Cardiopulmonary Bypass In Open Heart Surgery Research Articles

Urinary metabolomics reveals kynurenine pathway perturbation in newborns with transposition of great arteries after surgical repair

IntroductionTransposition of the great arteries (TGA) is a cyanotic congenital heart defect that requires surgical correction, with the use of cardiopulmonary-bypass (CPB), usually within 3 weeks of life. The use of CPB in open heart surgery results in brain hypoperfusion and in a powerful systemic inflammatory response and oxidative stress.ObjectiveWe aimed to develop a novel untargeted metabolomics approach to detect early postoperative changes in metabolic profile following neonatal cardiac surgery.MethodsWe studied 14 TGA newborns with intact ventricular septum undergoing arterial switch operation with the use of CPB. Urine samples were collected preoperatively and at the end of the surgery and were analyzed using an untargeted metabolomics approach based on UHPLC-high resolution mass spectrometry.ResultsSince post surgery metabolic spectra were heavily contaminated by metabolites derived from administered drugs, we constructed a list of drugs used during surgery and their related metabolites retrieved from urine samples. This library was applied to our samples and 1255 drugs and drug metabolites were excluded from the analysis. Afterward, we detected over 39,000 unique compounds and 371 putatively annotated metabolites were different between pre and post-surgery samples. Among these metabolites, 13 were correctly annotated or identified. Metabolites linked to kynurenine pathway of tryptophan degradation displayed the highest fold change.ConclusionsThis is the first report on metabolic response to cardiac surgery in TGA newborns. We developed an experimental design that allowed the identification of perturbed metabolic pathways and potential biomarkers of brain damage, limiting drugs interference in the analysis.

A Brief History of Cardiopulmonary Bypass

The development and application of cardiopulmonary bypass (CPB) to permit open heart surgery is considered among the most important clinical advances in medicine during the last half of the 20th century. The birth of CPB for cardiac surgery is attributed to its first successful clinical use by John Gibbon Jr, 51 years ago but its practical clinical use really began in the spring and summer of 1955 when 2 groups led by John Kirklin at the Mayo Clinic and C Walton Lillehei at the University of Minnesota, initiated the routine use of CPB for open heart surgery. However, considerable developments were necessary and preceded the clinical accomplishment of CPB, and much has followed to make it the remarkably safe and effective procedure that it has become today. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how brief its history is and how much the practice of CPB has changed during its short existence. The aim of this article is to review this fascinating history and the lessons that can be learned from this review, and to indicate the opportunities that still exist for advancement.

Evaluation of effect of continuous positive airway pressure during cardiopulmonary bypass on cardiac de-airing after open heart surgery in randomized clinical trial

Background:Cardiac and pulmonary veins de-airing are of the most important steps during open heart surgery. This study evaluates the effect of continuous positive airway pressure (CPAP) on air trapping in pulmonary veins and on quality of de-airing procedure.Materials and Methods:This randomized prospective double blind clinical trial conducted on 40 patients. In the control group: During cardiopulmonary bypass (CPB), the ventilator was turned off and adjustable pressure limit (APL) valve was placed in SPONT position. In CPAP group: During CPB, after turning the ventilator off, the flow of oxygen flow was maintained at the rate of 0.5 L/min and the APL valve was placed in MAN position on 20 mbar. During cardiopulmonary bypass (CPB) weaning, the patients were observed for air bubbles in left atrium by using transesophageal echocardiography.Results:The mean de-airing time after the start of mechanical ventilation in CPAP group (n = 20) was significantly lower than the control group (n = 20) (P = 0.0001).The mean time of the left atrium air bubbles occupation as mild (P = 0.004), moderate (P = 0.0001) and severe (P = 0.015) grading was significantly lower in CPAP group.Conclusions:By CPAP at 20 mbar during CPB in open heart surgery, de-airing process can be down in better quality and in significantly shorter time.

Influence of Thermistor Probe Depth from the Anterior Nares on Measurement of Nasopharyngeal Temperature

Nasopharyngeal temperature is allegedly accurate and is generally used during cardiopulmonary bypass for open-heart surgery. However, adequate depth from the anterior nares to measure nasopharyngeal temperature has not been evaluated. To test whether nasopharyngeal temperature is sufficiently accurate and precise for clinical use and to clarify the suitable depth of insertion, we compared nasopharyngeal temperature measurements to simultaneous tympanic temperature measurements during open-heart surgery with cardiopulmonary bypass. Subjects comprised 4 women and 6 men undergoing cardiac surgery with a target core temperature of 32 °C. Nasopharyngeal temperature was measured at 4 sites by placing thermocouples in the nasal cavity in 1-cm increments starting at 2 cm from the anterior nares. The reference temperature (tympanic temperature) was measured at the right tympanic membrane using a thermocouple. Both temperatures were measured every 5 min and compared using correlation coefficients of linear regression (r2) and bias (mean difference between the two methods). Compared to tympanic temperature, nasopharyngeal temperature showed regression slopes of 0.91–1.03 and correlation coefficients of 0.55–0.65 at all 4 depths. Accuracy (offset or bias) was 0.9–2.1 °C compared to tympanic temperature. Precision (standard deviation) of measurements was 0.8–1.2 °C. Nasopharyngeal temperature collected at 2 cm varied the most from tympanic temperature. In conclusion, the reliability of TNaso is low for monitoring core body temperature during open-heart surgery with CPB, particularly if the probe is placed at a shallow depth from the anterior nares. Nasopharyngeal temperature obtained closest to the anterior nares (2 cm) were the least accurate.

The effect of pentoxifylline on haemolysis during cardiopulmonary bypass in open-heart surgery

Objective — Haemolysis has long been recognized as one of the responses to cardiopulmonary bypass (CPB). Pentoxifylline (PTX), a methylxanthine derivative, has been known for many years for its haemorrheological properties. In this prospective, randomized study, we investigated whether a PTX treatment would reduce the haemolysis during CPB.Methods — The effect of PTX treatment on haemolysis during CPB was studied in 25 patients (PTX group). Oral PTX (1200 mg/day in 3 divided doses) treatment for 3 days was followed by 300 mg i.v. PTX administration after anaesthesia induction.The control group consisted of 25 patients with equivalent surgery but no PTX treatment. Blood samples were collected at seven time points: prior to CPB, at 5 and 10 min of CPB and 5, 10 and 15 min after removal of cross clamping and 10 min after weaning from bypass in order to measure the haemolysis parameters, which included free haemoglobin and haptoglobin.Results — PTX-treatment caused statistically significant decrements in plasma free haemoglobin levels during CPB. On the other hand, plasma haptoglobin levels stayed higher in PTX-medicated patients during the CPB as compared to control subjects.Conclusions — These findings suggested that PTX may be an effective agent in reducing the haemolysis during CPB.

Procalcitonin in patients undergoing cardiopulmonary bypass in open heart surgery—first results of the Procalcitonin in Heart Surgery study (ProHearts)

To investigate procalcitonin (PCT) levels in patients undergoing cardiopulmonary bypass (CPB) in order to assess the prevalence and prognostic capacity of elevated PCT levels following CPB in open heart surgery. prospective observational study in consecutive patients. Twenty-four-bed ICU, department of thoracic and cardiovascular surgery, university hospital. Seven hundred and twenty two patients, 691 of whom underwent CPB, i.e., 476 had coronary bypass surgery (CABG), 130 valve replacement, 34 combined CABG and valve replacement and 23 thoracic aortic surgery. Standard perfusion techniques were used with cardioplegic arrest and mild hypothermia (28-32 degrees C). With the exception of thoracic aortic procedures, full-flow perfusion was performed. PCT was measured prior to surgery and daily thereafter until ICU discharge or death. PCT significantly increased at day 1 postoperatively compared to baseline values (0.25+/-1.65 vs 6.49+/-22.0 ng/ml, p<0.005). However, in 55.1% of patients PCT was below 1.0 ng/ml. In 12.8% of CABG patients PCT was increased to >5.0 ng/ml, compared to 39% in valve patients and 35% of patients with aortic surgery. An elevated PCT level >1.0-5.0 ng/ml at day 1 was highly predictive of mortality (P<0.03, vs<1.0 ng/ml), with an additional accuracy when levels >5.0 ng/ml were measured (P<0.002 vs<1.0 ng/ml). These results provide evidence that PCT might serve as an early prognostic marker in patients undergoing CPB in open heart surgery. It may be worth considering immunomodulating approaches in patients presenting elevated PCT levels in the early phase after CPB.

Development of the Terumo Capiox Centrifugal Pump and Its Clinical Application to Open Heart Surgery: A Comparative Study with the Roller Pump

We have developed the Terumo Capiox centrifugal pump (CXP), which consists of a rotor having a unique straight-path design to reduce pump rotational speed without decreasing hydraulic efficiency. The CXP was tested in vitro for blood trauma with a specially designed test circuit using fresh bovine blood. The Biopump (BP) (Medtronic, Minneapolis, MN, U.S.A.) and the roller pump (RP) were used as controls. The CXP demonstrated the smallest elevation of free plasma hemoglobin compared with the BP and the RP. The CXP was then applied to cardiopulmonary bypass (CPB) in 10 patients (CXP group) who underwent elective coronary artery bypass grafting (CABG), and the results were compared with those for a comparable roller pump group (RP group). Free plasma hemoglobin level, platelet count, and serum beta-thromboglobulin (beta-TG) level were measured during CPB. There were no CXP-related complications nor hemodynamic abnormalities during CPB. The CXP group demonstrated less hemolysis and less platelet depletion than the RP group. Furthermore, the serum beta-TG level was significantly lower in the CXP group than in the RP group. The CXP showed excellent hemodynamic performance with less blood trauma both in vitro and in clinical application to open heart surgery. Thus, the CXP has significant potential to be safely applied to CPB for open heart surgery and circulatory support.

Abdominal complications following cardiopulmonary bypass in open-heart surgery.

Open-heart surgery was performed on 1686 adult patients between 1980 and 1984, with a mortality rate due to abdominal complications of 0.6%. Every operation involved the use of cardiopulmonary bypass (CPB). Abdominal complications occurred in 1.6%, with an overall mortality rate of 36%. The most frequent complication was gastrointestinal (Gl) bleeding (61%). The mortality of the patients who bled from the Gl tract was 53%. Other complications encountered were gastroduodenal ulcer, colitis, ileus, subphrenic abscess and intraperitoneal bleeding. Prolonged CPB and low output syndrome preceded multiple organ failure, which occurred in 39% of those who had abdominal complications and in 59% of those who bled. Gl bleeding after CPB did not correlate with a previous history of gastric ulcer. Reoperation because of cardiac tamponade or excessive chest tube drainage was a factor predisposing to Gl bleeding. The mortality and abdominal complication rates were significantly higher in valve surgery than in coronary revascularization.

Free amino acids in plasma and erythrocytes during and after cardiopulmonary by-pass in open-heart surgery.

The concentrations in plasma and erythrocytes of free amino acids before, during and after cardiopulmonary by-pass have been determined. During by-pass and the early postoperative period the total alpha-amino nitrogen decreased, mainly because of changes in glucogenic amino acids; ketogenic amino acids, on the other hand, increased. The phenylalanine/tyrosine ratio was markedly increased in all cases.

Studies on the serum concentration of cephalothin during cardiopulmonary bypass for openheart surgery

Studies on the serum concentration of cephalothin during cardiopulmonary bypass for openheart surgery

Cardiopulmonary bypass for open-heart surgery : Practical guide to its methods and management

Cardiopulmonary bypass for open-heart surgery : Practical guide to its methods and management

Plasma protein electrophoresis during a three-hour cardiopulmonary bypass in dogs.

In a randomly selected group of 20 dogs undergoing a three-hour cardiopulmonary bypass, a marked fall in total plasma protein, serum albumin and serum globulins was noted. Operative trauma, and the dilution produced by priming fluid, were responsible for these changes. The weak relationships noted between serum albumin and serum globulin levels on the one hand, and BSP retention levels on the other, suggested an altered hepatic function. The alteration was not significant enough to play an important part during prolonged cardiopulmonary bypass in open-heart surgery.

EB-virus antibodies in post-transfusion mononucleosis and cardiopulmonary bypass.

SUMMARY The possible role of EB virus in post-transfusion mononucleosis (PTM) was investigated serologically. Sera were obtained from patients before and after cardiopulmonary bypass for open-heart surgery, and tested for antibodie by immunofluorescence. No association of EB virus with cases of PTM was found; nor was there evidence of activation of infection, reinfection or super infection with EB virus resulting from the massive blood exchange. It appears that cytomegalovirus is implicated aetiologically in most cases of PTM, while EB virus infection is rarely associated with this disease. There was no evidence of reciprocal cross-reactivity between EB virus and CMV antibodies.