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Jufar AH, Lankadeva YR, May CN, Cochrane AD, Marino B, Bellomo R, Evans RG. Renal and Cerebral Hypoxia and Inflammation During Cardiopulmonary Bypass. Compr Physiol 2021; 12:2799-2834. [PMID: 34964119 DOI: 10.1002/cphy.c210019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac surgery-associated acute kidney injury and brain injury remain common despite ongoing efforts to improve both the equipment and procedures deployed during cardiopulmonary bypass (CPB). The pathophysiology of injury of the kidney and brain during CPB is not completely understood. Nevertheless, renal (particularly in the medulla) and cerebral hypoxia and inflammation likely play critical roles. Multiple practical factors, including depth and mode of anesthesia, hemodilution, pump flow, and arterial pressure can influence oxygenation of the brain and kidney during CPB. Critically, these factors may have differential effects on these two vital organs. Systemic inflammatory pathways are activated during CPB through activation of the complement system, coagulation pathways, leukocytes, and the release of inflammatory cytokines. Local inflammation in the brain and kidney may be aggravated by ischemia (and thus hypoxia) and reperfusion (and thus oxidative stress) and activation of resident and infiltrating inflammatory cells. Various strategies, including manipulating perfusion conditions and administration of pharmacotherapies, could potentially be deployed to avoid or attenuate hypoxia and inflammation during CPB. Regarding manipulating perfusion conditions, based on experimental and clinical data, increasing standard pump flow and arterial pressure during CPB appears to offer the best hope to avoid hypoxia and injury, at least in the kidney. Pharmacological approaches, including use of anti-inflammatory agents such as dexmedetomidine and erythropoietin, have shown promise in preclinical models but have not been adequately tested in human trials. However, evidence for beneficial effects of corticosteroids on renal and neurological outcomes is lacking. © 2021 American Physiological Society. Compr Physiol 11:1-36, 2021.
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Affiliation(s)
- Alemayehu H Jufar
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia.,Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yugeesh R Lankadeva
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Clive N May
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia
| | - Bruno Marino
- Cellsaving and Perfusion Resources, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia.,Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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2
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Jabur GN, Donnelly J, Merry AF, Mitchell SJ. A prospective observational study of emboli exposure in open versus closed chamber cardiac surgery. Perfusion 2021; 37:715-721. [PMID: 34112049 DOI: 10.1177/02676591211023897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exposure to cerebral emboli is ubiquitous and may be harmful in cardiac surgery utilizing cardiopulmonary bypass. This was a prospective observational study aiming to compare emboli exposure in closed-chamber with open-chamber cardiac surgery, distinguish particulate from gaseous emboli and examine cerebral laterality in distribution. METHODS Forty patients underwent either closed-chamber procedures (n = 20) or open-chamber procedures (n = 20). Emboli (gaseous and solid) were detected using transcranial Doppler in both middle cerebral arteries in two monitoring phases: 1, initiation of bypass to the removal of the aortic cross-clamp; and 2, removal of aortic cross-clamp to 20 minutes after venous decannulation. RESULTS Total (median (interquartile range)) emboli counts (both phases) were 898 (499-1366) and 2617 (1007-5847) in closed-chamber and open-chamber surgeries, respectively. The vast majority were gaseous; median 794 (closed-chamber surgery) and 2240 (open-chamber surgery). When normalized for duration, there was no difference between emboli exposures in closed-chamber and open-chamber surgery in phase 1: 6.8 (3.6-15.2) versus 6.4 (2.0-18.1) emboli per minute, respectively. In phase 2, closed-chamber surgery cases were exposed to markedly fewer emboli than open-chamber surgery cases: 9.6 (5.1-14.9) versus 43.3 (19.7-60.3) emboli per minute, respectively. More emboli (total) passed into the right cerebral circulation: 985 (397-2422) right versus 376 (198-769) left. CONCLUSIONS Patients undergoing open-chamber surgery are exposed to considerably higher numbers of cerebral arterial emboli after removal of the aortic cross-clamp than those undergoing closed-chamber surgery, and more emboli enter the right middle cerebral artery than the left. These results may help inform the evaluation of the pathophysiological impact of emboli exposure.
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Affiliation(s)
- Ghazwan Ns Jabur
- Department of Clinical Perfusion, Auckland City Hospital, Auckland, New Zealand.,Department of Anesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joseph Donnelly
- Department of Anesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Anesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Simon J Mitchell
- Department of Anesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Anesthesia, Auckland City Hospital, Auckland, New Zealand
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3
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Cardiopulmonary Bypass Mean Global Oxygen Delivery May Be Associated with Neurocognitive Preservation during Hypothermic Aortic Surgery. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:289-294. [PMID: 33343031 DOI: 10.1182/ject-2000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022]
Abstract
The purpose of this retrospective research was to investigate the relationship between mean global oxygen delivery (DO2) and neurocognitive function in adult patients who presented for aortic surgery with deep hypothermic circulatory arrest using cardiopulmonary bypass (CPB). From a pool of 132 patients, data from 100 CPB patients from 2012 to 2014 aged 50 years or older were randomly selected and analyzed, and global DO2 on CPB was used to categorize patients into those for whom the mean indexed cerebral oxygen delivery (DO2i) was either ≥272 mL O2/min/m2 (critical DO2 [DO2crit]) or less than DO2crit. Ten patients experienced either stroke or expired in the perioperative course. The proportion of patients with evidence of neurocognitive preservation was 98.3% in the group in which the DO2crit was met, compared with 80.6% in the group where DO2crit was not met (X 2 [1, 100] = 3.27, p = .07). Potentially, because of causes other than DO2, the subset of patients with stroke and/or death were removed, and data from 90 cases were analyzed, and a global mean DO2i value of 239.9 mL O2/min/m2 was identified. A larger sample size with controls may yield deeper insights into the hypothesis that a mean global CPB DO2i of 239.9 mL O2/min/m2 may play a role in predicting neurocognitive preservation in this patient population.
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4
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Yan L, Zhou X, Yang X, Zheng Y, Liu C, Zheng L, Fang L, Luo W, He G, He J, Zheng J, Zhou Y. Establishment and Evaluation of a Monkey Acute Cerebral Ischemia Model. Clinics (Sao Paulo) 2020; 75:e1339. [PMID: 32130353 PMCID: PMC7026944 DOI: 10.6061/clinics/2020/e1339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.
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Affiliation(s)
- Li Yan
- Institute of Medical Research, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi 710072, China
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Xiaodong Zhou
- Ultrasound Diagnosis & Treatment Center, Xi'an International Medical Center, Xi'an 710100, China
- *Corresponding authors. E-mail: /
| | - Xiaobin Yang
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Yu Zheng
- Department of Ultrasonography, Xi'an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi'an 710003, China
- *Corresponding authors. E-mail: /
| | - Chunying Liu
- Institute of Medical Research, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi 710072, China
| | - Lili Zheng
- Institute of Medical Research, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi 710072, China
| | - Ling Fang
- Department of Ultrasonography, Xi'an Children’s Hospital, The Affiliated Hospital of JiaoTong University, Xi'an 710003, China
| | - Wen Luo
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Guangbin He
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Jianguo He
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Jianmin Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Yin Zhou
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
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Forti A, Falla M, Scquizzato T, Strapazzon G. A New Approach to Detect Nonconvulsive Seizures in Patients in a Cardiac Surgery Intensive Care Unit by Monitoring Heart Rate Variability. J Cardiothorac Vasc Anesth 2019; 33:2770-2774. [PMID: 30928285 DOI: 10.1053/j.jvca.2019.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alessandro Forti
- Helicopter Emergency Medical Services of SUEM/118 ULSS 1, Pieve di Cadore, Italy; Department of Cardiac-Anesthesia and Intensive Care, ULSS2 Marca Trevigiana, Treviso, Italy.
| | - Marika Falla
- CIMeC and CeRiN, University of Trento, Rovereto, Italy; Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Gygax E, Kaeser HU, Stalder M, Gahl B, Rieben R, Carrel T, Erdoes G. Type II Minimal-Invasive Extracorporeal Circuit for Aortic Valve Replacement: A Randomized Controlled Trial. Artif Organs 2018; 42:620-629. [PMID: 29435996 DOI: 10.1111/aor.13093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022]
Abstract
Extracorporeal circulation triggers systemic inflammatory response and coagulation disorders which may lead to unfavorable clinical outcome. A type II minimally-invasive extracorporeal circuit (MiECC) is a closed system with markedly reduced artificial surface as compared to conventional extracorporeal circuits (CECC). The aim of this study was to investigate and compare inflammatory responses, complement activation and selected clinical end-points in isolated surgical aortic valve replacement (SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients were prospectively randomized to MiECC or CECC perfusion regimen. Complement activation (sC5b-9), inflammation (IL-6, TNF-α, sCD40-ligand) and activation of the coagulation system (D-dimer, TAT-complex) were determined before operation, at 2 hours and 24 hours after surgery. Clinical end-points included perfusion time, transfusion of allogeneic blood products, postoperative bleeding, sepsis, new onset of atrial fibrillation, stroke and in-hospital mortality. Patient characteristics and baseline plasma markers were similar in both groups. Levels for sC5b-9, TNF-α, sCD40 ligand, TAT-complex and D-dimers were not significantly different between MiECC and CECC at 2 hours and 24 hours after surgery. The IL-6 plasma concentration was lower in the CECC group at 24 hours (P = 0.026, vs. MiECC). Comparisons of the baseline level to values at 2 hours and 24 hours, adjusted for the type of oxygenator and hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours (P = 0.013), but no difference at 24 hours (P=0.990). Compared with CECC, MiECC patients had a shorter perfusion time (P = 0.037) and less transfusion requirements (P = 0.04). In this selected cohort of SAVR patients, the type II MiECC was not inferior to CECC in terms of inflammatory response and complement activation. Thus, MiECC might be an alternative perfusion strategy to conventional.
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Affiliation(s)
- Erich Gygax
- Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Hans-Ulrich Kaeser
- Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mario Stalder
- Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Brigitta Gahl
- Clinical Trials Unit, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Robert Rieben
- Department for Biomedical Research, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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7
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Browndyke JN, Berger M, Smith PJ, Harshbarger TB, Monge ZA, Panchal V, Bisanar TL, Glower DD, Alexander JH, Cabeza R, Welsh-Bohmer K, Newman MF, Mathew JP. Task-related changes in degree centrality and local coherence of the posterior cingulate cortex after major cardiac surgery in older adults. Hum Brain Mapp 2017; 39:985-1003. [PMID: 29164774 DOI: 10.1002/hbm.23898] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Older adults often display postoperative cognitive decline (POCD) after surgery, yet it is unclear to what extent functional connectivity (FC) alterations may underlie these deficits. We examined for postoperative voxel-wise FC changes in response to increased working memory load demands in cardiac surgery patients and nonsurgical controls. EXPERIMENTAL DESIGN Older cardiac surgery patients (n = 25) completed a verbal N-back working memory task during MRI scanning and cognitive testing before and 6 weeks after surgery; nonsurgical controls with cardiac disease (n = 26) underwent these assessments at identical time intervals. We measured postoperative changes in degree centrality, the number of edges attached to a brain node, and local coherence, the temporal homogeneity of regional functional correlations, using voxel-wise graph theory-based FC metrics. Group × time differences were evaluated in these FC metrics associated with increased N-back working memory load (2-back > 1-back), using a two-stage partitioned variance, mixed ANCOVA. PRINCIPAL OBSERVATIONS Cardiac surgery patients demonstrated postoperative working memory load-related degree centrality increases in the left dorsal posterior cingulate cortex (dPCC; p < .001, cluster p-FWE < .05). The dPCC also showed a postoperative increase in working memory load-associated local coherence (p < .001, cluster p-FWE < .05). dPCC degree centrality and local coherence increases were inversely associated with global cognitive change in surgery patients (p < .01), but not in controls. CONCLUSIONS Cardiac surgery patients showed postoperative increases in working memory load-associated degree centrality and local coherence of the dPCC that were inversely associated with postoperative global cognitive outcomes and independent of perioperative cerebrovascular damage.
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Affiliation(s)
- Jeffrey N Browndyke
- Geriatric Behavioral Health Division, Department of Psychiatry & Behavioral Sciences, Duke University Health System, Durham, North Carolina.,Duke Institute for Brain Sciences, Duke University, Durham, North Carolina.,Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | - Miles Berger
- Division of Neuroanesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Patrick J Smith
- Behavioral Medicine Division, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Todd B Harshbarger
- Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Zachary A Monge
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Viral Panchal
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Tiffany L Bisanar
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Donald D Glower
- Cardiovascular & Thoracic Division, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Roberto Cabeza
- Duke Institute for Brain Sciences, Duke University, Durham, North Carolina.,Duke Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.,Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Kathleen Welsh-Bohmer
- Geriatric Behavioral Health Division, Department of Psychiatry & Behavioral Sciences, Duke University Health System, Durham, North Carolina.,Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Mark F Newman
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Lakič N, Mrak M, Šušteršič M, Rakovec P, Bunc M. Perioperative erythropoietin protects the CNS against ischemic lesions in patients after open heart surgery. Wien Klin Wochenschr 2016; 128:875-881. [PMID: 27580595 DOI: 10.1007/s00508-016-1063-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to establish erythropoietin as a protective factor against brain ischemia during open heart surgery. METHODS A total of 36 consecutive patients scheduled for revascularization heart surgery were included in the study. Of the patients 18 received 3 intravenous doses of recombinant human erythropoietin (rHuEpo, 24,000 IU) and 18 patients received a placebo. Magnetic resonance imaging (MRI) to detect new brain ischemic lesions was performed. Additionally, S100A, S100B, neuron-specific enolase A and B (NSE-A and B) and the concentration of antibodies against N‑methyl-D-aspartate receptors (NMDAR) to identify new neurological complications were determined. RESULTS Patients who received rHuEpo showed no postoperative ischemic changes in the brain on MRI images. In the control group 5 (27.8 %) new ischemic lesions were found. The NMDAR antibody concentration, S100A, S100B and NSE showed no significant differences between the groups for new cerebral ischemia. High levels of lactate before and after external aortic compression (p = 0.022 and p = 0.048, respectively) and duration of operation could predict new ischemic lesions (p = 0.009). CONCLUSIONS The addition of rHuEpo reduced the formation of lesions detectable by MRI in the brain and could be used clinically as neuroprotection in cardiac surgery.
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Affiliation(s)
- Nikola Lakič
- Department for Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Mrak
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Miha Šušteršič
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Peter Rakovec
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Matjaž Bunc
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia.
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9
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Basciani R, Kröninger F, Gygax E, Jenni H, Reineke D, Stucki M, Hagenbuch N, Carrel T, Eberle B, Erdoes G. Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial. Artif Organs 2016; 40:E280-E291. [DOI: 10.1111/aor.12744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Reto Basciani
- Department of Anesthesiology and Pain Therapy; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
| | - Felix Kröninger
- Department of Anesthesiology and Pain Therapy; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
| | - Erich Gygax
- Department of Cardiovascular Surgery; Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern; Bern
| | - Hansjörg Jenni
- Department of Cardiovascular Surgery; Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern; Bern
| | - David Reineke
- Department of Cardiovascular Surgery; Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern; Bern
| | - Monika Stucki
- Department of Anesthesiology and Pain Therapy; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
| | | | - Thierry Carrel
- Department of Cardiovascular Surgery; Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern; Bern
| | - Balthasar Eberle
- Department of Anesthesiology and Pain Therapy; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Therapy; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
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10
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Santise G, Marinaro C, Maselli D, Dominici C, Di Vito A, Donato G, Camastra C, Zeppa P, Barni T, Rizzuto A, Viglietto G, Mignogna C. Circulating non-hematological cells during cardiopulmonary bypass: new findings in cardiac surgery procedures. Perfusion 2016; 31:584-92. [PMID: 27000150 DOI: 10.1177/0267659116638916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several factors have been historically advocated to explain the coagulative and inflammatory disorders following cardiopulmonary bypass (CPB). In this paper, we describe the presence of circulating non-hematological cells, introduced within the bloodstream during CPB. We defined the origin of the cells and tested their impact on coagulation. METHODS We collected peripheral arterial blood samples in twenty consecutive coronary artery bypass graft cases at four different surgical moments and assessed the presence and nature of circulating cells with the use of the CELLSEARCH® Test, immunocytochemistry and immunofluorescence, evaluating the expression of cytokeratin and calretinin. The effect of the circulating non-hematological cells on coagulation was tested in vitro, using the ROTEM assay. RESULTS A mean of 263.85 ± 57.5 (median 258.5) cells were present in the samples following the suction of blood from the surgical field while all the other samples were negative (zero cells) (p<0.00001). Immunologic tests confirmed the mesothelial origin of the cells. The ROTEM® assay of the blood samples contaminated by the mesothelial cells presented longer clotting times (53.4 ± 8.2 secs 48.3 ± 8.9 sec, p=0.05), longer clot formation times (137.1 ± 31.5 sec vs 111.9 ± 25.2 sec, p=0.009), smaller alfa angle amplitudes (66.7 ± 9.1° vs 71.1 ± 5.1°, p=0.04) and maximum clot firmness times (59.0 ± 5.4 sec vs 61.9 ±4.6 sec, p=0.004) than the controls. CONCLUSION The presence of circulating non-hematological cells during CPB with a mesothelial immunophenotype alters in vitro coagulation assays. This finding can help to further understand the pathophysiology of CPB.
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Affiliation(s)
- Gianluca Santise
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy
| | - Cinzia Marinaro
- Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Daniele Maselli
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy
| | - Carmelo Dominici
- Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy
| | - Anna Di Vito
- Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Caterina Camastra
- Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Italy
| | - Tullio Barni
- Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Antonia Rizzuto
- Department of Medical Surgery Science, University of Catanzaro, "Magna, Graecia", Catanzaro, Italy
| | - Giuseppe Viglietto
- Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
| | - Chiara Mignogna
- Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy
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Anastasiadis K, Murkin J, Antonitsis P, Bauer A, Ranucci M, Gygax E, Schaarschmidt J, Fromes Y, Philipp A, Eberle B, Punjabi P, Argiriadou H, Kadner A, Jenni H, Albrecht G, van Boven W, Liebold A, de Somer F, Hausmann H, Deliopoulos A, El-Essawi A, Mazzei V, Biancari F, Fernandez A, Weerwind P, Puehler T, Serrick C, Waanders F, Gunaydin S, Ohri S, Gummert J, Angelini G, Falk V, Carrel T. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS). Interact Cardiovasc Thorac Surg 2016; 22:647-62. [PMID: 26819269 DOI: 10.1093/icvts/ivv380] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022] Open
Abstract
Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists.
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Affiliation(s)
| | - John Murkin
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Canada
| | | | - Adrian Bauer
- Department of Cardiothoracic Surgery, MediClin Heart Centre Coswig, Coswig, Germany
| | - Marco Ranucci
- Department of Anaesthesia and Intensive Care, Policlinico S. Donato, Milan, Italy
| | - Erich Gygax
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Jan Schaarschmidt
- Department of Cardiothoracic Surgery, MediClin Heart Centre Coswig, Coswig, Germany
| | - Yves Fromes
- University Pierre and Marie Curie (Paris 06), Paris, France
| | | | - Balthasar Eberle
- Department of Anesthesiology and Pain Therapy, University of Bern, Bern, Switzerland
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Helena Argiriadou
- Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Alexander Kadner
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Hansjoerg Jenni
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Guenter Albrecht
- Department of Cardiothoracic and Vascular Surgery, Ulm University, Ulm, Germany
| | - Wim van Boven
- Department of Cardiothoracic Surgery, Amsterdam Medical Center, Amsterdam, Netherlands
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, Ulm University, Ulm, Germany
| | | | - Harald Hausmann
- Department of Cardiothoracic Surgery, MediClin Heart Centre Coswig, Coswig, Germany
| | | | - Aschraf El-Essawi
- Department of Thoracic and Cardiovascular Surgery, Braunschweig, Germany
| | - Valerio Mazzei
- Department of Adult Cardiac Surgery, Mater Dei Hospital, Bari, Italy
| | - Fausto Biancari
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - Adam Fernandez
- Department of Surgery, Sidra Medical & Research Centre, Doha, Qatar
| | - Patrick Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thomas Puehler
- Department of Thoracic and Cardiovascular Surgery, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | | | | | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Medline Hospitals, Adana, Turkey
| | - Sunil Ohri
- Department of Cardiothoracic Surgery, Wessex Cardiac Centre, University Hospital Southampton, Hampshire, UK
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Gianni Angelini
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Volkmar Falk
- Department of Cardiothoracic Surgery, German Heart Centre, Berlin, Germany
| | - Thierry Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
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Bianco J, Rossi P, Belziti C, García Fornari G, Marenchino R. Intraoperative Use of Several Inotropes Is Associated With Increased Mid-term Mortality in Patients Undergoing Orthotopic Heart Transplantation. Transplant Proc 2014; 46:3054-9. [DOI: 10.1016/j.transproceed.2014.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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