Impact Of Cardiopulmonary Bypass Research Articles

Impact of cardiopulmonary bypass on cerebrovascular autoregulation assessed by ultrafast ultrasound imaging.

Newborns with congenital heart disease undergoing cardiac surgery are at risk of neurodevelopmental impairment with limited understanding of the impact of intra-operative cardiopulmonary bypass (CPB), deep hypothermia and selective cerebral perfusion on the brain. We hypothesized that a novel ultrasound technique, ultrafast power Doppler (UPD), can assess variations of cerebral blood volume (CBV) in neonates undergoing cardiac surgery requiring CPB. UPD was performed before, during and after surgery in newborns with hypoplastic left heart syndrome undergoing a Norwood operation. We found that global CBV was not significantly different between patients and controls (P=0.98) and between pre- and post-surgery (P=0.62). UPD was able to monitor changes in CBV throughout surgery, revealing regional differences in CBV during hypothermia during which CBV correlated with CPB flow rate (R2 =0.52, P=0.021). Brain injury on post-operative magnetic resonance imaging was observed in patients with higher maximum variation in CBV. Our findings suggest that UPD can quantify global and regional brain perfusion variation during neonatal cardiac surgery with this first intra-operative application demonstrating an association between CBV and CPB flow rate, suggesting loss of autoregulation. Therefore, the measurement of CBV by UPD could enable optimization of cerebral perfusion during cardiac surgery in neonates. KEY POINTS: The impact of cardiopulmonary bypass (CPB) on the neonatal brain undergoing cardiac surgery is poorly understood. Ultrafast power Doppler (UPD) quantifies cerebral blood volume (CBV), a surrogate of brain perfusion. CBV varies throughout CPB surgery and is associated with variation of the bypass pump flow rate during deep hypothermia. Association between CBV and bypass pump flow rate suggests loss of cerebrovascular autoregulatory processes. Quantitative monitoring of cerebral perfusion by UPD could provide a direct parameter to optimize CPB flow rate.

Complex protocol of cardiopulmonary bypass

Complex protocol of cardiopulmonary bypass

Impact of cardiopulmonary bypass and surgical complexity on plasma soluble urokinase-type plasminogen activator receptor levels after cardiac surgery

Background Circulating soluble urokinase plasminogen activator receptor (suPAR) is a marker of inflammation with prognostic value for elevated risk of morbidity and mortality. It has not yet been shown how the inflammatory process induced by cardiac surgery affects suPAR concentrations postoperatively Methods In a prospective observational study, plasma suPAR levels were measured in 30 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), pre-, peri, post-operatively, and 3–5 days after surgery. Fifteen patients underwent coronary artery bypass grafting (CABG) and 15 underwent complex procedures with longer CPB duration. Concentrations of suPAR at each time point were compared to the preoperative levels and compared between the two groups. Results In both groups, plasma suPAR concentrations were significantly higher on the first postoperative day (3.27 (interquartile range (IQR) 2.75–3.86) µg/L compared to baseline (2.62 (1.98–3.86)) µg/L, p < .001. There were no significant differences in suPAR concentrations between the groups at any time point. Preoperatively, the median suPAR concentration was 2.57 (2.01–3.60) µg/L in the CABG group versus 2.67 (1.89–3.97) µg/L in the complex group (p = .567). At ICU arrival 2.48 (2.34–3.23) µg/L versus 2.73 (2.28–3.44) µg/L in CABG and complex patients, respectively (p = .914). There was no difference in suPAR concentrations between the groups on postoperative day 1 (3.34 (2.89–3.89) versus 3.19 (2.57–3.62) p = .967) or 3–5 days after surgery (2.72 (1.98–3.16) versus 2.96 (2.39–4.28) p = .085. Conclusions After a transient rise on the first postoperative day, the suPAR levels returned to the preoperative levels by the third postoperative day. There was no significant difference in suPAR levels between the routine CABG and complex group with longer CPB time.

Impact of Cardiopulmonary Bypass on Neurogenesis and Cortical Maturation.

Neurodevelopmental delays and frontal lobe cortical dysmaturation are widespread among children with congenital heart disease (CHD). The subventricular zone (SVZ) is the largest pool of neural stem/progenitor cells in the postnatal brain. Our aim is to determine the effects of cardiopulmonary bypass (CPB) on neurogenesis and cortical maturation in piglets whose SVZ development is similar to human infants. Three-week-old piglets (n=29) were randomly assigned to control (no surgery), mild-CPB (34°C full flow for 60 minutes) and severe-CPB groups (25°C circulatory-arrest for 60 minutes). The SVZ and frontal lobe were analyzed with immunohistochemistry 3 days and 4 weeks postoperatively. MRI of the frontal lobe was used to assess cortical development. SVZ neurogenic activity was reduced up to 4 weeks after both mild and severe CPB-induced insults. CPB also induced decreased migration of young neurons to the frontal lobe, demonstrating that CPB impairs postnatal neurogenesis. MRI 4 weeks after CPB displayed a decrease in gyrification index and cortical volume of the frontal lobe. Cortical fractional anisotropy was increased after severe CPB injury, indicating a prolonged deleterious impact of CPB on cortical maturation. Both CPB-induced insults displayed a significant change in densities of three major inhibitory neurons, suggesting excitatory-inhibitory imbalance in the frontal cortex. In addition, different CPB insults altered different subpopulations of inhibitory neurons. Our results provide novel insights into cellular mechanisms contributing to CHD-induced neurological impairments. Further refinement of CPB hardware and techniques is necessary to improve long-term frontal cortical dysmaturation observed in children with CHD. ANN NEUROL 2021;90:913-926.

Hematic Antegrade Repriming: A Reproducible Method to Decrease the Cardiopulmonary Bypass Insult.

The current practice of cardiopulmonary bypass (CPB) requires a preoperative priming of the circuit that is frequently performed with crystalloid solutions. Crystalloid priming avoids massive embolism but is unable to eliminate all microbubbles contained in the circuit. In addition, it causes a sudden hemodilution which is correlated with transfusion requirements and an increased risk of cognitive impairment. Several repriming techniques using autologous blood, collectively termed retrograde autologous priming (RAP), have been demonstrated to reduce the hemodilutional impact of CPB. However, the current heterogeneity in the practice of RAP limits its evidence and benefits. Here, we describe hematic antegrade repriming as an easy and reliable method that could be applied with any circuit in the market to decrease transfusion requirements, emboli, and inflammatory responses, reducing costs and the impact of CPB on postoperative recovery.

Acute kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: a retrospective propensity score matching analysis

ObjectivesThis single-centre, retrospective propensity score matching (PSM) study designed to study the impact of cardiopulmonary bypass (CPB) on postoperative acute kidney injury (AKI) and the relationship between AKI and long-term outcomes in elderly patients undergoing coronary artery bypass grafting (CABG).MethodsAfter PSM, 466 pairs of patients (A group, on-pump; B group, off-pump) who were aged≥70 years undergoing first isolated CABG surgery from January 2012 to December 2016 entered the study. AKI was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. The incidence and severity of in-hospital AKI were compared. The impacts of AKI on the long-term outcomes including new onset of dialysis and mortality were analyzed.ResultsThe two PSM groups had similar baseline and procedure except whether the CPB was used or not. In hospital and 30-day mortality was of no difference(χ2 = 0.051, p = 0.821). AKI of any severity occurred in 40.3% of all patients, with stage 1 accounting for most cases. No difference regarding the incidence and severity of AKI could be found: AKIN stage 1: 139 (29.8%) vs 131 (28.1%); AKIN stage 2: 40 (8.6%) vs 35 (7.5%); AKIN stage 3: 18 (3.9%) vs 13 (2.8%), (u = 0.543, p = 0.532). No difference was observed in the in-hospital new onset of dialysis (χ2 = 0.312, P = 0.576). The use of CPB was not found to influence long-term new onset of dialysis (χ2 = 0.14, p = 0.708) and mortality (χ2 = 0.099, p = 0.753). Comparing with non-AKI patients, AKI patients were associated with an increased rates of new onset of dialysis (χ2 = 8.153, p = 0.004) and mortality (χ2 = 6.277, p = 0.012) during the follow-up. Multivariable logistic regression manifested that the HR for long-term new onset of dialysis and mortality in AKI patients vs. non-AKI patients was 1.83 and 1.31 respectively (95%CI 1.12–2.86, p = 0.007; 95%CI 1.17–2.58, p = 0.015). The HR for long-term new onset of dialysis and mortality in on-pump group vs. off-pump group was 1.07 and 1.11 respectively (95%CI 1.03–1.23, p = 0.661; 95%CI 1.09–1.64, p = 0.702).ConclusionsFor elderly CABG patients, AKI was common, but deterioration of dialysis was a seldom incidence. Comparing with on-pump, off-pump did not decrease the rates or severity of AKI, long-term new onset of dialysis or mortality. AKI was associated with an increased long-term new onset of dialysis and decreased long-term survival.

Predictors of Increased Lactate in Neonatal Cardiac Surgery: The Impact of Cardiopulmonary Bypass

Hyperlactatemia develops intraoperatively during cardiac surgery and is associated with postoperative mortality. This study aimed to determine the factors that lead to an increase in lactate during cardiopulmonary bypass (CPB) in neonates undergoing cardiac surgery. Retrospective study from July 2015 to December 2018. Academic tertiary children's hospital. The study comprised 376 neonates. No interventions were performed. Lactate measurements at prebypass, upon initiation of CPB and before coming off CPB, last in the operating room, and first in the cardiac intensive care unit were collected. The changes in lactate levels were compared using the nonparametric Wilcoxon signed rank test for paired data. Univariate and multivariate median regression models of the change during CPB were determined. The cohort characteristics were male (60%), median age 5 days (range 1-30), and weight 3.2 kg (range 1.5-4.7). Most patients had a STAT score of 4 (45%) or 5 (23%). Significant increases in lactate were observed from pre-CPB to start of CPB (p < 0.001) and from start to end of CPB (p < 0.001). In the multivariate regression analysis, duration of circulatory arrest (coefficient = 1.216; 95% confidence interval [CI] 0.754-1.678; p < 0.001), duration of mean arterial pressure < 25 mmHg (coefficient = 0.423; 95% CI 0.196-to- 0.651; p < 0.001), and duration of mean arterial pressure between 35 and 39 mmHg (coefficient = -0.246; 95% CI -0.397 to -0.095; p = 0.001) were identified as significant independent predictors of the lactate change per 30- minutes duration. These results emphasized the importance of blood pressure management during CPB and the importance of the duration of circulatory arrest.

Impact of Cardiopulmonary Bypass and Aorta Cross Clamp Time on the Length of Mechanical Ventilation after Cardiac Surgery among Children: A Saudi Arabian Experience.

AimSeveral factors determine the perioperative outcome besides the nature of the congenital heart defect. Prolonged mechanical ventilation (PMV) is a major factor that determines mortality, length of stay (LOS), residual disability, and other functional outcomes. We aim to determine the clinical variables predicting PMV and LOS in hospital, and specifically the impact from the duration of cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC).MethodWe conducted a retrospective review of the medical records of 413 children consecutively admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in one year at a single center. We collected demographic information (e.g., age, gender, and weight), perioperative variables, clinical outcomes, length of mechanical ventilation, high-frequency ventilator use, and mortality. We used logistic regression to analyze the data. PMV was defined as mechanical ventilation for longer than seven days.ResultsA total of 410 records were included in our study. We found no statistically significant association between CPB time and mechanical ventilation days. Forty-seven children had PMV, 362 did not have PMV. We found no statistically significant association between CPB time and mechanical ventilation days after adjusting for covariates. Reanalyzing the data with PMV defined as longer than four days produced the same results. Using a regression model to assess the variables via the least absolute shrinkage and selection operator for feature selection, we found no statistically significant association between ACC time and mechanical ventilation days after adjusting for covariates.ConclusionAccording to our results, CPB and ACC time are not associated with PMV or prolonged hospital LOS.

Study Protocol for a Pilot, Open-Label, Prospective, and Observational Study to Evaluate the Pharmacokinetics of Drugs Administered to Patients during Extracorporeal Circulation; Potential of In Vivo Cytochrome P450 Phenotyping to Optimise Pharmacotherapy.

Pharmacokinetic alterations of medications administered during surgeries involving cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) have been reported. The impact of CPB on the cytochrome P450 (CYP) enzymes’ activity is the key factor. The metabolic rates of caffeine, dextromethorphan, midazolam, omeprazole, and Losartan to the CYP-specific metabolites are validated measures of in vivo CYP 1A2, 2D6, 3A4, 2C19, and 2C9 activities, respectively. The study aim is to assess the activities of major CYPs in patients on extracorporeal circulation (EC). This is a pilot, prospective, open-label, observational study in patients undergoing surgery using EC and patients undergoing laparoscopic cholecystectomy as a control group. CYP activities will be measured on the day, and 1–2 days pre-surgery/3–4 days post-surgery (cardiac surgery and Laparoscopic cholecystectomy) and 1–2 days after starting ECMO, 1–2 weeks after starting ECMO, and 1–2 days after discontinuation from ECMO. Aforementioned CYP substrates will be administered to the patient and blood samples will be collected at 0, 1, 2, 4, and 6 h post-dose. Major CYP enzymes’ activities will be compared in each participant on the day, and before/after surgery. The CYP activities will be compared in three study groups to investigate the impact of CYPs on EC.

Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model.

BackgroundThe impact of cardiac surgery using cardiopulmonary bypass (CPB) on the respiratory mucociliary function is unknown. This study evaluated the effects of CPB and interruption of mechanical ventilation on the respiratory mucociliary system.MethodsTwenty-two pigs were randomly assigned to the control (n = 10) or CPB group (n = 12). After the induction of anesthesia, a tracheostomy was performed, and tracheal tissue samples were excised (T0) from both groups. All animals underwent thoracotomy. In the CPB group, an aorto-bicaval CPB was installed and maintained for 90 minutes. During the CPB, mechanical ventilation was interrupted, and the tracheal tube was disconnected. A second tracheal tissue sample was obtained 180 minutes after the tracheostomy (T180). Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF) and in situ mucociliary transport (MCT) were studied in ex vivo tracheal epithelium. Mucus viscosity (MV) was assessed using a cone-plate viscometer. Qualitative tracheal histological analysis was performed at T180 tissue samples.ResultsCBF decreased in the CPB group (13.1 ± 1.9 Hz vs. 11.1 ± 2.1 Hz, p < 0.05) but not in the control group (13.1 ± 1 Hz vs. 13 ± 2.9 Hz). At T90, viscosity was increased in the CPB group compared to the control (p < 0.05). No significant differences were observed in in situ MCT. Tracheal histology in the CPB group showed areas of ciliated epithelium loss, submucosal edema and infiltration of inflammatory cells.ConclusionCPB acutely contributed to alterations in tracheal mucocilliary function.

Impact of cardiopulmonary bypass (CPB) on lung injury and marginated leukocyte dynamics during bilateral lung transplantation (LTx)

Impact of cardiopulmonary bypass (CPB) on lung injury and marginated leukocyte dynamics during bilateral lung transplantation (LTx)

Cardiovascular Surgery with Cardiopulmonary Bypass in Patients with Preoperative Non-dialysis Dependent Renal Insufficiency.

Preoperative renal insufficiency is a predictor of acute renal injury in patients undergoing cardiovascular surgery with cardiopulmonary bypass. From January 2010 to September 2012, 121 patients undergoing coronary bypass, valve replacement, or both were included in our retrospective study, using cardiopulmonary bypass. We compared the changes in renal function and clinical outcomes of 66 patients with a baseline serum creatinine level more than 1.5 mg/dL with 55 patients with normal serum creatinine levels. We analyzed the impact of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency. In the group of patients with preoperative renal injury, the need for dialysis was greater, time of mechanical ventilation longer, and daily diuresis lesser compared with the group of patients with normal serum creatinine levels. Other clinical outcomes such as postoperative hemodynamic problems and organ dysfunction were similar. Prolonged time of cardiopulmonary bypass and cross-clamp affected postoperative renal injury. The study also showed intraoperative dopamine infusion at renal dose and ultrafiltration are not effective with protecting renal tubular function. Serum creatinine levels and glomerular filtration rate (GFR) were found to be useful parameters for renal injury. These results demonstrate the safety and trustworthiness of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency.

The impact of blood use on patients undergoing coronary artery bypass surgery: a prospective study

This survey aimed at assessing the incidence of blood use and the impact of cardiopulmonary bypass (CBP), sex, age, number of grafts, combined cardiac interventions, and hematocrit level in patients who undergo coronary artery bypass graft (CABG) surgery. A prospective study included patients in the department of cardiac surgery at the American Hospital, in Tirana, Albania. We studied 164 consecutive patients who underwent CABG surgery over a 2-year period (2011-2013). We analyzed 164 patients: 138 men and 26 women. The average age was 61.8 years (range, 34-82 years). Of these, 116 patients (101 men/15 women) and 48 patients (37 men/11 women) were operated on-pump and off-pump, respectively. Packed red blood cells (PRBC) were administered to 79.87% of patients (131/164). In total, 334 units were transfused. The average number of PRBC units per patient was 2.03 ± 1.5 (range, 0-8 units). Blood transfusion was administered to 87.06% and 62.5% of on-pump and off-pump patients, respectively. On-pump and off-pump patients received 2.4 and 1 unit of PRBC, respectively (p < 0.001). Female and male patients received 2.2 and 2 units, respectively (p = 0.1). Patients aged ≥ 62.5 years received 2.3 units on average versus the average of 1.7 units received by patients aged < 62.5 years (p < 0.001). Interventions with 4-6 grafts (79/164) received an average 2.5 units, while those with 1-3 grafts (85/164) received 1.5 units (p < 0.001). Patients requiring other cardiac surgical interventions (35/164) received an average of 2.6 units, while those without other cardiac surgical interventions (129/164) received an average of 1.8 units (p < 0.001). Patients with preoperative hematocrit < 35% received an average 1.2 units of PRBC intraoperatively, and 2.8 units throughout the hospital stay, while patients with preoperative hematocrit ≥ 35% received an average of 0.75 units intraoperatively (p < 0.001) and 1.9 units throughout the hospital stay (p < 0.001). Blood transfusion was required for 79.87% of patients. Five variables were important factors in the use of blood in patients undergoing CABG: using CBP, a higher number of grafts, age ≥ 62.5 years, combined heart interventions and preoperative hematocrit< 35%. Female patients required more PRBC than male patients, although it was not statistically significant. Knowledge of these risk factors enables better prediction of the probability of patients who might require more blood, better distribution of blood in CABG procedures, use by the blood bank, and evaluation of cost-effectiveness in the use of blood products.

Indocyanine green clearance after cardiac surgery: the impact of cardiopulmonary bypass

Plasma clearance of indocyanine green has recently been established as a tool to monitor hepatic function and perfusion non-invasively. Reduced indocyanine green clearance has been associated with adverse outcome in cardiac surgery patients, and cardiopulmonary bypass has been hypothesized to be one important triggering factor. We performed a prospective observational study comparing the influence of off-pump and on-pump coronary surgery on perioperative indocyanine green clearance. Twenty-five consecutive adult patients without known pre-existing hepatic diseases scheduled for off-pump coronary artery bypass grafting were evaluated for hepatic dysfunction pre- and postoperatively with serial measurements of indocyanine green plasma clearance, specific laboratory values and liver function scores. Twenty-five matched patients who underwent coronary artery bypass grafting surgery with cardiopulmonary bypass in the same period served as controls. Parameters of postoperative hepatic function, including measurements of indocyanine green plasma clearance and specific laboratory values and scores, did not differ significantly between patients undergoing off-pump coronary artery bypass grafting and patients undergoing coronary artery bypass grafting with extracorporeal circulation. In patients without pre-existing hepatic diseases, a significant influence of cardiopulmonary bypass on perioperative indocyanine green plasma clearance as well as on liver specific laboratory parameters and scores cannot be proven.

Hepatic dysfunction and Indocyanine green clearance (LiMON) after coronary surgery: Impact of cardiopulmonary bypass

Aims: Hepatic dysfunction is a rare but serious complication after cardiac surgery. Plasma clearance of indocyanine green has recently been established as an excellent tool to measure even small changes in hepatic function. Reduced indocyanine green clearance has been associated with adverse outcome in cardiac surgery patients, and cardiopulmonary bypass (CPB) has been hypothesized to be one important triggering factor. Thus, we performed a prospective observational study comparing the influence of off-pump and on-pump coronary surgery on perioperative indocyanine green clearance.

Impact of cardiopulmonary bypass on postoperative renal function in coronary artery bypass grafting

Objectives: Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function, especially in patients with preoperative renal dysfunction. This study evaluates the role of cardiopulmonary bypass in coronary artery bypass grafting (CABG) on postoperative renal function.

The Impact of Cardiopulmonary Bypass on Systemic Interleukin-6 Release, Cerebral Nuclear Factor-kappa B Expression, and Neurocognitive Outcome in Rats

Neurocognitive deficits after cardiac surgery with cardiopulmonary bypass (CPB) continue to affect patients' quality of life, and an inflammatory reaction may be one of the contributors. We designed this experiment to study perioperative systemic interleukin-6 (IL-6) concentrations, cerebral expression of nuclear factor-kappa B (NF-kappaB), and neurocognitive outcome after CPB in young rats. The impact of oxygenator size on these outcomes was also assessed. Rats were randomly assigned to 1 of 4 groups: control (n = 7, nonanesthetized), sham-operated rats (n = 10, anesthetized, cannulated, and not connected to CPB), and 2 CPB groups, anesthetized, cannulated, and subjected to 90 min of CPB, using either a small-volume rat oxygenator (CPB/rat oxygenator, n = 10) or a neonate oxygenator (CPB/neonate oxygenator, n = 10). Systemic IL-6 was determined before, at the end of, and 2 h after CPB or at equivalent times. Hippocampal NF-kappaB expression was assessed on postoperative day 21 using immunohistochemistry. Neurocognitive performance was assessed with the modified hole-board test at baseline and for 21 postoperative days. Both CPB groups had increased systemic IL-6 levels compared with sham, with the neonate oxygenator causing a substantially larger increase at 2 h after CPB compared with the rat oxygenator group (CPB/rat oxygenator: 220 pg/mL [16-415]; CPB/neonate oxygenator: 1400 pg/mL [592-5812]) (P < 0.05). Hippocampal NF-kappaB was increased in experimental groups compared with controls (10 +/- 4). CPB resulted in more NF-kappaB-positive neurons (271 +/- 57 CPB/neonate oxygenator and 269 +/- 72 CPB/rat oxygenator) compared with sham operation (173 +/- 24). Neurocognitive and behavioral performances were unaltered and comparable among all groups. Pronounced systemic inflammatory responses to experimental CPB associated with increased hippocampal expression of NF-kappaB were not accompanied by neurocognitive impairment. This suggests that other factors beyond CPB and inflammatory responses might contribute to adverse neurocognitive outcomes after cardiac surgery.

Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow

The aim of this study was to monitor and compare the changes in metabolism and blood flow in the skeletal muscles during cardiac operations performed with cardiopulmonary bypass (CPB) and operations without CPB (off-pump) by means of interstitial microdialysis (Figure 1). Surgical revascularization, coronary artery bypass grafting (CABG), was performed in 40 patients randomized to two groups. Twenty patients (On-Pump Group) were operated on using CPB, 20 patients (Off-Pump Group) were operated on without CPB. Interstitial microdialysis was performed by 2 probes of a CMA 60 (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Microdialysis measurements were performed at 30-minute intervals. Glucose, lactate, pyruvate and glycerol as markers of basic metabolism and tissue perfusion were measured in samples from the first probe, using a CMA 600 Analyzer (CMA Microdialysis AB). Blood flow through the interstitium was monitored by means of dynamic microdialysis of ethanol as a flow-marker in the dialysates taken from the second probe (ethanol dilution technique). Results in both the groups were statistically processed and compared. Both the groups were similar in respect of preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in both the patient groups (on-pump vs. off-pump) during the operation. There was no significant difference in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate and glycerol interstitial concentrations, lactate/pyruvate ratio and lactate/glucose ratio between the on-pump vs. off-pump patients. In the Off-Pump Group, pyruvate concentrations were higher and the values of concentrations of glycerol lower. The lactate/pyruvate ratio and the lactate/glucose ratio, indicating the aerobic and anaerobic tissue metabolism status, were lower in the Off-Pump Group. There was no significant difference in dialysate concentrations of ethanol as a flow-marker during the surgery in either of the groups. There was no statistically significant difference between the groups (On-Pump Group vs. Off-Pump Group) comparing the postoperative clinical outcome (ICU stay, ventilation duration, length of hospital stay). The dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both the groups of patients (On-Pump Group and Off-Pump Group), but there was no difference in local blood flow when the ethanol dilution technique was used. These results showed significantly higher aerobic metabolic activity of the peripheral tissue of patients in the Off-Pump Group vs. the On-Pump Group during the course of cardiac revascularization surgery. Results suggest that extracorporeal circulation, cardiopulmonary bypass, compromises peripheral tissue (skeletal muscles) energy metabolism. These changes have no impact on the postoperative clinical outcome; no significant difference between the groups was found.

Abstract 2595: Cardiopulmonary Bypass Does Not Cause Neurocognitive Decline in Children and Adolescents Undergoing Repair of Acyanotic Congenital Heart Disease

Background: Previous studies describing the neurocognitive (neuro) effects of cardiopulmonary bypass (CPB) have been performed following surgery in infancy for complex congenital heart disease (CHD) and in adults with acquired heart disease. These patients (pts) have many causes for adverse neuro outcomes with conflicting results regarding the contribution of CPB. The impact of CPB in children with less complex CHD is unknown. We sought to describe the effects of CPB on neuro function in children following repair of acyanotic CHD. Methods: We performed a prospective cohort study of pts 5–18 yrs of age undergoing primary repair of CHD. Neuro testing battery included assessment of intellectual function (IQ), memory, motor skills, attention, executive function, and an evaluation by a pediatric neurologist pre- and 6 months post-CPB. Non-CPB effects of surgery were assessed by similarly testing pts undergoing repair of pectus excavatum (non-CPB). Practice effects of serial testing were controlled by enrolling non-surgical pts (mild CHD) and creating a reliability-stability index to adjust surgical group scores. Anxiety was assessed as a covariate. Results: CPB pts ( n =41) included repair of atrial [17] or ventricular [6] septal defect, coronary anomaly [8], aortic valve [5] or other [5]. Control pts included pectus repair ( n =20) and non-surgical CHD pts ( n =16). Groups were similar in age, gender, race, socioeconomic status and baseline scores. Neurological exams before and after surgery were not different between groups. Controlling for the effects of serial testing, there were no significant (p&lt;.05) changes in the mean scores of either surgical group in areas of IQ, memory, motor skills, attention, or executive function. In addition, there were no differences in the percentage of patients in either surgical group that had a significant (&gt;1 SD) decline in scores after surgery. Conclusions : When controlling for the non-CPB effects of surgery (hospitalization, anxiety, etc.) and the practice effects of serial testing, there were no independent effects of CPB on neuro status 6 months after repair of acyanotic CHD. We believe that the potential neuro sequelae of CPB should not be a major factor in the decision to recommend CHD surgery in otherwise healthy children.

ヘパリン起因性血小板減少症ＩＩ型患者に対し人工心肺を施行した４症例

ヘパリン起因性血小板減少症？ 型患者に対して、抗凝固薬としてアルガトロバンを使用した人工心肺を4症例経験した。人工心肺中のACTは600秒以上を維持できたが、全例において静脈リザーバーおよびカルディオトミーフィルターで血栓が形成された。人工心肺施行後のACTは長時間にわたって遷延傾向にあった。今後、半閉鎖型人工心肺の使用やアルガトロバン投与量の再検討が必要と考えられた。