Complication Of Cardiopulmonary Bypass Research Articles

Metabolomics profiling for diagnosis of acute renal failure after cardiopulmonary bypass.

Acute renal failure (ARF) is one of the most serious complications of cardiopulmonary bypass (CPB) surgery. Serum creatinine level is a key compound examined to understand whether renal function is normal. However, its level may vary based on age, gender, race, muscle mass, nutrition, and drugs taken by an individual. In addition, it may not be detected without a 50% reduction in renal function and may lead to delays in treatment. New markers are needed for early diagnosis of ARF. They were determined for early diagnosis of ARF after CPB. Metabolic differences in plasma samples of individuals who developed and did not develop ARF after cardiopulmonary bypass were determined. This study was the first to perform an untargeted metabolomics analysis for early diagnosis of ARF after CPB surgery. Plasma samples were taken from 105 patients (9 ARF patients) at five time points to identify the time at which a more accurate ARF diagnosis can be made. A total of 687 samples, including quality control samples, were analyzed. Two hundred twenty-six metabolites were identified using retention index libraries. Based on the statistical evaluations, tryptophan, threonine, and methionine were found in lower concentrations in patients with ARF compared to the control group at all time points. Whereas gluconic acid, hypoxanthine, and lactic acid showed a decreasing trend over time, longitudinal analysis showed that cysteine, hippuric acid, and uric acid levels increased over time in the ARF group. These metabolites are candidate biomarkers for early diagnosis of ARF as well as biomarkers for tracking the recovery of ARF patients.

The effects of pentoxyphiline on neurocognitive functions and neurobiochemical markers in coronary artery bypass graft surgery

Aim: Neurocognitive dysfunction is a complication of cardiopulmonary bypass (CPB). Neuron-specific enolase (NSE) and S100ß protein are markers of cerebral injury. With its beneficial rheological and anti-inflammatory properties, pentoxyphiline (PTX) is an interesting agent in cardiac surgery patients. The study was designed to evaluate the influence of prophylactic use of PTX on cognitive function and S100ß and NSE in on-pump coronary artery bypass grafting (CABG) patients.Method: In this prospective study, 40 patients undergoing on-pump CABG and received either PTX (bolus of 5 mg kg-1) after induction of anesthesia or saline are included. Neurological examination and neuropsychologic tests, including the mini-mental state examination test (MMSET) and Benton visual retention test (BVRT), were obtained preoperatively and on the seventh postoperative day. Blood samples for analysis of S100ß and NSE were collected before anesthesia, at the end of CPB, at the 3rd hour and 24th hour postoperatively.Results: Demographic and perioperative data were similar for the two groups. Mean cross-clamping times were 67.86±22.22 and 66.32±27.84 min, respectively. In both groups, S100ß and NSE increased significantly (p<0.01) at the end of the CPB and remained slightly increased at T2 (at the CPB exit), and T3 (at the 3rd hour after surgery) than preoperative levels (p>0.05). MMSET and BVRT performances of the two groups were similar and did not change compared to preoperative scores.Conclusions: Coronary artery bypass surgery caused a significant increase in NSE and S100ß serum levels but with no deterioration in neuropsychological outcome assessed in the first postoperative week. Although it was reported that PTX could be a promising agent to prevent post-CPB organ dysfunction in elderly cardiac surgery patients, prophylactic use of PTX appeared to offer no advantage for cerebral protection in the age group involved in this study.

Carboxyhemoglobin and Methemoglobin Levels and Hemolysis in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass.

Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHb CPB ) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHb CPB ) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHb CPB and MetHb CPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited.

Complications of Cardiopulmonary Bypass From an Anesthesia Perspective: A Clinical Review.

Description Cardiopulmonary bypass (CPB) is frequently used for open heart surgery and other procedures that utilize temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications. CPB can be seen as the ultimate "team sport" as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. In this clinical review paper, we examine possible complications of CPB, primarily from the perspective of the anesthesiologist, and how to troubleshoot them if they arise, which often requires the involvement of other essential team members.

Influence of Fibrinogen Concentrate on Neonatal Clot Structure When Administered Ex Vivo After Cardiopulmonary Bypass.

Bleeding is a serious complication of cardiopulmonary bypass (CPB) in neonates. Blood product transfusions are often needed to adequately restore hemostasis, but are associated with significant risks. Thus, neonates would benefit from other effective, and safe, hemostatic therapies. The use of fibrinogen concentrate (FC; RiaSTAP, CSL Behring, Marburg, Germany) is growing in popularity, but has not been adequately studied in neonates. Here, we characterize structural and degradation effects on the neonatal fibrin network when FC is added ex vivo to plasma obtained after CPB. After approval by the institutional review board and parental consent, blood samples were collected from neonates undergoing cardiac surgery and centrifuged to yield platelet poor plasma. Clots were formed ex vivo from plasma obtained at several time points: (1) baseline, (2) immediately post-CPB, and (3) post-transfusion of cryoprecipitate. In addition, we utilized post-CPB plasma to construct the following conditions: (4) post-CPB +0.5 mg/mL FC, and (5) post-CPB +0.9 mg/mL FC. The resultant fibrin networks were imaged using confocal microscopy to analyze overall structure, fiber density, and alignment. Clots were also analyzed using a microfluidic degradation assay. Fibrinogen content was quantified for all plasma samples. The addition of 0.5 or 0.9 mg/mL FC to post-CPB samples significantly enhanced the median fiber density when compared to untreated post-CPB samples (post-CPB = 0.44 [interquartile range {IQR}: 0.36-0.52], post-CPB +0.5 mg/mL FC = 0.69 [0.56-0.77], post-CPB +0.9 mg/mL FC = 0.87 [0.59-0.96]; P = .01 and P = .006, respectively). The addition of 0.9 mg/mL FC to post-CPB samples resulted in a greater fiber density than that observed after the in vivo transfusion of cryoprecipitate (post-transfusion = 0.54 [0.45-0.77], post-CPB +0.9 mg/mL FC = 0.87 [0.59-0.96]; P = .002). Median fiber alignment did not differ significantly between post-CPB samples and samples treated with FC. Degradation rates were not statistically significant from baseline values with either 0.5 or 0.9 mg/mL FC. In addition, we found a significant correlation between the difference in the baseline and post-CPB fibrinogen concentration with patient age ( P = .033) after controlling for weight. Our results show that clots formed ex vivo with clinically relevant doses of FC (0.9 mg/mL) display similar structural and degradation characteristics compared to the in vivo transfusion of cryoprecipitate. These findings suggest that FC is effective in restoring structural fibrin clot properties after CPB. Future studies after the administration of FC in vivo are needed to validate this hypothesis.

A Comparison of Success Rate in Off-Pump Coronary Artery Bypass Grafting Surgery among Patients with Varying Preoperative Left Ventricular Ejection Fractions: Retrospective Observational Study

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to coronary artery revascularization and avoids the complications of cardiopulmonary bypass (CPB). The procedure’s success, however, depends on intraoperative hemodynamic stability. Preoperative cardiac function can predict the tolerance to compromised hemodynamics during cardiac surgery. Inability to manage hypotension and low cardiac output while manipulating the heart is the most frequent cause of intraoperative conversion to CPB. Objective: The authors investigated the effects of the preoperative left ventricular ejection fraction (LVEF) on the success of OPCAB surgery and the relation of intraoperative factors to the success of OPCAB surgery. Material and Methods: Medical records of 284 patients who underwent OPCAB surgery in Ramathibodi Hospital between January 2015 and December 2017 were retrospectively reviewed. Preoperatively, the patients were classified into groups 1 to 4 based on LVEFs of 50% to 70%, 40% to 49%, 30% to 39%, and &lt;30%, respectively. Preoperative characteristics were collected. Intraoperative success of OPCAB surgery, application of inotropes, vasopressor, fluid, and intra-aortic balloon pump (IABP), and post-operative outcomes were analyzed and compared among the four LVEF groups. Results: No significant differences in success of OPCAB surgery emerged among the four groups (p=0.430). Intraoperative requirements of IABP were significantly higher for LVEF &lt;30% patients (p=0.001). In addition, the time to extubation was significantly delayed (p=0.001) and the LVEF &lt;30% patients stayed longer in intensive care unit (ICU) (p=0.002) when compared with the good LVEF patients. There were no significant differences in the operative time, amount of intravenous fluid, blood transfusion requirement, or blood loss among the groups. There were no significant differences in major postoperative morbidities. Conclusion: OPCAB surgery can be performed successfully in patients with severe cardiac dysfunction (LVEF &lt;30%) without significant differences from LVEF ≥30% patients, although the need for an intraoperative IABP device and inotropic drugs for hemodynamic support were greater and the extubation times and ICU stays were longer. Keywords: Coronary artery bypass graft; Left ventricular ejection fraction; Off-pump CABG; OPCAB; Poor cardiac function

Effect of cardiopulmonary bypass on a stress response pathway in a recovery rat's model

The systemic inflammation response syndrome (SIRS) is a common side-effect of the cardiopulmonary bypass (CPB) in cardiac surgery. SIRS can trigger multiple organ dysfunction which can lead to patient death. Pulmonary dysfunction is the most common post-operative complication of CPB. However, the lack of animal models recapitulating the disease prevents the investigation of pathophysiological mechanisms of CPB's complications. This project aims to develop a robust rat model recapitulating the SIRS during an extracorporeal circulation. This model mimics the clinical procedure and will be used to investigate the activation of stress response pathway (ISR). Surgery was made under isoflurane (3%, 02: 0.4L/min) and CPB was performed under propofol infusion (5μg/kg/hr) on mechanically ventilated 12 weeks old rats. Blood was drawn from cava vein then reinjected in the aorta. Hemodynamic parameters were measured in femoral artery. The circuit was primed with Ringer Lactate (< 1/3 of rats’ volemia). To oxygenate the blood, an oxygenator was in line with the peristaltic pump. Hemodynamic and blood gases were monitored during the procedure. After 30 mins of CPB, rats were culled. Blood and organs were collected for ISR pathway analyses. Mean blood pressure was maintained at 50mmHg with a PaO2 > 380mmHg. Lactate and kaliemia were increased after CPB (pre: 1.31 ± 0.49 vs post: 5.32 ± 3.67 and pre: 4.73 ± 0.15 vs post: 6.83 ± 2.22, respectively, N = 3). An activation of the ISR pathway was demonstrated by western blot on lung from CPB rats compared to Sham rats, with a 10-fold increase in p(ser51)-eIF2α/eIF2α ratio, a 2-fold increase in CHOP and GADD34 protein levels. We have developed a pre-clinical rat model of CPB in which preliminary data highlight an early activation of ISR pathway in lung. This model will be used to decipher the pathophysiological mechanisms of CPB's complications.

Cardiopulmonary Bypass Complications in a West African Country (Senegal)

Although cardiopulmonary bypass (CPB) has simplified open heart surgery, it causes adverse effects on the body’s systems. This study aims to report the complications related to CPB at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a 24 months period (from January 2015 to December 2016). All adult and children patients who underwent open heart surgery using CPB machines were included in this study. 193 patients were eligible during this study’s period. Patients' mean age was 23 ± 15 years (range, 2–65), and 52% were female patients. Two complications were observed during CPB. One case of hemolysis and one case of an impossible weaning from CPB. Post-CPB complications were allocated as follows: hematological complications (88.5%) followed by cardiovascular (56%), pleuropulmonary (22.4%), septicemia (4%), renal (3%), systemic inflammatory response syndrome (SIRS) (2%) and neurologic (1%) complications. The overall hospital mortality was 5%. One (1) patient died intra operatively and nine (9) patients in the intensive care unit. The morbidity and mortality related to CPB in our cardiac surgery center is superimposed to those of the literature.

Simulator Teaching of Cardiopulmonary Bypass Complications: A Prospective, Randomized Study

Complications of cardiopulmonary bypass (CPB) are rare, but life-threatening events that need prompt and rehearsed actions involving a team. This is not adequately taught to cardiothoracic surgical trainees. The objective of this study was to assess the knowledge of cardiothoracic trainees required to manage these events after simulation-based vs. lecture-based teaching. Totally, 17 cardiac surgical trainees with no formal teaching in intraoperative complications of CPB management were randomly assigned by computer to either a study group receiving simulation-based complications of CPB teaching via the Orpheus simulator (n = 9) or a control group receiving complications of CPB teaching via a lecture (n = 8). Each subject undertook a written test comprising 20 multiple choice questions on complications of CPB before and after teaching. Trainees were then asked to rate their satisfaction with each session from 1 to 5, with 5 being most satisfied. St George Simulation and Clinical Skills Laboratory, St George's Hospital, London. There was no significant difference in the pretest scores between the 2 groups (p = 0.29). After teaching, both groups showed a statistically significant improvement in their knowledge (p < 0.05). The trainees in the simulation group performed better than the lecture-based group; however, this was not statistically significant (p = 0.21). Satisfaction levels in both the lecture session and the simulation session were very high with means of 4.4/5 and 4.8/5, respectively. Despite the familiarity with CPB during surgery, the simulation group performed at least as well as the lecture group. Cardiothoracic trainees would benefit from formal teaching of complications of CPB management via either learning modality being incorporated into their training.

The Effect of Patient-Specific Cerebral Oxygenation Monitoring on Postoperative Cognitive Function: A Multicenter Randomized Controlled Trial.

BackgroundIndices of global tissue oxygen delivery and utilization such as mixed venous oxygen saturation, serum lactate concentration, and arterial hematocrit are commonly used to determine the adequacy of tissue oxygenation during cardiopulmonary bypass (CPB). However, these global measures may not accurately reflect regional tissue oxygenation and ischemic organ injury remains a common and serious complication of CPB. Near-infrared spectroscopy (NIRS) is a noninvasive technology that measures regional tissue oxygenation. NIRS may be used alongside global measures to optimize regional perfusion and reduce organ injury. It may also be used as an indicator of the need for red blood cell transfusion in the presence of anemia and tissue hypoxia. However, the clinical benefits of using NIRS remain unclear and there is a lack of high-quality evidence demonstrating its efficacy and cost effectiveness.ObjectiveThe aim of the patient-specific cerebral oxygenation monitoring as part of an algorithm to reduce transfusion during heart valve surgery (PASPORT) trial is to determine whether the addition of NIRS to CPB management algorithms can prevent cognitive decline, postoperative organ injury, unnecessary transfusion, and reduce health care costs.MethodsAdults aged 16 years or older undergoing valve or combined coronary artery bypass graft and valve surgery at one of three UK cardiac centers (Bristol, Hull, or Leicester) are randomly allocated in a 1:1 ratio to either a standard algorithm for optimizing tissue oxygenation during CPB that includes a fixed transfusion threshold, or a patient-specific algorithm that incorporates cerebral NIRS monitoring and a restrictive red blood cell transfusion threshold. Allocation concealment, Internet-based randomization stratified by operation type and recruiting center, and blinding of patients, ICU and ward care staff, and outcome assessors reduce the risk of bias. The primary outcomes are cognitive function 3 months after surgery and infectious complications during the first 3 months after surgery. Secondary outcomes include measures of inflammation, organ injury, and volumes of blood transfused. The cost effectiveness of the NIRS-based algorithm is described in terms of a cost-effectiveness acceptability curve. The trial tests the superiority of the patient-specific algorithm versus standard care. A sample size of 200 patients was chosen to detect a small to moderate target difference with 80% power and 5% significance (two tailed).ResultsOver 4 years, 208 patients have been successfully randomized and have been followed up for a 3-month period. Results are to be reported in 2015.ConclusionsThis study provides high-quality evidence, both valid and widely applicable, to determine whether the use of NIRS monitoring as part of a patient-specific management algorithm improves clinical outcomes and is cost effective.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 23557269; http://www.isrctn.com/ISRCTN23557269 (Archived by Webcite at http://www.webcitation.org/6buyrbj64)

Petechial and subcutaneous hemorrhage with blister formations in right upper extremity during cardiopulmonary bypass by axillary artery cannulation.

A 72-year-old man underwent aortic valve replacement and coronary artery bypass graft using cardiopulmonary bypass with right axillary artery cannulation. After undraping, petechial and subcutaneous hemorrhage with blister formations were found in right upper extremity. Axillary artery cannula was considered to compress right subclavian and disturb venous return in the right subclavian vein, which caused an acute compartment syndrome during cardiopulmary bypass. This case was a rare,but severe complication of cardiopulmonary bypass with right axillary artery cannulation.

Cardiopulmonary Bypass in an Infant With a Recent History of Malaria

Severe malarial infection is associated with impaired cardiac function. We report a child who underwent repair of tetralogy of Fallot two weeks after being treated for malaria. The postoperative course was complicated by impaired left ventricular function. The pathogenesis of malaria is discussed as well as the potential complications of cardiopulmonary bypass (CPB).

Platelet-dependent thrombography gives a distinct pattern of in vitro thrombin generation after surgery with cardio-pulmonary bypass: potential implications

BackgroundBleeding remains a potentially lethal complication of cardio-pulmonary bypass (CPB) surgery. The purpose of this study was to obtain a better insight into in vitro thrombin generation in the context of CPB.MethodsWe used Calibrated Automated Thrombography to assess blood coagulation of 10 low-risk patients operated for valve replacement with CPB, under 2 experimental conditions, one implicating platelets as platelet dysfunction has been described to occur during CPB.ResultsOur main finding was that CPB-induced coagulopathy was differently appreciated depending on the presence or absence of platelets: the decrease in thrombin generation was much less pronounced in their presence (mean endogenous thrombin potential change values before and after CPB were -3.9% in the presence of platelets and -39.6% in their absence).ConclusionOur results show that experimental conditions have a profound effect in the study of in vitro thrombin generation in the context of CPB.

Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery*

Acute kidney injury is a frequent and serious complication of cardiopulmonary bypass. In current clinical practice, serum creatinine is used to detect acute kidney injury. Cystatin C is a novel biomarker for kidney function that has been shown to be superior to serum creatinine in predicting acute kidney injury in adults after cardiopulmonary bypass. The aim of this study was to determine whether early cystatin C levels predict acute kidney injury associated with cardiopulmonary bypass in pediatric patients undergoing cardiac surgery and if cystatin C could predict pediatric-modified RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) class and renal injury as determined by estimated glomerular filtration rate. We also investigated whether ultrafiltration during cardiopulmonary bypass affects cystatin C levels. Prospective, observational cohort study. Cardiac intensive care unit in a tertiary, academic pediatric hospital. One hundred pediatric patients who underwent cardiac surgery involving cardiopulmonary bypass. None. Acute kidney injury was defined as a 50% increase in serum creatinine from a preoperative baseline anytime through postoperative day 4. Severity of acute kidney injury was determined by pediatric RIFLE class using estimated glomerular filtration rate criteria only. Renal injury was also determined by an absolute estimated glomerular filtration rate <80 mL/min/1.73 m. Cystatin C levels were measured before and after ultrafiltration. Twenty-eight patients (28%) developed acute kidney injury. Cystatin C predicted acute kidney injury as early as 8 hrs after surgery. When applying pediatric RIFLE criteria to the entire study, 30 patients reached "risk" and five developed "injury." Cystatin C was a good predictor of the development of "injury" (under the receiver operating characteristic curve, 0.834-0.875) and of renal injury by estimated glomerular filtration rate (under the receiver operating characteristic curve, 0.717-0.835) (all p < .05). Cystatin C levels decreased perioperatively and correlated with volume of fluid removed by ultrafiltration. Cystatin C is an early predictor of acute kidney injury in children after cardiopulmonary bypass. Cystatin C is a good predictor of pediatric RIFLE classification and of decreased estimated glomerular filtration rate after cardiopulmonary bypass. Serum cystatin C may be cleared by ultrafiltration.

Methylene blue: potential use of an antique molecule in vasoplegic syndrome during cardiac surgery

Vasoplegic syndrome is a common complication of cardiopulmonary bypass, appearing with an incidence ranging between 5 and 25%. It is characterized by significant hypotension, high or normal cardiac output and low systemic vascular resistance. This syndrome is hypothesized to be caused by the inflammation-mediated dysregulation of endothelial homeostasis and subsequent endothelial dysfunction. In vasoplegic syndrome, the inhibition of the nitric oxide/cyclic guanosine monophosphate pathway with concomitant administration with traditional ionotropes may represent a promising therapeutic option. Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, may contribute to the improvement of refractory hypotension associated with endothelial dysfunction in vasoplegia. In this article, we will update evidence on the potential therapeutic use of methylene blue in vasoplegic syndrome.

Surgical management of distal tracheal stenosis in children

The objective of this study was to describe the long-term outcomes of tracheoplasty for distal tracheal stenosis, demonstrate the utility of cardiopulmonary bypass for intraoperative airway management, and compare perioperative morbidity and mortality of slide tracheoplasty for distal tracheal stenosis to costochondral graft, and resection with end-to-end anastomosis. Retrospective chart review. A retrospective chart review of all patients undergoing tracheoplasty for distal obstruction and also requiring the use of cardiopulmonary bypass for intraoperative airway management from 1994 to 2009 was performed. The setting for the study was a tertiary care children's hospital. A total of 11 patients, aged 1 month to 12 years, were identified. Four patients underwent slide tracheoplasty, two had end-to-end anastomosis, and five had costochondral graft. Average cardiopulmonary bypass time was 120 minutes, 60 minutes, and 63 minutes, respectively. The only complication of cardiopulmonary bypass was a superficial wound infection. There was one late death due to airway obstruction after repair of severe cardiac anomalies. The numbers of bronchoscopies required for resolution of granulation tissue in the slide tracheoplasty and end-to-end anastomosis groups were less than for the cartilage graft group. Three patients in the cartilage graft group required tracheostomy, and one remained tracheostomy dependent at last follow-up. None in the slide tracheoplasty or end-to-end anastomosis groups required a tracheostomy during management. Improvements in operative techniques and perioperative management have led to significant decreases in morbidity and mortality. At our institution, slide tracheoplasty has become the preferred technique for all except very short segment stenosis, and cardiopulmonary bypass is used in all cases involving the distal trachea.

Greater increase in urinary hepcidin predicts protection from acute kidney injury after cardiopulmonary bypass

Acute kidney injury (AKI) is a common and serious complication of cardiopulmonary bypass (CPB) surgery. Hepcidin, a peptide hormone that regulates iron homeostasis, is a potential biomarker of AKI following CPB. We investigated the association between post-operative changes in serum and urinary hepcidin and AKI in 93 patients undergoing CPB. Twenty-five patients developed AKI based on the Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria in the first 5 days. Serum hepcidin, urine hepcidin concentration, the urinary hepcidin:creatinine ratio and fractional excretion of hepcidin in urine rose significantly after surgery. However, urine hepcidin concentration and urinary hepcidin:creatinine ratio were significantly lower at 24 h in patients with RIFLE-Risk, Injury or Failure compared to those without AKI (P = 0.0009 and P < 0.0001, respectively). Receiver operator characteristic analysis showed that lower 24-h urine hepcidin concentration and urinary hepcidin:creatinine ratio were sensitive and specific predictors of AKI. The urinary hepcidin:creatinine ratio had an area under the curve for the diagnosis of RIFLE ≥ risk at 24 h of 0.77 and of 0.84 for RIFLE ≥ injury. Urinary hepcidin had similar predictive accuracy. Such predictive ability remained when patients with early creatinine increases were excluded. Urinary hepcidin and hepcidin:creatinine ratio are biomarkers of AKI after CPB, with an inverse association between its increase at 24 h and risk of AKI in the first five post-operative days. Measuring hepcidin in the urine on the first day following surgery may deliver earlier diagnosis and interventions.

P-40 Brain injury and neuromarker changes in children undergoing cardiac surgery with cardiopulmonary bypass

The S100β protein and neuron specific enolase (NSE) are sensitive brain injury markers. The aim was to study S100β protein and NSE changes in children with congenital heart disease with/without chronic hypoxaemia who underwent cardiac surgery during cardiopulmonary bypass (CPB). Twenty four children underwent cardiac surgery with CPB and unexpected perfusion problems. Group I: 10 pts with VSD, 4.5±2.7 yr, 15.2±6.1 kg. Group II: 14 pts with tetralogy of Fallot, 4.4±2.5 yr; 14.4±5.7 kg. We studied the level of neuromarkers of jugular bulb blood at 4 stages: S1 - initial stage; S2 - CPB initiation; S3 - end of surgery; S4 - next day after surgery. Neurological assessments of children were made before and after surgery. Data were compared using t-test and correlation analysis was performed. Frequency of postoperative neurological complications (post-ischaemic brain oedema, subdural haematoma, encephalopathy) in group I was 20%, postoperative mortality 10%; in group II, 31% and 21.7% respectively. We have found correlation between S100β protein and rate of postoperative neurological complication (r=0.61), between S100β protein and rate of postoperative mortality (r=0.77) and between NSE and neurological complication (r=0.71) in group II.TableChanges of neuromarkers in children who underwent cardiac surgeryStagesneuron specific enolase (mg/L)S100β protein (ng/L)Gp IGp IIGp IGp IIS131.1 ± 35.556.9 ± 35.0#P<0.05 between groups.103.7 ± 91.9236.1 ± 116.1#P<0.05 between groups.S233.0 ± 31.357.5 ± 35.8 #P<0.05 between groups.108.3 ± 94.3175.5 ± 100.5⁎P<0.05 in comparison with stage 1;#P<0.05 between groups.S329.1 ± 28.764.2 ± 33.9#P<0.05 between groups.119.5 ± 80.2⁎P<0.05 in comparison with stage 1;183.9 ± 99.3⁎P<0.05 in comparison with stage 1;#P<0.05 between groups.S432.7 ± 31.262.3 ± 33.7#P<0.05 between groups.95.3 ± 70.3197.2 ± 95.3#P<0.05 between groups. P<0.05 in comparison with stage 1;# P<0.05 between groups. Open table in a new tab S100β protein and NSE are highly sensitive and predictive markers of neurological outcomes after paediatric cardiac surgery with CPB. Brain injury after CPB complications is higher and severe in patients with chronic hypoxaemia.

Simultaneously performed off-pump coronary artery bypass grafting and colectomy: a case report

This is written so as to report the case of a 71-year-old male with a diagnosis of sigmoid adenocarcinoma accompanied by severe coronary artery disease and unstable angina, which was subject to simultaneous surgical treatment. The patient initially underwent an off-pump coronary artery revascularization in order to avoid the complications of cardiopulmonary bypass, providing the opportunity of a colectomy at the same time with the use of safe surgical means. Our case suggests that performing an off-pump bypass procedure prior to cancer surgery can be an appropriate course of action in carefully selected cases.

Inflammatory Response and Neurodevelopmental Outcome After Open-Heart Surgery in Children

Long-term neurodevelopmental sequelae are commonly detectable in children after open-heart surgery with cardiopulmonary bypass (CPB). The objective of the study was to determine the neurodevelopmental outcome in these children in relation to postoperative inflammatory reaction. This is a prospective, observational study on children with congenital heart defects (n = 32) undergoing elective open-heart surgery in a tertiary pediatric cardiac center. Neurodevelopmental outcome was assessed in the median 6 months after CPB. Neurological examination was done in all children before the operation and, additionally, complete neurodevelopmental status was assessed preoperatively in 14 children. Three hours after the end of CPB, plasma concentrations of interleukin (IL)-6 and IL-8 were strongly elevated (p < 0.001). Moreover, there was a rise of neutrophils and C-reactive protein at 24 h postoperatively (p < 0.001). Intellectual performance after surgery was correlated with preoperative performance, r ( S ) = 0.83, p < 0.001 (mean IQ scores after CPB = 90.4 +/- 18.4 and before CPB = 87.5 +/- 14.5, p = 0.20). Multiple regression analysis demonstrated that preoperative IQ scores accounted for 83.8% of the variance of postoperative IQ scores (p < 0.0001). Inflammatory variables were not significant predictors of postoperative IQ scores. The frequency of neuromotor abnormalities at 6 months after CPB was influenced by the presence of a cyanotic heart defect, duration of CPB and aortic clamp time, and plasma levels of IL-6 shortly after CPB (R (2) = 67.8%, p = 0.002). In conclusion, in the examined population, preexisting neurodevelopmental impairment is frequent and predicts postoperative outcome. The high frequency of postoperative neuromotor disabilities seems to be associated with the type of congenital heart defect but also with the procedure and possible complications of CPB.