Does the roller pump adjustment in cardiopulmonary bypass settings influence hemolysis?

INTRODUCTION: Roller pumps are widely used in procedures involving cardiopulmonary bypass (CPB) due to their ease of operation and maintenance, safety, and cost. Several studies in the literature have compared the use of roller pumps with centrifugal pumps, but the influence of the roller pump adjustment on hemolysis has been poorly explored. METHODS: Measurements of hemolysis rates were carried out in 86 patients. The pump was adjusted by the dynamic calibration method, which was performed by an auxiliary device, and the patients were grouped according to the pump calibration: Group 1 (n = 20) 75 mmHg; Group 2 (n = 24) 150 mmHg; Group 3 (n = 22) 300 mmHg and Group 4 (n = 21) 450 mmHg. The hemolysis rates were measured at 4 different times during CPB (T0: before the surgical procedure; T1: 5 minutes after the start of CPB; T2: 30 minutes of CPB; and T3: 5 minutes after the CPB procedure). Hemolysis rates were calculated between the time intervals T0-T1, T1-T2, and T0-T3. RESULTS: No difference in hemolysis rates was observed between the groups (p>0.31). During the first 5 minutes of CPB, hemolysis represented 35.5% of the total hemolysis and no significant difference was found between groups (p>0.60). CONCLUSIONS: Calibration of roller pumps by the dynamic method did not influence the hemolysis rates. Additionally, the hemolysis during the first 5 minutes of CPB accounted for ~1/3 of the total hemolysis.

Effect of Ultrafiltration on Pulmonary Function and Interleukins in Patients Undergoing Cardiopulmonary Bypass.

OBJECTIVE: To evaluate the effect of ultrafiltration on interleukins, TNF-α levels, and pulmonary function in patients undergoing coronary artery bypass grafting (CABG). DESIGN: Prospective, randomized, controlled trial. SETTING: University hospital. PARTICIPANTS: Forty patients undergoing CABG were randomized into a group assigned to receive ultrafiltration (UF) during cardiopulmonary bypass (CPB) or into another group (control) that underwent the same procedure but without ultrafiltration. METHODS: Interleukins and TNF-α levels, pulmonary gas exchange, and ventilatory mechanics were measured in the preoperative, intraoperative, and postoperative periods. Interleukins and TNF-α also were analyzed in the perfusate of the test group. MEASUREMENTS AND MAIN RESULTS: There were increases in IL-6 and IL-8 at 30 minutes after CPB and 6, 12, 24, and 36 hours after surgery, along with an increase in TNF-α at 30 minutes after CPB and 24, 36, and 48 hours after surgery in both groups. IL-1 increased at 30 minutes after CPB and 12 hours after surgery, while IL-6 increased 24 and 36 hours after surgery in the UF group. The analysis of the ultrafiltrate showed the presence of TNF-α and traces of IL-1ß, IL-6, and IL-8. There were alterations in the oxygen index, alveolar-arterial oxygen difference, deadspace, pulmonary static compliance and airway resistance after anesthesia and sternotomy, as well as in airway resistance at 6 hours after surgery in both groups, with no difference between them. CONCLUSIONS: Ultrafiltration increased the serum level of IL-1 and IL-6, while it did not interfere with gas exchange and pulmonary mechanics in CABG.

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages.

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

Sistema a vácuo na circulação extracorpórea: vantagens e desvantagens / Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

Revisão sistemática sobre drenagem assistida a vácuo na circulação extracorpórea, demonstrando seus benefícios, desvantagens, por relatos de casos e evidências sobre seus efeitos na microcirculação. Realizou-se pesquisa sistemática, no período de 1997-2012, nas bases de dados do PubMed-Medline, Lilacs e SciELO. Termos: "circulação extracorpórea", "vácuo", "drenagem", "cirurgia cardíaca" e suas correspondentes traduções, em condições variadas. Dos 70 artigos selecionados, 26 foram incluídos na revisão. Embora a drenagem assistida a vácuo possua potencial significante de complicações e exija tecnologia e profissionalismo respectivo adequado, prevaleceu na literatura revisada o conceito de que a drenagem assistida a vácuo contribuiu na redução no índice de transfusões, hemodiluições, melhor campo operatório, não aumento de hemólise significativa, redução de complicações pós-cirúrgicas, uso de menor prime e uso de cânulas de menor calibre.

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

Laser Doppler anemometry measurements of steady flow through two bi-leaflet prosthetic heart valves / Velocimetria laser de escoamento permanente através de duas próteses cardíacas de duplo folheto

INTRODUCTION: In vitro hydrodynamic characterization of prosthetic heart valves provides important information regarding their operation, especially if performed by noninvasive techniques of anemometry. Once velocity profiles for each valve are provided, it is possible to compare them in terms of hydrodynamic performance. In this first experimental study using laser doppler anemometry with mechanical valves, the simulations were performed at a steady flow workbench. OBJECTIVE: To compare unidimensional velocity profiles at the central plane of two bi-leaflet aortic prosthesis from St. Jude (AGN 21 - 751 and 21 AJ - 501 models) exposed to a steady flow regime, on four distinct sections, three downstream and one upstream. METHODS: To provide similar conditions for the flow through each prosthesis by a steady flow workbench (water, flow rate of 17L/min.) and, for the same sections and sweeps, to obtain the velocity profiles of each heart valve by unidimensional measurements. RESULTS: It was found that higher velocities correspond to the prosthesis with smaller inner diameter and instabilities of flow are larger as the section of interest is closer to the valve. Regions of recirculation, stagnation of flow, low pressure, and flow peak velocities were also found. CONCLUSIONS: Considering the hydrodynamic aspect and for every section measured, it could be concluded that the prosthesis model AGN 21 - 751 (RegentTM) is superior to the 21 AJ - 501 model (Master Series). Based on the results, future studies can choose to focus on specific regions of the these valves.

INTRODUÇÃO: A caracterização hidrodinâmica in vitro de próteses de válvulas cardíacas fornece informações importantes quanto ao seu funcionamento, sobretudo se realizada por meio de métodos não-invasivos de anemometria. Uma vez obtidos os perfis de velocidade para cada válvula, é possível compará-las quanto ao seu desempenho hidrodinâmico. Neste primeiro estudo experimental de anemometria laser com válvulas mecânicas, as simulações foram realizadas em bancada de testes para escoamento permanente. OBJETIVO: Comparar perfis de velocidade unidimensional no plano central de duas próteses aórticas de duplo folheto St. Jude (modelos AGN 21 - 751 e 21 AJ - 501) submetidas a um regime de fluxo permanente, para quatro seções distintas, três à jusante e uma à montante. MÉTODOS: Proporcionar condições de similaridade para o escoamento através de cada prótese, por meio de bancada hidrodinâmica para escoamento permanente (água, à vazão de 17 L/min.) e, por meio de anemometria laser unidimensional, obter os perfis de velocidades para as mesmas seções e varreduras. RESULTADOS: Verificou-se que as maiores velocidades correspondem à prótese de diâmetro interno menor e que as instabilidades do fluxo são maiores à medida que a seção de interesse encontra-se mais próxima da válvula. Também foram verificadas as regiões de recirculação, de estagnação do fluxo e de baixa pressão, além dos picos de velocidade para o escoamento em questão. CONCLUSÕES: Sob o aspecto hidrodinâmico e para todas as seções de interesse, foi possível concluir a preferência da válvula de modelo AGN 21 - 751 (RegentTM) sobre a 21 AJ - 501 (Master Series). Os resultados obtidos permitiram escolher, para os próximos trabalhos, um foco de estudo mais específico para regiões concretas dessas próteses.

Laser Doppler anemometry measurements of steady flow through two bi-leaflet prosthetic heart valves.

INTRODUCTION: In vitro hydrodynamic characterization of prosthetic heart valves provides important information regarding their operation, especially if performed by noninvasive techniques of anemometry. Once velocity profiles for each valve are provided, it is possible to compare them in terms of hydrodynamic performance. In this first experimental study using laser doppler anemometry with mechanical valves, the simulations were performed at a steady flow workbench. OBJECTIVE: To compare unidimensional velocity profiles at the central plane of two bi-leaflet aortic prosthesis from St. Jude (AGN 21 - 751 and 21 AJ - 501 models) exposed to a steady flow regime, on four distinct sections, three downstream and one upstream. METHODS: To provide similar conditions for the flow through each prosthesis by a steady flow workbench (water, flow rate of 17L/min.) and, for the same sections and sweeps, to obtain the velocity profiles of each heart valve by unidimensional measurements. RESULTS: It was found that higher velocities correspond to the prosthesis with smaller inner diameter and instabilities of flow are larger as the section of interest is closer to the valve. Regions of recirculation, stagnation of flow, low pressure, and flow peak velocities were also found. CONCLUSIONS: Considering the hydrodynamic aspect and for every section measured, it could be concluded that the prosthesis model AGN 21 - 751 (RegentTM) is superior to the 21 AJ - 501 model (Master Series). Based on the results, future studies can choose to focus on specific regions of the these valves.

Hemólise na circulação extracorpórea: correlação com tempo e procedimentos realizados / Hemolysis in extracorporeal circulation: relationship between time and procedures

INTRODUÇÃO: A circulação extracorpórea (CEC) é indispensável para a maioria das operações cardíacas, mas causa danos significantes ao sangue, dentre eles a hemólise. OBJETIVO: Quantificar as taxas de hemólise em diferentes tempos nas operações para revascularização do miocárdio com uso de CEC. MÉTODOS: Foram medidas as taxas de hemólise de 22 pacientes em 6 tempos distintos durante a revascularização do miocárdio com uso de CEC: T0 - antes do início da CEC, T1 - 5 minutos após o início da CEC, T2 - com 30 minutos de CEC, T3 - imediatamente antes do despinçamento da aorta, T4 - imediatamente antes da passagem do volume residual para o paciente e T5 - 5 minutos após o término da passagem do volume residual para o paciente. Foram calculadas as taxas de hemólise entre os intervalos de tempo: T0-T1; T1-T2; T2-T3; T3-T4 e T4-T5. RESULTADOS: Os primeiros 5 minutos após a CEC demonstraram maior taxa de hemólise (P = 0,0003) em comparação às outras taxas calculadas, representando 29% da hemólise total até T4 (imediatamente antes da passagem do volume residual para o paciente). CONCLUSÃO: Não foram observadas variações significantes nas taxas de hemólise durante a aspiração na raiz da aorta (P > 0,38) nem com o procedimento utilizado para a passagem do volume residual de sangue no circuito para os pacientes.

INTRODUCTION: Extracorporeal circulation (EC) is very important in cardiac surgery but causes significant damage to the blood, including hemolysis. OBJECTIVE: To quantify the rate of hemolysis at different times during EC in elective coronary artery bypass grafting. METHODS: We measured rates of hemolysis of 22 patients at 6 different times during myocardial revascularization during EC: T0 - before the start of EC, T1 - five minutes after of the EC initiation, T2 - 30 minutes of EC, T3 - immediately before the aortic unclamping, T4 - immediately before passage of the residual volume to the patient and T5 - five minutes after the passage of the residual volume to the patient. Rates of hemolysis were calculated between the intervals of time: T0-T1; T1-T2; T2-T3; T3-T4 and T4-T5. RESULTS: The first 5 minutes after the EC showed the highest rate of hemolysis (P = 0.0003) compared to the others calculated rates, representing 29% of the total haemolysis until T4 (Immediately before passage of the residual volume to the patient). CONCLUSION: There were no significant changes in the rate of hemolysis during the suction in the aortic root (P> 0.38), nor with the procedure used for the passage of the residual volume of blood in the circuit to the patient.

Hemolysis in extracorporeal circulation: relationship between time and procedures.

INTRODUCTION: Extracorporeal circulation (EC) is very important in cardiac surgery but causes significant damage to the blood, including hemolysis. OBJECTIVE: To quantify the rate of hemolysis at different times during EC in elective coronary artery bypass grafting. METHODS: We measured rates of hemolysis of 22 patients at 6 different times during myocardial revascularization during EC: T0 - before the start of EC, T1 - five minutes after of the EC initiation, T2 - 30 minutes of EC, T3 - immediately before the aortic unclamping, T4 - immediately before passage of the residual volume to the patient and T5 - five minutes after the passage of the residual volume to the patient. Rates of hemolysis were calculated between the intervals of time: T0-T1; T1-T2; T2-T3; T3-T4 and T4-T5. RESULTS: The first 5 minutes after the EC showed the highest rate of hemolysis (P = 0.0003) compared to the others calculated rates, representing 29% of the total haemolysis until T4 (Immediately before passage of the residual volume to the patient). CONCLUSION: There were no significant changes in the rate of hemolysis during the suction in the aortic root (P> 0.38), nor with the procedure used for the passage of the residual volume of blood in the circuit to the patient.

The effect on hemolysis of the raceway profile of roller pumps used in cardiopulmonary bypass.

This study aims at the influence on hemolysis of the differences between the maximum and minimum amplitudes of pressure in the outlet of three roller pump models adjusted by dynamic calibration method. Tests were performed with silicone tubes (½ × (3)/(16) inches) in fluid analogous to blood and fresh bovine blood from slaughterhouse. Tests with analogous solution to blood were performed varying the dynamic calibration pressure between 78 and 500 mm Hg. Tests with fresh bovine blood were performed with the three pumps simultaneously, and pressure differences and free hemoglobin in the plasma were measured during 360 minutes. Tests with both analogous solution to blood and fresh bovine blood showed differences of mean pressures of pump 2 related to pumps 1 and 3 (p < 0.01). The different models of roller pumps analyzed presented differences in pressure amplitudes (p < 0.01) and hemolysis (p < 0.01) adjusted for the same dynamic calibration pressure. Raceway profile of pump 2 resulted in smaller pressure amplitude, implying lower hemolysis rate compared with pumps 1 and 3.

Brazilian perfusionists and arterial roller pump adjustment: comparison between static and dynamic calibration method.

INTRODUCTION: Roller pumps play an important role in extracorporeal circulation. However, occlusion of the rollers should be adequately performed and this can be adjusted mainly by two methods: static and dynamic. OBJECTIVE: To investigate how the Brazilian perfusionists adjust arterial roller pumps in their services and evaluate the application of a Device to Assist Calibration (DAC) that facilitates roller adjustment by the dynamic calibration method. METHODS: We installed a roller pump with accessories to perform adjustment by drop rate (static calibration) and dynamic calibration methods during the XXVIII Brazilian Congress of Extracorporeal Circulation. Perfusionists were asked to adjust the roller pump according to the procedure they usually do in their service. After each adjustment pressure was measured by dynamic calibration method with DAC. The research was approved by the Research Ethics Committee of UNICAMP, Nº 1144/2010. RESULTS: There were 56 perfusionists in this study. Pressure average of 56 measurements of dynamic calibration was 434 ± 214 mmHg; 76% of measurements were within the recommended range for the use of the dynamic calibration method (between 150 and 500 mmHg). CONCLUSION: Brazilian perfusionists tend to adjust roller pumps with less occlusive settings. The amplitudes of the dynamic calibration pressure tend to be smaller for more experienced perfusionists because their skills increase with time. The device can be used by the perfusionist to adjust roller pumps with greater accuracy and mainly repeatability in few minutes.

Os perfusionistas Brasileiros e o ajuste do rolete arterial: comparação entre a calibração estática e dinâmica / Brazilian perfusionists and arterial roller pump adjustment: comparison between static and dynamic calibration method

INTRODUÇÃO: Bombas de roletes desempenham um papel importante na circulação extracorpórea. No entanto, a oclusão dos roletes das bombas deve ser realizada de forma adequada e estas podem ser ajustadas, principalmente por dois métodos: estático e dinâmico. OBJETIVO: Investigar como os perfusionistas brasileiros ajustam as bombas de rolete arterial em seus serviços e testar o uso de um Dispositivo Auxiliar de Calibração que facilita o ajuste pelo método de calibração dinâmica. MÉTODOS: Foi instalada uma bomba de roletes com os acessórios necessários para a realização de sua calibração pelos métodos de velocidade de queda (calibração estática) e calibração dinâmica durante o XXVIII Congresso Brasileiro de Circulação Extracorpórea. Foi solicitado aos perfusionistas que ajustassem uma bomba de roletes conforme procedimento normalmente utilizado em seu serviço. Após cada regulagem, foi medida a respectiva pressão pelo método de calibração dinâmica com o auxílio do dispositivo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da UNICAMP, sob Nº 1144/2010. RESULTADOS: Participaram da pesquisa 56 perfusionistas. A média das 56 medidas de pressão de calibração dinâmica foi 434 ± 214 mmHg; 76 por cento das medidas realizadas ficaram no intervalo preconizado para o uso da técnica de calibração dinâmica (entre 150 e 500 mmHg). CONCLUSÃO: Os perfusionistas brasileiros tendem a calibrar bombas de roletes com ajustes menos oclusivos. As amplitudes das medidas de pressão de calibração dinâmica tendem a ser menores para perfusionistas mais experientes. O dispositivo pode ser utilizado por perfusionistas para ajustar bombas de roletes com maior precisão e, principalmente, repetitividade e em alguns minutos.

INTRODUCTION: Roller pumps play an important role in extracorporeal circulation. However, occlusion of the rollers should be adequately performed and this can be adjusted mainly by two methods: static and dynamic. OBJECTIVE: To investigate how the Brazilian perfusionists adjust arterial roller pumps in their services and evaluate the application of a Device to Assist Calibration (DAC) that facilitates roller adjustment by the dynamic calibration method. METHODS: We installed a roller pump with accessories to perform adjustment by drop rate (static calibration) and dynamic calibration methods during the XXVIII Brazilian Congress of Extracorporeal Circulation. Perfusionists were asked to adjust the roller pump according to the procedure they usually do in their service. After each adjustment pressure was measured by dynamic calibration method with DAC. The research was approved by the Research Ethics Committee of UNICAMP, Nº 1144/2010. RESULTS: There were 56 perfusionists in this study. Pressure average of 56 measurements of dynamic calibration was 434 ± 214 mmHg; 76 percent of measurements were within the recommended range for the use of the dynamic calibration method (between 150 and 500 mmHg). CONCLUSION: Brazilian perfusionists tend to adjust roller pumps with less occlusive settings. The amplitudes of the dynamic calibration pressure tend to be smaller for more experienced perfusionists because their skills increase with time. The device can be used by the perfusionist to adjust roller pumps with greater accuracy and mainly repeatability in few minutes.

Systemic inflammation caused by chronic periodontite in patients victims of acute ischemic heart attack.

OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD). METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP) were included in this study. Patients were admitted to the HC UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55.1 +/- 11.29 years old); the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54.8 +/- 10.37 years old) and group 3 represented by the toothless (43 men and 20 women, mean age 67.5 +/- 8.55 years old). Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal mammary arteries without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA) and Scheffé test for multiple comparisons was performed. RESULTS: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20% in group 1 and remained reduced by 8% in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58.8% of the coronary arteries. CONCLUSIONS: Patients with (AIHD) and severe chronic periodontitis may have altered lipid profile, as well as microorganisms associated with CP can permeate into coronary vessels.

Considerações sobre métodos de ajuste de bombas de roletes usadas em circulação extracorpórea: velocidade de queda e calibração dinâmica / Considerations on roller pumps setting methods used in cardiopulmonary bypass: drop rate and dynamic calibration

As bombas de roletes ocupam um papel de destaque entre os dispositivos utilizados na circulação extracorpórea, pois são responsáveis pela movimentação do sangue. O ajuste adequado desses equipamentos é fundamental para minimizar o trauma nas células sanguíneas. O presente trabalho analisou dois métodos para ajuste das bombas: o método de medida de velocidade de queda e a calibração dinâmica em dois modelos de bombas, com o objetivo de avaliar as suas variações e limitações práticas de uso em centro cirúrgico. A velocidade de queda foi medida em dois modelos de bombas de roletes e em três pontos do leito rígido com valor final calculado pela média entre eles. A calibração dinâmica foi medida sequencialmente às medidas de velocidade de queda, e os valores médios de pressão foram registrados em arquivo, com intervalo entre medidas de 20 ms. Os valores médios de velocidade de queda mostraram diferenças significantes (p < 0,0007), quando comparados com os valores mínimos e entre os dois modelos de bombas. Nos dois métodos analisados foram observadas variações de ajuste entre os roletes, com possíveis consequências para a hemólise. A bomba 1 mostrou descentralização do leito rígido entre os pontos medidos (p < 0,02). O método de ajuste por medida de velocidade de queda mostrou erros em seus valores absolutos e com dificuldade de repetitividade e não foi possível estabelecer correlação com a respectiva medida de calibração dinâmica.

Roller pumps have an important role among the devices used in cardiopulmonary bypass, being responsible for pumping blood. The setting of pumps is essential to minimize the trauma on blood cells. This study examined two methods for pump adjustment: the drop rate method and dynamic calibration method, applied to two different pumps in order to evaluate their variations and practical limitations of use in operating room. The drop rate was measured in the lowest point of pump raceway (0º) and in two other points close to it (–20º and +20º) and the average values of the three points was also taken. The dynamic calibration was measured sequentially, and the pressure average values were recorded on file with a sampling interval of 20 ms. There were significant differences (p < 0.0007) in drop rate averages when compared with the lowest point in the two types of pumps. In two pumps were observed variations in settings between rollers with possible consequences for the hemolysis. The pump 1 showed decentralization in raceway between points measured (p < 0.02). The drop rate method showed errors in their absolute values and with limited repeatability, and it was not possible to correlate with their dynamic calibration measurements.

Inflamação sistêmica causada pela periodontite crônica em pacientes vítimas de ataque cardíaco isquêmico agudo / Systemic inflammation caused by chronic periodontite in patients victims of acute ischemic heart attack

OBJETIVO: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA). MÉTODOS: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1 - pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos); grupo 2 - pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos); grupo 3 - pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos). Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias mamárias internas sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA) e o teste de Scheffé para comparações múltiplas. RESULTADOS: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20 por cento dos pacientes do grupo 1, e em 8 por cento nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8 por cento das artérias coronárias. CONCLUSÕES: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos.

OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD). METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP) were included in this study. Patients were admitted to the HC UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55.1 ± 11.29 years old); the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54.8 ± 10.37 years old) and group 3 represented by the toothless (43 men and 20 women, mean age 67.5 ± 8.55 years old). Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal mammary arteries without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA) and Scheffé test for multiple comparisons was performed. RESULTS: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20 percent in group 1 and remained reduced by 8 percent in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58.8 percent of the coronary arteries. CONCLUSIONS: Patients with (AIHD) and severe chronic periodontitis may have altered lipid profile, as well as microorganisms associated with CP can permeate into coronary vessels.

The influence of the residual stress in silicone tubes in the calibration methods of roller pumps used in cardiopulmonary bypass.

The rotation of rollers in cardiopulmonary bypass pumps propels the blood through various devices to reach the patient. Very occlusive settings may squeeze red blood cells, whereas a nonocclusive setting may result in retrograde flow. Occlusion of roller pumps may be regulated either by measuring the drop rate or by dynamic calibration. This study evaluated the influence of silicone tubing residual stress found on pump regulation. Silicone tubes obtained from two different suppliers were used in 6-inch DeBakey roller pumps. The variations occurring over time in the measurements of drop rate, dynamic calibration, and tube residual stress were analyzed. Covariance analysis of the four linear regressions has shown a progressive and accentuated reduction in drop rate (p < 0.002). It is noticeable that the angular coefficients of the drop rate measurements of the four silicone tubes are the same (p > 0.56). This reduction in drop rate measurements may affect the regulation of the pumps before surgical procedures. One probable cause for this reduction is the residual stress found in the silicone tubes. Settings based on the dynamic calibration process tended to be repeated over time. Simple linear regression test (angular coefficient equals zero) has shown a p > 0.79 showing no interference of the silicone tubes residual stress on dynamic calibration, suggesting that one should use this method to calibrate roller pumps.

Visualização de refluxo em aspirador de sangue e reservatório de cardiotomia usados em circulação extracorpórea / Flow visualization in blood aspirator and cardiotomy reservoir used in cardiopulmonary bypass

Objetivo: Um dos maiores danos causados pela oclusão em bombas de rolete é a hemólise. Estudos comparativos entre bomba de roletes com ajustes não oclusivos e bombas centrífugas têm sido realizados nas últimas décadas na tentativa de desenvolver novos produtos e ajustes que causem menos trauma aos elementos figurados do sangue. Comumente as bombas de rolete são ajustadas pelo método estático devido à preocupação com fluxos variáveis que podem ocorrer com ajustes não oclusivos. Folga excessiva nos roletes permite refluxo e pode acarretar erros no cálculo dos fluxos pela rotação da bomba, de acordo com os dispositivos adicionados ao circuito e a resistência sistêmica do paciente. O objetivo desse trabalho é avaliar o refluxo causado por dois modelos de bombas de rolete em aspirador de sangue e em reservatório de cardiotomia. Métodos: A visualização do refluxo foi realizada em aspirador de sangue e, em reservatório de cardiotomia, a visualização foi acompanhada de respectiva medida. Foram testados dois modelos de bombas de rolete de diferentes fabricantes, ajustadas pelo método de velocidade de queda e calibração dinâmica. Os testes foram conduzidos com tubos de silicone de 3/8 x 1/16 e 1/2 x 3/32 polegadas de diâmetro em água e solução análoga ao sangue. Resultados: Foram registrados visualmente os refluxos em aspirador de sangue e em reservatório de cardiotomia, com respectiva medida dos valores. As bombas apresentaram diferenças nos refluxos medidos ajustadas pelo método de calibração dinâmica. A bomba #2 apresentou refluxo, ajustada totalmente ocluída. Conclusão: Os refluxos medidos nos dois modelos de bomba apresentaram diferenças (P<0,008). Os resultados indicam diferenças nas características construtivas ocasionadas pelo processo de fabricação, projeto ou possíveis desgastes. Ajustes pouco oclusivos podem proporcionar variações nos fluxos com a resistência adicionada ao circuito, com dificuldade de correção do fluxo pelo incremento da rotação.

Objective: One of the major damage caused by occlusion in roller pumps is hemolysis. Comparative studies between roller pump with adjustments non occlusive and centrifugal pumps have been made in recent decades in an attempt to develop new products and adjustments that cause fewer traumas to the figurative elements of blood. Usually the roller pumps are adjusted by the static method due to concern variables flow that can occur with non-occlusive settings. Excessive slack in the rollers provoke back flow and can provides errors in the calculation of flow by the rotation of the pump, according to the devices added to the circuit and the systemic resistance of the patient. The objective of this study is to evaluate the back flow caused by two types of roller pumps in blood aspirator and cardiotomy reservoir. Method: Back flow visualization was performed in blood aspirator and cardiotomy reservoir. It was tested two different models of roller pumps, adjusted by drop rate and dynamic calibration. The tests were conducted with silicone tubes of 3/8 x 1/16 e 1/2 x 3/32 inches in diameter in water and solution similar to blood. Results: We recorded back flow visually in blood aspirator and in cardiotomy reservoir with their measure of values. The pumps had differences in refluxes measured adjusted by the dynamic calibration method. Pump#2 presents back flow adjusted fully occluded. Conclusion: The back flow measured in two models of pump present differences (P <0.008). The results indicate differences in its characteristics caused by the process of manufacturing, design or possible wear. Non-occlusive adjustments may cause variations in flow with the increase of resistance added to the circuit, with difficulty to fix the flow by increasing the rotation.

Analysis of the hydrodynamic profile in different roller pumps models used in cardiopulmonary bypass.

OBJECTIVE: Among the equipments used in cardiopulmonary bypass the roller pumps have great importance with various models available from several manufacturers. The calibration is an important factor in hemolysis rates and its potential is different in each. Researchers do not always approach details on the pump bed profiles assuming that the standardized calibration settings ensure equal and comparable values for all models of roller pumps. We have mainly two methods for calibration of pumps which also interferes on the hemolytic potential. In both of them, the characteristics of fluid impulsion defined by the pump bed design are not considered. The aim of this study is to compare the hydrodynamic profile of three models of roller pumps available in the Brazilian market. METHOD: The rollers occlusion was performed by measures of drop and dynamic calibration. Two different silicone diameter tubes were used (3/8 x 1/16 and 1/2 x 3/32 inches). RESULTS: The profiles showed differences in their variances, P<0.01 for drop rate measures and P<0.0001 for dynamic calibration. Different changes in pressure were found between the pumps analyzed (P<0.002). CONCLUSION: The measures of occlusion are dependent on the design of the pump bed and comparisons involving roller pumps should be performed with caution. Blood tests should be performed to verify the influence of changes in hemolysis pressure.

Análise do perfil hidrodinâmico em diferentes modelos de bombas de rolete utilizadas em circulação extracorpórea / Analysis of the hydrodynamic profile in different roller pumps models used in cardiopulmonary bypass

OBJETIVO: Dentre os equipamentos utilizados em circulação extracorpórea, as bombas de rolete têm grande importância, com diversos modelos disponíveis de vários fabricantes. A calibração é um fator importante nas taxas de hemólise e o seu potencial difere em cada uma delas. Pesquisadores nem sempre abordam detalhes sobre os perfis do leito rígido, supondo que as formas padronizadas de calibração garantem valores iguais e comparáveis para todos os modelos de bombas de rolete. Dispomos principalmente de dois métodos para a calibração das bombas, o que também interfere com o potencial hemolítico. Nenhum dos métodos considera as características de impulsão do fluído, definido pela forma construtiva do leito rígido. O objetivo é avaliar o perfil hidrodinâmico de três modelos de bombas de roletes disponíveis no mercado brasileiro. MÉTODOS: A oclusão dos roletes foi feita por medidas de velocidade de queda e calibração dinâmica. Foram utilizados dois diferentes diâmetros de tubos de silicone (3/8 x 1/16 e 1/2 x 3/32 polegadas). RESULTADOS: Os perfis apresentaram diferenças em suas variâncias. P<0,01 para medidas de velocidade de queda e P<0,0001 para medidas de calibração dinâmica. Foram encontradas diferenças nas variações de pressão entre as bombas analisadas (P<0,002). CONCLUSÃO: As medidas de oclusão são dependentes da forma do leito rígido e comparações envolvendo bombas de rolete devem ser feitas com cautela. Testes com sangue deveriam ser realizados para verificar a influência das variações de pressão na hemólise.

OBJECTIVE: Among the equipments used in cardiopulmonary bypass the roller pumps have great importance with various models available from several manufacturers. The calibration is an important factor in hemolysis rates and its potential is different in each. Researchers do not always approach details on the pump bed profiles assuming that the standardized calibration settings ensure equal and comparable values for all models of roller pumps. We have mainly two methods for calibration of pumps which also interferes on the hemolytic potential. In both of them, the characteristics of fluid impulsion defined by the pump bed design are not considered. The aim of this study is to compare the hydrodynamic profile of three models of roller pumps available in the Brazilian market. METHODS: The rollers occlusion was performed by measures of drop and dynamic calibration. Two different silicone diameter tubes were used (3/8 x 1/16 and 1/2 x 3/32 inches). RESULTS: The profiles showed differences in their variances, P<0.01 for drop rate measures and P<0.0001 for dynamic calibration. Different changes in pressure were found between the pumps analyzed (P<0.002). CONCLUSION: The measures of occlusion are dependent on the design of the pump bed and comparisons involving roller pumps should be performed with caution. Blood tests should be performed to verify the influence of changes in hemolysis pressure.

Flow visualization in blood aspirator and cardiotomy reservoir used in cardiopulmonary bypass.

OBJECTIVE: One of the major damage caused by occlusion in roller pumps is hemolysis. Comparative studies between roller pump with adjustments non occlusive and centrifugal pumps have been made in recent decades in an attempt to develop new products and adjustments that cause fewer traumas to the figurative elements of blood. Usually the roller pumps are adjusted by the static method due to concern variables flow that can occur with non-occlusive settings. Excessive slack in the rollers provoke back flow and can provides errors in the calculation of flow by the rotation of the pump, according to the devices added to the circuit and the systemic resistance of the patient. The objective of this study is to evaluate the back flow caused by two types of roller pumps in blood aspirator and cardiotomy reservoir. METHOD: Back flow visualization was performed in blood aspirator and cardiotomy reservoir. It was tested two different models of roller pumps, adjusted by drop rate and dynamic calibration. The tests were conducted with silicone tubes of 3/8 x 1/16 e 1/2 x 3/32 inches in diameter in water and solution similar to blood. RESULTS: We recorded back flow visually in blood aspirator and in cardiotomy reservoir with their measure of values. The pumps had differences in refluxes measured adjusted by the dynamic calibration method. Pump#2 presents back flow adjusted fully occluded. CONCLUSION: The back flow measured in two models of pump present differences (P <0.008). The results indicate differences in its characteristics caused by the process of manufacturing, design or possible wear. Non-occlusive adjustments may cause variations in flow with the increase of resistance added to the circuit, with difficulty to fix the flow by increasing the rotation.

Influencia da ultrafiltração na remoção de mediadores inflamatorios durante circulação extracorporea e alterações da função organica monitorada pelo "Sequencial Organ Failure Assessment Score - SOFA" em pacientes submetidos a revascularização do miocardio / Inflammatory mediators and sequencial organ failure assessment score - SOFA outcomes after conventional ultrafiltration during circulatory bypass in patients underwent coronary artery bypass graft

Objetivo: Investigar a eficácia da ultrafiltração na remoção de mediadores inflamatórios liberados pela circulação extracorpórea e correlacionar ultrafiltração com alterações da função orgânica de acordo com o "Seqüential Organ Failure Assessment Score". Métodos: Quarenta pacientes foram incluídos e randomizados em dois grupos: "sem ultrafiltração" (n=20; Grupo I) e "ultrafiltração" (n=20; Grupo II). Complementos 3 e 4 ativados, interleucina 1beta, 6, 8 e fator de necrose tumoral alfa foram dosados antes da indução anestésica (T1), 5 minutos antes da circulação extracorpórea (T2), no líquido ultrafiltrado (T3), 30 minutos (T4), 6 (T5), 12 (T6), 24 (T7), 36 (T8) e 48 (T9) horas após término da circulação extracorpórea. "Sequential Organ Failure Assessment Score" foi avaliado nos tempos 1, 6 e 9. Significância estatística foi estabelecida com...

Objective: To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score. Methods: Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established...