Safety Of Cardiopulmonary Bypass Research Articles

Intestinal protection by nitric oxide supply in the simulation of artificial blood circulation and circulatory arrest: an experimental study

Cardiac surgery is associated with high risks of complications, and these risks increase when it comes to aortic surgery because of the technical complexity of the surgeries, the use of cardiopulmonary bypass (CPB) and “circulatory arrest” (CA) that leads to ischemia-reperfusion damage. Abdominal complications in cardiovascular surgery are not the most common complications but are associated with high mortality. Protecting the gastrointestinal (GI) organs from ischemia-reperfusion injury is still a serious problem. According to a study of the organoprotective properties of nitric oxide (NO), its effectiveness in the treatment of diseases of the cardiovascular system, lungs, and kidneys has been proven, and observational results have shown that patients who were administered NO were less prone to complications from the gastrointestinal tract.The aim of the study was to evaluate the protective properties of NO for the intestines during simulated surgery under CPB and hypothermic CA. Methods. The study was conducted on sheep (n = 24). The animals were divided into 4 groups: the “CPB” group with the standard CPB protocol, the “CPB + NO” group with CPB and NO administration, the “CPB + CA” group with the standard CPB and CA protocol, and the group “CPB + CA + NO” with CPB and CA and NO administration. Instrumental and laboratory parameters were monitored at all stages of the experiment to assess the effectiveness and safety of CPB and CA simulation. In intestinal biopsy samples, the changes in the defecation rate, the concentration of a biochemical marker of intestinal ischemia (intestinal enterocyte fatty acid binding protein – i-FABP), and tissue concentrations of adenosine triphosphate (ATP) and lactate were assessed.Results. A higher rate of defecation was established (p = 0.046) in the “CPB + NO” group after CPB compared to the “CPB” group. The concentration of i-FABP in the CPB + NO group after CPB was lower compared to that in the CPB group (p = 0.002), and it was lower in the “CPB + CA + NO” group compared to the “CPB + CA” group (p = 0.033). 1 hour after CPB, the tissue concentration of ATP in intestinal biopsies in the “CPB + NO” group was higher than in the CPB group (p = 0.005).Conclusion. When modeling CPB and CA in the experiment, a positive effect of NO therapy on the intestine was noted: the functional state improved, the concentration of i-FABP decreased, and the concentration of ATP in intestinal biopsies increased.

Reversal of Ischemic Hepatitis after Cardiac Surgery under Cardiopulmonary Bypass: A Case Report

Acute hepatic failure due to ischemic hepatitis is associated with high mortality. The safety of cardiopulmonary bypass in this setting is not fully described. Here we report a case of a 21-year-old female who developed an acute fulminant hepatic failure due to ischemic hepatitis following a cardiogenic shock. She underwent subsequent successful mitral valve replacement under cardiopulmonary bypass, thus providing an evidence of its safety in acute fulminant hepatic failure.

Infective endocarditis and neurologic events: indications and timing for surgical interventions.

A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.

Invited Commentary

Invited Commentary

Impact of stroke on therapeutic decision making in infective endocarditis

The diagnosis of infective endocarditis (IE) must be made as soon as possible to initiate antimicrobial therapy and identify patients at high risk for complications who may be best managed by early surgery. Cerebral complications make the timing of cardiac surgery difficult. The safety of cardiopulmonary bypass (CPB) surgery in stroke patients remains controversial. Stroke complicates the outcome of left-sided IE in 20-40% of cases and is associated with poor outcome. The risk of stroke in IE falls rapidly after the initiation of effective antimicrobial therapy. The risk of embolization is highest during the first week of therapy, and in patients with mobile vegetations or vegetations >10 mm in diameter occurring on the anterior mitral leaflet. Indications for valvular surgery are significant congestive heart failure or valvular regurgitation, myocardial abscess, persistent bacteremia and large-size vegetations with high risk of embolism. Decisions regarding surgical intervention in patients with IE should be individualized. In the absence of large prospective studies, optimal timing of surgery is still discussed when stroke complicates IE. A multidisciplinary assessment of the situation, involving cardiologists, cardiac surgeons, infectiologists and neurologists, is recommended. Estimating the risk of recurrence after a first embolic event and careful evaluation of the indication for valve replacement are essential steps in making the therapeutic decision. Surgery should be delayed if possible in the event of large cerebral infarction or ICH in order to prevent neurological deterioration. It has been suggested that valve replacement should be considered within the first 72 h if the patients with brain infarction have severe heart failure, otherwise after 4 weeks. Early surgery appears safe in patients presenting transient ischemic attacks or "silent" cerebral embolism.

Clinical Experience with Minimally Invasive Coronary Artery and Mitral Valve Surgery with the Advantage of Cardiopulmonary Bypass and Cardioplegic Arrest Using the Port Access Technique

To minimize surgical trauma, the use of Port Access cardiac surgery was initiated in patients (pts) with coronary artery disease (CAD) (42 pts) or mitral valve disease (MVD) (24 pts) in March 1996 at our institution. Altogether 42 pts (36 men, 6 women; age 31-75 years, median 59.0 years) with isolated lesions of the left anterior descending (LAD) artery underwent Port Access coronary artery surgery (PACAS). A small (5-9 cm) incision was done parasternally on top on the fourth rib. The left internal mammary artery (LIMA) was dissected through the minithoracotomy or by using an additional thoracoscopic approach. A total of 24 pts (12 men, 12 women; age 30-75 years, median 62 years) underwent Port Access mitral valve surgery (PAMVS). In these pts the procedure was performed through a small right thoracotomy (6-8 cm). In all cases, endovascular cardiopulmonary bypass (CPB) was instituted through femoral cannulation, and an additional endoaortic balloon catheter was introduced into the ascending aorta for aortic occlusion. In pts with PACAS the survival was 98% (41/42) and in the PAMVS group 100%. All pts but one survived the PACAS and are well today. There were no deaths in the PAMVS group. The hospital stay was reduced by 1 day on average after PACAS and 3 days after PAMVS. Thus in well selected patients Port Access cardiac surgery represents a safe and feasible minimally invasive surgical approach that avoids the potential complications of a sternotomy while offering the advantages and safety of CPB and cardioplegic arrest. This minimally invasive approach offers a shortened hospital stay and earlier rehabilitation.

Should HIV Endocarditis Patients Be Operated On? A Case Presentation

Emergency valve replacement for left-sided endocarditis in intravenous drug abusers with a poor long-term prognosis makes the operative decision a difficult one, especially when they are also at risk for HIV infection. The influence of cardiopulmonary bypass on 2 patients may have accelerated the clinical manifes tations of their underlying infections, including a marked acceleration and death in one. These cases suggest that cardiopulmonary bypass perturbs the immune system. The safety of cardiopulmonary bypass in these settings is questioned and a nonoperative approach may be justified in this high-risk group of endocarditis patients.