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1.
Blood Coagul Fibrinolysis ; 32(1): 29-36, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33196514

RESUMO

Coronary artery bypass grafting (CABG) done on-pump may cause a significant blood loss. Low fibrinogen is associated with perioperative bleeding. The influence of cardiopulmonary bypass on fibrin clot properties is poorly investigated. We studied 55 patients with isolated coronary artery disease on aspirin undergoing on-pump CABG with tranexamic acid. Fibrinogen levels, fibrinolytic capacity expressed as clot lysis time (CLT), thrombin generation potential and platelet count were assessed before and after the surgery (prior to admission to the intensive care unit). A postoperative drop in haemoglobin (-30% from baseline), haematocrit (-31% from baseline) and platelet count (-42% from baseline) was observed (all, P < 0.0001). Postoperative fibrinogen level was lower by 57%, compared with preoperative value (1.5 [1.3-1.8] vs. 3.5 [2.8-3.9] g/l, P < 0.0001). Postoperative CLT was longer by 48 min, compared with preoperative (182 [170-218] vs. 134 [122-165] min, P < 0.0001). Thrombin generation was impaired postoperatively: both lag time and time to peak thrombin were prolonged by 44 and 45%, respectively, whereas endogenous thrombin potential and peak thrombin generation decreased by 45 and 78%, respectively (all P < 0.0001). Median postoperative drainage at 12 h was 400 [290-570] ml. Predictors of blood loss at 12 h identified in multivariable linear regression model adjusted for sex and preoperative fibrinogen level were: BMI (b = -23.4, P = 0.048) and postoperative CLT (b = -2.4, P = 0.042). Despite decreased fibrinogen levels after on-pump CABG with tranexamic acid, fibrin clot susceptibility to lysis is impaired, as reflected by prolonged CLT. Postoperative CLT is associated with mediastinal drainage at 12 h.


Assuntos
Antifibrinolíticos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Tempo de Lise do Coágulo de Fibrina/métodos , Fibrinólise/efeitos dos fármacos , Ácido Tranexâmico/efeitos adversos , Idoso , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Masculino
2.
Medicine (Baltimore) ; 99(50): e23240, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327245

RESUMO

BACKGROUND: Although corticosteroid prophylaxis in adult cardiac surgery has been studied extensively for 40 years, its role remains controversial, and the optimal dose remains uncertain. The objective of this meta-analysis was to estimate the clinical benefits and risks of corticosteroid use in cardiopulmonary bypass. METHODS: We will search Pubmed, Web of Science, Embase, Clinical Trials, and Cochrane Central Register of Controlled Trials for relevant clinical trials published in any language before August 1, 2020. Randomized controlled trials (RCTs) of interest which meet inclusion criteria published or unpublished will be included. We will divide the included studies into child and adult groups for analysis. If sufficient data are available, the included trials will be divided into 4 subgroups: ≤20 mg/kg (low dose), 20-40 mg/kg (slightly high dose), 40-100 mg/kg (high dose), and >100 mg/kg (ultra high dose) based on the equivalent hydrocortisone dose. INPLASY registration number: INPLASY2020100044. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will compare the efficacy of tprophylactic corticosteroids for adults and children undergoing cardiac surgery with CPB. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Ponte Cardiopulmonar , Corticosteroides/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Humanos , Medição de Risco , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle
3.
Medicine (Baltimore) ; 99(50): e23253, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327246

RESUMO

BACKGROUND: To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release. METHODS: We performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU. RESULTS: Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ±â€Š1.09 µg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay. CONCLUSION: The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.


Assuntos
Anestesia por Inalação , Anestésicos Inalatórios , Ponte Cardiopulmonar , Sedação Profunda , Sevoflurano , Troponina I/sangue , Idoso , Anestesia por Inalação/métodos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Cuidados Críticos/métodos , Sedação Profunda/métodos , Feminino , Fator 15 de Diferenciação de Crescimento/sangue , Humanos , Tempo de Internação , Masculino , Estudos Prospectivos
4.
BMC Surg ; 20(1): 286, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208110

RESUMO

BACKGROUND: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. METHODS: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). RESULTS: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. CONCLUSIONS: In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Circulação Cerebrovascular , Circulação Extracorpórea/métodos , Doenças do Sistema Nervoso/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Encéfalo/irrigação sanguínea , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Perfusão/métodos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
5.
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 Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Cateterismo Cardíaco/métodos , Ponte Cardiopulmonar/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/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
6.
World J Pediatr Congenit Heart Surg ; 11(5): 636-640, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32853072

RESUMO

Avoiding cardiopulmonary bypass during palliation of single ventricle has the advantages of minimizing transfusions, pulmonary vascular resistance, and avoiding the inflammatory response from cardiopulmonary bypass. It is however not always straightforward, and the technique may be faced with challenges.


Assuntos
Anormalidades Múltiplas/cirurgia , Dextrocardia/cirurgia , Técnica de Fontan/métodos , Síndrome de Heterotaxia/cirurgia , Anormalidades Múltiplas/diagnóstico , Ponte Cardiopulmonar/métodos , Pré-Escolar , Dextrocardia/diagnóstico , Síndrome de Heterotaxia/diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X
7.
J Cardiothorac Surg ; 15(1): 214, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778123

RESUMO

BACKGROUND: Does Glyceryl trinitrate (GTN) administered during rewarming on cardiopulmonary bypass (CPB) impact: time to completion of rewarming prior to separation from CPB circuit, early post-op patient peripheral - core temperature gradient, time to maintenance of normothermia (core temperature > 36.5 °C) for minimum of 2 h in the initial post-op period, and plasma lactate concentrations initially post-CPB. METHODS: Single centre prospective randomized trial conducted in the Mater Misericordiae University teaching hospital in Dublin Ireland. TRIAL REGISTRATION: ISRCTN registry, ISRCTN10480871 , registered 16th of August 2017. 82 patients enrolled. Patients randomised to low dose GTN infusion (0.01 mcg/kg/min) or higher dose GTN infusion (0.5 mcg/kg/min) during rewarming on CPB. MEASUREMENTS AND MAIN RESULTS: There was no significant difference between the treatment arms for the total time to being rewarmed, U = 759.0, p = 0.84. There were also no differences between the treatment arms for the time to achieve core temperature greater than 36.5 after two hours, U = 714.0, p = 0.52, the time to achieve plateau core skin temperature, U = 688.0, p = 0.37, and the post-intervention protamine lactate, U = 721.0, p = 0.56. CONCLUSIONS: Higher dose GTN infusion during rewarming on CPB does not improve peripheral-core temperature gradient post operatively and has no effect on post-operative lactate concentrations.


Assuntos
Ponte Cardiopulmonar/métodos , Nitroglicerina/administração & dosagem , Reaquecimento , Vasodilatadores/administração & dosagem , Idoso , Temperatura Corporal/efeitos dos fármacos , Ponte Cardiopulmonar/efeitos adversos , Humanos , Hipotermia Induzida/métodos , Infusões Intravenosas , Ácido Láctico/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
8.
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
9.
Medicine (Baltimore) ; 99(28): e20934, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664090

RESUMO

This study aimed to investigate the myocardial protective effect of liquid sodium phosphocreatine cardiac arrest in extracorporeal circulation surgery treating infants with atrial septal defects.Eighty-four infants with atrial septal defects who required extracorporeal circulation surgery treatment at our hospital from January 2016 to June 2018 were divided into an observation group and a control group through a digitally randomized method, with 42 cases in each group. The control group adopted the conventional modified St Thomas II high potassium cold liquid crystal cardiac arrest, while the observation group adopted the liquid sodium phosphocreatine cardiac arrest.The myocardial enzyme indexes of the 2 groups 3, 6, 12, and 24 hours postoperatively were higher than before establishing the cardiopulmonary bypass and the enzyme indexes of the control group at the same time were higher than that of the observation group; adenosine triphosphate, adenosine diphosphate, and other energy levels and the postoperative recovery rate energy levels of the observation group were higher than those in the control group, the difference was statistically significant (P < .05).Liquid sodium phosphocreatine cardiac arrest used in extracorporeal circulation surgery treating infants with atrial septal defects can reduce myocardial ischemia-reperfusion injury, maintain energy supply during ischemia, strengthen the St Thomas II effect, and aid postoperative cardiac function recovery of high potassium cold liquid crystal cardiac arrest used in infants with atrial septal defects and treated with extracorporeal circulation surgery.


Assuntos
Ponte Cardiopulmonar/métodos , Cardiotônicos/farmacologia , Parada Cardíaca Induzida/métodos , Comunicação Interatrial/cirurgia , Fosfocreatina/farmacologia , Difosfato de Adenosina/metabolismo , Trifosfato de Adenosina/metabolismo , Cardiotônicos/administração & dosagem , Estudos de Casos e Controles , Pré-Escolar , Circulação Extracorpórea/métodos , Feminino , Parada Cardíaca/induzido quimicamente , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/tratamento farmacológico , Humanos , Lactente , Masculino , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Miocárdio/química , Miocárdio/enzimologia , Preservação de Órgãos/métodos , Fosfocreatina/administração & dosagem , Período Pós-Operatório , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/farmacologia , Substâncias Protetoras/administração & dosagem , Recuperação de Função Fisiológica/efeitos dos fármacos
10.
Perfusion ; 35(6): 465-473, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32666887

RESUMO

Coronavirus disease 2019 (COVID-19) is a serious health concern which affects all healthcare professionals worldwide. The pandemic puts health services, including cardiac surgery units, under escalating pressure. There are significant challenges caused by this novel virus and ensuing disease that leads to great uncertainty. While it has been advocated to delay elective surgeries, most cardiac surgical patients present in a more urgent manner which elevates the critical nature for intervention, which may make the surgical decision inevitable. To date, no definitive treatments to the pandemic have been promoted. Cardiac surgical centers may experience an increasing number of COVID-19 patients in clinical practice. Preparation for managing these patients will require a change in the current modalities for perioperative care. Therefore, the goal of this report is to share our own experiences, combined with a review of the emerging literature, by highlighting principles for the adult cardiac surgery community regarding treatment of patients scheduled for surgery. The following report will recommend perioperative guidance in patient management to include safety precautions for the heart team, the conduct of extracorporeal circulation and related equipment, and covering the early period in intensive care in the context of the current pandemic.


Assuntos
Betacoronavirus , Ponte Cardiopulmonar/métodos , Infecções por Coronavirus/complicações , Pandemias , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Doença da Artéria Coronariana , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Saúde Global , Humanos , Morbidade/tendências , Pneumonia Viral/epidemiologia
11.
J Card Surg ; 35(8): 1920-1926, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652793

RESUMO

BACKGROUND: Redo cardiac surgery carries an inherent risk for adverse short-term outcomes and worse long-term survival. Strategies to mitigate these risks have been numerous, including initiation of cardiopulmonary bypass via peripheral cannulation before resternotomy. This study evaluated the impact of central versus peripheral cannulation on long-term survival after redo cardiac surgery. METHODS: This was an observational study of open cardiac surgeries between 2010 and 2018. Patients undergoing open cardiac surgery that utilized cardiopulmonary bypass, who also had more than equal to 1 prior cardiac surgery, were identified. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of peripheral cannulation on survival. To isolate long-term survival, patients with operative mortality were excluded and survival time was counted from the date of discharge until the date of death. RESULTS: Of the 1660 patients with more than equal to 1 prior cardiac surgery, 91 (5.5%) received peripheral cannulation. After excluding patients with operative mortality and after multivariable risk-adjustment, the peripheral cannulation group had significantly increased hazard of death, as compared to the central cannulation group (HR 1.53, 95% CI: 1.01, 2.30, P = .044). Yet, there were no relevant differences for other postoperative outcomes, including blood product requirement, prolonged ventilation (>24 hours), pneumonia, reoperation for bleeding, stroke, sepsis, and new dialysis requirement. CONCLUSIONS: This is the first study reporting the long-term impact of peripheral cannulation for redo cardiac surgery after excluding patients with operative mortality. These data suggest that central cannulation may to be the preferred approach to redo cardiac surgery whenever safe and possible.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/métodos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/mortalidade , Reoperação/efeitos adversos , Reoperação/mortalidade , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Segurança , Taxa de Sobrevida , Fatores de Tempo
12.
Transplant Proc ; 52(8): 2554-2557, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32571702

RESUMO

BACKGROUND: Cystic fibrosis is a congenital, progressive disease affecting many organs. It frequently leads to severe respiratory failure, which can be treated by means of a double lung transplantation. Single lung transplantation is justified only in certain cases. CASE REPORT: This is a case report describing a 20-year-old female patient who became the recipient of a single lung transplant as a result of cystic fibrosis. The transplant was performed during cardiothoracic surgery, which included an intervention in the right atrium. At the age of 14, the patient underwent left pneumonectomy. In addition, the patient had a percutaneous endoscopic gastrostomy placed and a vascular port implanted. During preoperative evaluation, she presented with clinical symptoms of chronic respiratory failure. The patient was approved for lung transplantation at the age of 16. After 2 years on the national lung transplant waiting list, in 2018, the patient underwent right lung transplantation and removal of numerous thrombi in the right atrium during 1 procedure. This surgery was accomplished with the use of extracorporeal circulation, which is an extracorporeal membrane oxygenator combined with cardiopulmonary bypass. The patient was discharged 3 weeks after the procedure in good general condition. Presently, her pulmonary function is excellent and she presents with normal respiratory capacity. CONCLUSIONS: Patients with cystic fibrosis often require double lung transplantation. Under normal circumstances, performing only a single lung transplantation would be considered medical malpractice. However, in certain cases, a single lung transplant is a life-saving procedure.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Fibrose Cística/cirurgia , Transplante de Pulmão/métodos , Insuficiência Respiratória/cirurgia , Terapia Combinada , Fibrose Cística/complicações , Feminino , Humanos , Pulmão/cirurgia , Pneumonectomia/métodos , Insuficiência Respiratória/etiologia , Adulto Jovem
13.
Pediatr Cardiol ; 41(6): 1238-1241, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367306

RESUMO

Muscular pulmonary atresia with intact ventricular septum (PA/IVS) in neonates is traditionally managed by surgery. We describe hybrid approach to decompress the right ventricle (RV) and establish RV to pulmonary artery connection in a neonate avoiding cardiopulmonary bypass. A 21-gauge access needle was used to perforate the atretic pulmonary valve via periventricular approach followed by stent placement. This case is an example of how patients with congenital heart disease can be palliated in creative ways through thoughtful collaboration between surgical and interventional cardiology teams.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Descompressão Cirúrgica/métodos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Atresia Pulmonar/cirurgia , Septo Interventricular , Angiografia , Ponte Cardiopulmonar/métodos , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/diagnóstico por imagem , Resultado do Tratamento
14.
J Cardiothorac Surg ; 15(1): 118, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460864

RESUMO

BACKGROUND: Cardiopulmonary bypass (CPB) with high-priming volume can significantly activate the inflammatory response and increse the usage of packed red blood cells (PRBCs). As risks and complications related to transfusions are increasing, many cardiac centers are focusing on reducing the priming volume of CPB. In our center, efforts have also been made to reduce the priming volume, and the effects of CPB with low-priming volume on clinical outcomes in children undergoing congenital heart disease (CHD) surgery were investigated in this study to provide referential experiences for pediatric CPB. METHODS: The clinical case data of 158 children undergoing CHD surgery with CPB were collected. The children were divided into the low-priming-volume group (group A, n = 79) and the traditional group (group B, n = 79) according to the priming volume. The amount of PRBCs transfused, the postoperative hematological test results and the clinical outcomes of the two groups were compared by the independent sample t-test or the chi-square test. RESULTS: The amount of PRBCs transfused during CPB and during the whole operation were significantly lower in group A than in group B (p < 0.01), but the hemoglobin (Hb) concentration was higher in group A on the first day after surgery (p < 0.01) and before hospital discharge. However, the latter showed no statistical significant difference. The lowest postoperative platelet count was higher in group A than in group B (p < 0.05). There was no statistical difference in the postoperative inflammatory markers and the main clinical outcomes between the two groups. CONCLUSIONS: The usage of PRBCs in CPB with low-priming volume decreased significantly, but the postoperative Hb concentration and platelet count could still be maintained at a high level, improving the use efficiency of PRBCs. CPB with low-priming volume did not affect the postoperative recovery of patients, so it is worthy of continuous promotion and optimization.


Assuntos
Transfusão de Sangue Autóloga , Ponte Cardiopulmonar/métodos , Cardiopatias Congênitas/cirurgia , Volume Sanguíneo , Procedimentos Cirúrgicos Cardíacos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias
15.
J Surg Res ; 253: 8-17, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32305498

RESUMO

BACKGROUND: Cytochrome P450 epoxygenase 2J2 (CYP2J2) metabolizes arachidonic acid to epoxyeicosatrienoic acids, which exert anti-inflammatory effects and alleviate oxidative stress in the cardiovascular system. Our previous work revealed that CYP2J2 is expressed in pulmonary artery endothelial cells. It was therefore hypothesized that CYP2J2 overexpression may prevent lung ischemia/reperfusion injury (LIRI) in 3-week-old C57BL/6 mice during deep hypothermic low flow (DHLF). This study aimed to establish whether CYP2J2 protects against LIRI and the mechanisms of CYP2J2 overexpression during DHLF in mice. The aim of this study was to explore the effects of DHLF on lung tissue in mice and to find out the regularity of this process, so as to provide theoretical data for lung tissue protection in children undergoing this process in clinic. METHODS: A 3-week-old C57BL/6 mouse model was used to mimic LIRI conditions during DHLF by clamping the left pulmonary artery and left main bronchus for 120 min, followed by reperfusion for 2 h. The body temperature of the mice was maintained between 18°C and 19°C to induce DHLF. RESULTS: During DHLF, lung ischemia/reperfusion increased the left lung wet/dry weight, the left lung weight/body weight ratio, the protein concentration in bronchoalveolar lavage fluid, and the concentration of proinflammatory mediators in the lungs, including interleukin (IL)-1, IL-8, and necrosis factor (NF)-α, and decreased the concentration of the anti-inflammatory mediator IL-10. Furthermore, activation of NF-κB p65 and degradation of IKBα were remarkably increased in lung tissues after ischemia/reperfusion. The CYP2J2 overexpression group showed the opposite results (P < 0.05), and p-Akt1 and p-GSK-3ß expression were significantly higher in the CYP2J2 overexpression group (P < 0.05). Moreover, the changes in IL-1, IL-8, tumor necrosis factor-α, IL-10, p-Akt1, p-GSK-3ß, NF-κB p65, and IKBα were reversed in the Akt1 gene heterozygous knockout group, and lung damage was significantly higher in the Akt1 gene heterozygous knockout group than in the CYP2J2 overexpression group. CYP2J2 overexpression can protect against LIRI, whereas Akt1 gene heterozygous knockout in mice can abolish this protective effect. CONCLUSIONS: CYP2J2 overexpression can protect against LIRI by activating the P13K/Akt/GSK-3ß/NF-kB signaling pathway during DHLF. Thus, changing CYP2J2 expression can be a novel strategy for the prevention and treatment of LIRI during DHLF.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Sistema Enzimático do Citocromo P-450/metabolismo , Terapia Genética/métodos , Lesão Pulmonar/terapia , Traumatismo por Reperfusão/terapia , Animais , Ponte Cardiopulmonar/métodos , China , Sistema Enzimático do Citocromo P-450/genética , Modelos Animais de Doenças , Glicogênio Sintase Quinase 3 beta/metabolismo , Cardiopatias Congênitas/cirurgia , Humanos , Pulmão , Lesão Pulmonar/etiologia , Lesão Pulmonar/patologia , Camundongos , Camundongos Transgênicos , Estresse Oxidativo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Transdução de Sinais , Fator de Transcrição RelA/metabolismo , Transfecção
16.
Med Sci Monit ; 26: e920039, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32310911

RESUMO

BACKGROUND Lung injury after cardiopulmonary bypass (CPB) is a serious postoperative complication and can affect the postoperative recovery. The purpose of this study was to explore whether erythropoietin (EPO) has an effect on lung injury caused by CPB. MATERIAL AND METHODS Sixty patients who received the CPB were randomly divided into a saline group and the EPO group. All the patients received saline or EPO preoperatively, respectively. The ventilation function, including dynamic compliance, peak airway pressure, and plateau pressure, were recorded. The level of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1ß, and IL-10 in serum and arterial blood gas were analyzed. The mechanical ventilation time in the intensive care unit (ICU), the length of time spent in the ICU, the time from operation to discharge, and the total time of hospitalization were recorded. Adverse events in the ICU were monitored and recorded. RESULTS EPO significantly decreased the level of TNF-alpha and IL-1ß, but increased the level of IL-10 after CPB. EPO significantly improved pulmonary ventilated function and gas exchange function after CPB. EPO significantly shortened the mechanical ventilation time and stay in the ICU. CONCLUSIONS Preoperative EPO injection reduced lung injury and promoted lung function in patients who underwent CPB. The protection effect of EPO may be associated with inhibition of inflammatory response.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Eritropoetina/uso terapêutico , Lesão Pulmonar/tratamento farmacológico , Adulto , Idoso , Ponte Cardiopulmonar/métodos , China , Citocinas/sangue , Eritropoetina/metabolismo , Feminino , Humanos , Mediadores da Inflamação/sangue , Interleucina-1beta , Pulmão/patologia , Lesão Pulmonar/etiologia , Lesão Pulmonar/metabolismo , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Respiração Artificial/efeitos adversos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fator de Necrose Tumoral alfa
17.
Ann Thorac Surg ; 110(5): 1541-1547, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32302659

RESUMO

BACKGROUND: The optimum priming fluid for the cardiopulmonary bypass (CPB) circuit is still debated. We compared a new hyperoncotic priming solution containing dextran 40, which has an electrolyte composition that mimics extracellular fluid, with a standard crystalloid-based prime. METHODS: Eighty cardiac surgery patients were included in this double-blind, randomized, single-center study. Patients were randomized to either a dextran-based prime or a crystalloid prime containing Ringer's acetate and mannitol. The primary end point was colloid oncotic pressure in serum during CPB. Secondary end points included fluid balance, bleeding and transfusion requirements, pulmonary function, hemolysis, systemic inflammation, and markers of renal, hepatic, myocardial, and brain injury. Blood samples were collected before, during, and after CPB. RESULTS: Colloid oncotic pressure was higher in the dextran group than in the crystalloid prime group during CPB (18.8 ± 2.9 versus 16.4 ± 2.9 mm Hg; P < .001) and 10 minutes after CPB (19.2 ± 2.7 versus 16.8 ± 2.9 mm Hg; P < .001). Patients in the dextran group required less intravenous fluid during CPB (1090 ± 499 versus 1437 ± 543 mL; P = .004) and net fluid balance was less positive 12 hours after surgery (1431 ± 741 versus 1901 ± 922 mL; P = .014). Plasma-free hemoglobin was significantly lower in the dextran group 2 hours after CPB (0.18 ± 0.11 versus 0.41 ± 0.33; P = .001). There were no significant differences in bleeding, transfusion requirements, organ function, systemic inflammation, or brain and myocardial injury markers between groups at any time point. CONCLUSIONS: Our results suggest that a hyperoncotic dextran-based priming solution preserves intraoperative colloid oncotic pressure compared with crystalloid prime. Larger studies with clinically valid end points are necessary to evaluate hyperoncotic prime solutions further.


Assuntos
Ponte Cardiopulmonar/métodos , Soluções Cristaloides/administração & dosagem , Dextranos/administração & dosagem , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
18.
Biomarkers ; 25(3): 296-304, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32301345

RESUMO

Background: For many biomarkers in cardiac surgery, there is a lack of knowledge regarding the normal dynamics of plasma levels during the perioperative course. The aim of this study was to investigate the perioperative dynamics of MR-proADM, MR-proANP, hs-CRP and sP-selectin in cardiac surgery.Method: A prospective observational pilot study with 20 patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Plasma samples were taken for each patient and biomarker during the pre-, per- and postoperative period until Day 6 postoperatively.Results: MR-proADM increased significantly from 0.62 [IQR; 0.54-0.93] nmol/L preoperatively to 1.20 [1.04-1.80] nmol/L postoperative Day 1. MR-proANP increased significantly from 125 [77-152] pmol/L preoperatively to 198 [168-307] pmol/L on weaning from CPB. hs-CRP increased significantly from 2.5 mg/L [0.4-12] preoperatively to peak at 208 mg/L [186-239] postoperative Day 3. The preoperative level of sP-selectin at 23.0 [21.3-26.3] ng/mL initially fell at weaning from CPB, followed by a significant peak of 25.5 [22.7-27.7] ng/mL 8 h postoperatively.Conclusions: The findings in this study may help to understand the physiology of the biomarkers analysed and their response to cardiac surgical trauma including CPB. Furthermore, these findings will guide us in further research on the clinical usefulness of these biomarkers.


Assuntos
Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Adrenomedulina/sangue , Idoso , Análise de Variância , Fator Natriurético Atrial/sangue , Proteína C-Reativa/análise , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Fragmentos de Peptídeos/sangue , Período Perioperatório , Projetos Piloto , Estudos Prospectivos , Precursores de Proteínas/sangue
19.
Ann Thorac Surg ; 110(6): 2076-2081, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32240645

RESUMO

BACKGROUND: Use of antegrade cerebral perfusion (ACP) as an alternative neuroprotection strategy to deep hypothermic circulatory arrest (DHCA) in the setting of cardiopulmonary bypass in neonates has become a common approach, although the value of ACP over DHCA remains highly debated. This study investigated the disruption to neonatal brain homeostasis by DHCA and ACP. METHODS: Neonatal pigs (7 days old) undergoing bypass were assigned to 4 groups: DHCA at 18°C and ACP at 18°, 25°, and 32° for 45 minutes (n = 6 per group). ACP was initiated through the innominate artery and maintained at 40 mL/kg/min. After bypass, all animals were maintained sedated and intubated for 24 hours before being euthanized. Brain subventricular zone tissues were analyzed for histologic injury by assessing apoptosis and neural homeostasis (Nestin). RESULTS: Histologic examination showed no significant ischemic/hypoxic neuronal death at any cooling temperature among the 4 treatment groups. However, we detected a significantly higher apoptotic rate in DHCA compared with ACP at 18°C (P = .003-.017) or 25°C (P = .012-.043), whereas apoptosis at 32°C was not different from DHCA. Of note, we identified increased Nestin expression in the DHCA group compared with all ACP groups (P range = .011-.041). CONCLUSIONS: Neonatal piglet ACP at 18° or 25°C provides adequate protection from increased brain cellular apoptosis. In contrast to ACP, however, DHCA induces brain Nestin expression, indicating activation of neural progenitor cells and the potential of altering neonatal neurodevelopmental progression. DHCA has potential to more profoundly disrupt neural homeostasis than does ACP.


Assuntos
Encéfalo/patologia , Ponte Cardiopulmonar/métodos , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Células-Tronco Neurais/patologia , Perfusão/métodos , Animais , Animais Recém-Nascidos , Apoptose , Encéfalo/metabolismo , Modelos Animais , Nestina/metabolismo , Células-Tronco Neurais/metabolismo , Suínos
20.
PLoS One ; 15(3): e0229648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119707

RESUMO

BACKGROUND: Hemopericardium is a common and hazardous complication of acute type A aortic dissection (ATAAD). This retrospective study aimed to clarify the short-term and mid-term outcomes in patients who underwent surgical rescues for hemopericardium complicated by ATAAD. METHODS: Between January 2007 and March 2019, 586 consecutive patients underwent ATAAD repair at our institution. According to preoperative computed tomography, hemopericardium was found in 191 patients (32.6%), 150 were stabilized with medical treatment, and 41 underwent surgical rescues for critical hemodynamics. The 41 patients were classified into groups according to their rescue procedures: emergent subxiphoid pericardiotomy (E-SXP group, n = 26, 63.4%) or emergent cardiopulmonary bypass (E-CPB group, n = 15, 36.6%). Clinical features, surgical information, postoperative complications, and 3-year survival were analyzed and compared. RESULTS: Demographics, comorbidities and aortic repair procedures were generally homogenous between the two groups, except for sex. The average systolic blood pressure was 62.4 ± 13.3 mmHg and 67.1 ± 13.1 mmHg in the E-SXP and E-CPB groups, respectively. A total of 29.3% of patients underwent cardiopulmonary resuscitation (CPR) before surgical rescues. The in-hospital mortality was similar (30.8% versus 33.3%, P = 0.865) in the two groups. Multivariate analysis revealed that preoperative CPR was an in-hospital predictor of mortality. For patients who survived to discharge, 3-year cumulative survival rates were 87.8% ± 8.1% and 60.0% ± 19.7% in the E-SXP and E-CPB groups, respectively (P = 0.170). CONCLUSIONS: Patients who underwent surgical rescues for ATAAD-complicated hemopericardium are at a high risk of in-hospital mortality. The two rescue procedures revealed similar short-term and mid-term outcomes.


Assuntos
Aneurisma Dissecante/cirurgia , Ponte Cardiopulmonar/métodos , Derrame Pericárdico/cirurgia , Idoso , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Reanimação Cardiopulmonar/métodos , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Derrame Pericárdico/complicações , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
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