isquemia Miocárdica/prevenção & controle , Miocárdio/patologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Animais , Modelos Animais de Doenças , Desenho de Equipamento , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Ratos , Ratos Wistar , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
15.
Perfusion ; 35(1): 19-25, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31144581

RESUMO

BACKGROUND: Cardiac surgery using cardiopulmonary bypass carries a high risk of bleeding and need for blood transfusion. Blood administration is associated with increased rates of morbidity and mortality. Perioperatively, strategies are often employed to reduce blood transfusions in high-risk patients or in situations where blood transfusion is contraindicated. Normovolemic hemodilution is a blood conservation technique used during cardiac surgery that involves replacement of blood with fluids. SANGUINATE® (PEGylated carboxyhemoglobin bovine) is a novel hemoglobin-based oxygen carrier that can deliver oxygen effectively to tissues in the presence of severe hypoxia. The use of a hemoglobin-based oxygen carrier during hemodilution may augment tissue oxygen delivery and reduce blood transfusion. METHODS: Six standardized cardiopulmonary bypass runs simulating normovolemic hemodilution using varying proportions of bovine whole blood and SANGUINATE were performed. Pump speed, flow rate, line pressures, hemoglobin concentration, oxygenation, and degree of anticoagulation were assessed at regular intervals. Membrane oxygenators and arterial line filters were inspected for evidence of clotting following each run. RESULTS: Increases in the pressure drop across the membrane oxygenator were detected during runs 5 and 6. Median activated clotting time values were able to be maintained at goal during the runs, and SANGUINATE did not appear to be thrombogenic. Hemoglobin concentration decreased following the addition of SANGUINATE. Oxygenation was maintained during all runs that included SANGUINATE. CONCLUSION: SANGUINATE does not impact the performance of the cardiopulmonary bypass circuit in a bovine whole blood model. The results support further evaluation of SANGUINATE in the setting of normovolemic hemodilution and cardiopulmonary bypass.


Assuntos
Substitutos Sanguíneos/farmacologia , Carboxihemoglobina/farmacologia , Ponte Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Hemodiluição , Polietilenoglicóis/farmacologia , Animais , Anticoagulantes/farmacologia , Biomarcadores/sangue , Coagulação Sanguínea/efeitos dos fármacos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Bovinos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigênio/sangue , Oxigenadores de Membrana , Estudo de Prova de Conceito , Trombose/sangue , Trombose/etiologia , Trombose/prevenção & controle , Fatores de Tempo
16.
Artif Organs ; 44(1): 28-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30512218

RESUMO

The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 arterial filter to Capiox FX05 oxygenator with integrated arterial filter. Arterial cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.


Assuntos
Ponte Cardiopulmonar/instrumentação , Hemodinâmica , Oxigenadores de Membrana , Drenagem/instrumentação , Desenho de Equipamento , Humanos , Recém-Nascido , Modelos Cardiovasculares , Vácuo , Dispositivos de Acesso Vascular
17.
Int J Artif Organs ; 43(3): 208-214, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31674867

RESUMO

Assessing the platelets' functional status during surgery on cardiopulmonary bypass is challenging. This study used multiple electrode impedance aggregometry (Multiplate®) to create a timeline of platelet aggregation changes as induced by cardiopulmonary bypass in antiplatelet-naive patients undergoing elective surgery for mitral valve regurgitation. We performed six consecutive measurements (T1: pre-operatively, T2: after heparinization, T3: 3 min after establishment of cardiopulmonary bypass, T4: immediately after administration of cardioplegia, T5: 5 min after administration of cardioplegia, and T6: 45 min after administration of cardioplegia). Platelet aggregation was determined after stimulation with 3.2-µg/mL collagen, 6.4-µM adenosine diphosphate, and 32-µM thrombin receptor activating peptide. Five patients were included (age: 64 ± 10 years, one female). We observed a decrease in hematocrit levels by -17.1% ± 3.7% (T1 vs T6) with a drop after establishment of cardiopulmonary bypass (T2 vs T3) and slightly decreasing platelet counts by -6.2% ± 7.7% (T1 vs T6). Immediately after establishment of cardiopulmonary bypass (T2 vs T3), we observed reduced platelet aggregation responses for stimulation with adenosine diphosphate (-19.7% ± 12.8%) and thrombin receptor activating peptide (-19.3% ± 6.3%). Interestingly, we found augmented platelet aggregation for all stimuli 45 min after administration of cardioplegia (T5 vs T6) with the strongest increase for collagen (+83.4% ± 42.8%; adenosine diphosphate: +39.0% ± 37.2%; thrombin receptor activating peptide: +34.5% ± 18.5%). Thus, after an initial drop due to hemodilution upon establishment of cardiopulmonary bypass, platelet reactivity increased over time which was not outweighed by decreasing platelet counts due to mechanical platelet destruction and absorption. These findings have implications for rational transfusion, peri-operative antiplatelet therapy, and for the management of patients on other extracorporeal support, such as extracorporeal life support or extracorporeal membrane oxygenation.


Assuntos
Ponte Cardiopulmonar , Cuidados Intraoperatórios , Insuficiência da Valva Mitral/sangue , Agregação Plaquetária , Testes de Função Plaquetária , Idoso , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Ponte Cardiopulmonar/métodos , Circulação Extracorpórea , Feminino , Humanos , Cuidados Intraoperatórios/instrumentação , Cuidados Intraoperatórios/métodos , Cinética , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Projetos Piloto , Agregação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/fisiologia , Testes de Função Plaquetária/instrumentação , Testes de Função Plaquetária/métodos
18.
Curr Top Med Chem ; 20(1): 78-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31820691

RESUMO

The advancement of cardiac surgery benefits from the continual technological progress of cardiopulmonary bypass (CPB). Every improvement in the CPB technology requires further clinical and laboratory tests to prove its safety and effectiveness before it can be widely used in clinical practice. In order to reduce the priming volume and eliminate a separate arterial filter in the CPB circuit, several manufacturers developed novel hollow-fiber membrane oxygenators with integrated arterial filters (IAF). Clinical and experimental studies demonstrated that an oxygenator with IAF could reduce total priming volume, blood donor exposure and gaseous microemboli delivery to the patient. It can be easily set up and managed, simplifying the CPB circuit without sacrificing safety. An oxygenator with IAF is expected to be more beneficial to the patients with low body weight and when using a minimized extracorporeal circulation system. The aim of this review manuscript was to discuss briefly the concept of integration, the current oxygenators with IAF, and the in-vitro / in-vivo performance of the oxygenators with IAF.


Assuntos
Desenho de Equipamento , Oxigênio/administração & dosagem , Oxigenadores de Membrana , Ponte Cardiopulmonar/instrumentação , Humanos , Nitrogênio
19.
Ann Thorac Cardiovasc Surg ; 26(3): 170-173, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29681595

RESUMO

Metal allergy is an uncommon problem during surgery. Among them, titanium allergy is said to be rare, but can lead to serious complications, such as palmoplantar pustulosis (PPP). A 69-year-old woman was admitted to our hospital with a chief complaint of chest pain. Coronary angiography showed severe coronary artery disease that required coronary artery bypass grafting (CABG). The patient had a history of orthopedic surgery for left distal radius fracture 2 years previously, which resulted in inflammation on the left arm and PPP. We suspected titanium allergy based on results of skin patch tests and use of titanium alloy in the previous orthopedic operation. The patient underwent CABG without use of permanent metallic material. As a result, her PPP disappeared. In this rare case, it is difficult to identify the exact cause of the improvement in PPP; thus, further studies are required to clarify the mechanism of remission.


Assuntos
Placas Ósseas/efeitos adversos , Ponte Cardiopulmonar , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Hipersensibilidade/etiologia , Psoríase/induzido quimicamente , Titânio/efeitos adversos , Idoso , Ponte Cardiopulmonar/instrumentação , Ponte de Artéria Coronária/instrumentação , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Hipersensibilidade/diagnóstico , Desenho de Prótese , Psoríase/diagnóstico , Resultado do Tratamento
20.
BMC Cardiovasc Disord ; 19(1): 292, 2019 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-31835993

RESUMO

BACKGROUND: Recent scientific reports have brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The aim of our study was to analyse patients' interim physiology while on cardiopulmonary bypass based on the haemodynamic and tissue oxygen delivery measurements. We also aimed to create a universal formula that may help in further implementation of the GDP concept. METHODS: We retrospectively analysed patients operated on at the Wroclaw University Hospital between June 2017 and December 2018. Since our observations provided an extensive amount of data, including the patients' demographics, surgery details and the perfusion-related data, the Data Science methodology was applied. RESULTS: A total of 272 (mean age 62.5 ± 12.4, 74% male) cardiac surgery patients were included in the study. To study the relationship between haemodynamic and tissue oxygen parameters, the data for three different values of DO2i (280 ml/min/m2, 330 ml/min/m2 and 380 ml/min/m2), were evaluated. Each set of those lines showed a descending function of CI in Hb concentration for the set DO2i. CONCLUSIONS: Modern calculation tools make it possible to create a common data platform from a very large database. Using that methodology we created models of haemodynamic compounds describing tissue oxygen delivery. The obtained unique patterns may both allow the adaptation of the flow in relation to the patient's unique morphology that changes in time and contribute to wider and safer implementation of perfusion strategy which has been tailored to every patient's individual needs.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Ciência de Dados , Modelos Cardiovasculares , Oxigênio/sangue , Idoso , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/instrumentação , Feminino , Máquina Coração-Pulmão , Hemodinâmica , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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