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Yoshida T, Matsuura K, Mandour AS, Aboshi Y, Yamada S, Yotsuida H, Hasegawa M, Cheng CJ, Yaginuma Y, Watanabe M, Fukuzumi S. Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty. Vet Sci 2022; 9:vetsci9040178. [PMID: 35448675 PMCID: PMC9031179 DOI: 10.3390/vetsci9040178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging (ACVIM: stage B2, C, D) and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion.
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Affiliation(s)
- Tomohiko Yoshida
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Katsuhiro Matsuura
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
- Correspondence: (K.M.); (A.S.M.)
| | - Ahmed S. Mandour
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
- Department of Animal Medicine, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (K.M.); (A.S.M.)
| | - Yuki Aboshi
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Shusaku Yamada
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Hideki Yotsuida
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan;
| | - Mizuki Hasegawa
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Chieh-Jen Cheng
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Youta Yaginuma
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
| | - Momoko Watanabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
| | - Shou Fukuzumi
- VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan; (T.Y.); (Y.A.); (S.Y.); (M.H.); (C.-J.C.); (Y.Y.); (S.F.)
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan;
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Borgarelli M, Lanz O, Pavlisko N, Abbott JA, Menciotti G, Aherne M, Lahmers SM, Lahmers KK, Gammie JS. Mitral valve repair in dogs using an ePTFE chordal implantation device: a pilot study. J Vet Cardiol 2017; 19:256-267. [PMID: 28576476 DOI: 10.1016/j.jvc.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/07/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitral valve (MV) regurgitation due to degenerative MV disease is the leading cause of cardiac death in dogs. We carried out preliminary experiments to determine the feasibility and short-term effects of beating-heart MV repair using an expanded polytetrafluorethylene (ePTFE) chordal implantation device (Harpoon TSD-5) in dogs. ANIMALS This study involved six healthy purpose-bred Beagles (weight range 8.9-11.4 kg). MATERIAL AND METHODS Following a mini-thoracotomy performed under general anesthesia, the TSD-5 was used to place 1 or 2 artificial ePTFE cords on the anterior MV leaflet or the posterior MV leaflet via a left-ventricular transapical approach. The procedure was guided and monitored by transesophageal echocardiography. Postoperative antithrombotic treatment consisted of clopidogrel or a combination of clopidogrel and apixaban. Dogs were serially evaluated by transthoracic echocardiography at day 1, 7, 14, 21, and 30. The hearts were then examined for evaluation of tissues reactions and to detect signs of endothelialization. RESULTS One or two chords were successfully implanted in five dogs. Four dogs completed the 30 days follow-up. One dog died intra-operatively because of aortic perforation. One dog died early post-operatively from a hemorrhagic pleural effusion attributed to overly aggressive antithrombotic treatment. One dog developed a thrombus surrounding both the knot and the synthetic cord. Postmortem exam confirmed secure placement of ePTFE knots in the mitral leaflets in all dogs and the presence of endothelialization of the knots and chords. CONCLUSIONS These preliminary results demonstrate the feasibility of artificial chordal placement using an ePTFE cordal implantation device in dogs.
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Affiliation(s)
- M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA.
| | - O Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - N Pavlisko
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - M Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - S M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA
| | - K K Lahmers
- Department of Biomedical Sciences & Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, 205 Duck Pond Dr., VA 24061, USA
| | - J S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S. Paca St., MD 21201, USA
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Pelosi A, Anderson LK, Paugh J, Robinson S, Eyster GE. Challenges of cardiopulmonary bypass-a review of the veterinary literature. Vet Surg 2012; 42:119-36. [PMID: 23164065 DOI: 10.1111/j.1532-950x.2012.01008.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiopulmonary bypass (CPB) has been used in veterinary medicine in experimental surgery and to address congenital and acquired diseases. We review the veterinary literature and expose common challenges of CPB in dogs and cats. Specifically, we describe the most specific elements of this technique in veterinary patients. The variety in animal size has made it difficult to standardize cannulation techniques, oxygenators, and priming volumes and solutions. The fact that one of the most common cardiovascular disorders, mitral valve disease, occurs predominantly in small dogs has limited the use of bypass in these patients because of the need for small, low prime oxygenators and pumps that have been unavailable until recently. Coagulation, hemostasis, and blood product availability have also represented important factors in the way CPB has developed over the years. The cost and the challenges in operating the bypass machine have represented substantial limitations in its broader use.
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Affiliation(s)
- Augusta Pelosi
- Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824-1314, USA.
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