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Belletti A, Lee DK, Yanase F, Naorungroj T, Eastwood GM, Bellomo R, Weinberg L. Changes in SedLine-derived processed electroencephalographic parameters during hypothermia in patients undergoing cardiac surgery with cardiopulmonary bypass. Front Cardiovasc Med 2023; 10:1084426. [PMID: 37469479 PMCID: PMC10352607 DOI: 10.3389/fcvm.2023.1084426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Objective Processed electroencephalography (pEEG) is used to monitor depth-of-anesthesia during cardiopulmonary bypass (CPB). The SedLine device has been recently introduced for pEEG monitoring. However, the effect of hypothermia on its parameters during CPB is unknown. Accordingly, we aimed to investigate temperature-induced changes in SedLine-derived pEEG parameters during CPB. Design Prospective observational study. Setting Cardiac surgery operating theatre. Participants 28 patients undergoing elective cardiac surgery with CPB. Interventions We continuously measured patient state index (PSI), suppression ratio (SR), bilateral spectral edge frequency (SEF) and temperature. We used linear mixed modelling with fixed and random effects to study the interactions between pEEG parameters and core temperature. Measurements and main results During CPB maintenance, the median temperature was 32.1°C [interquartile range (IQR): 29.8-33.6] at the end of cooling and 32.8°C (IQR: 30.1-34.0) at rewarming initiation. For each degree Celsius change in temperature during cooling and rewarming the PSI either decreased by 0.8 points [95% confidence interval (CI): 0.7-1.0; p < 0.001] or increased by 0.7 points (95% CI: 0.6-0.8; p < 0.001). The SR increased by 2.9 (95% CI: 2.3-3.4); p < 0.001) during cooling and decreased by 2.2 (95% CI: 1.7-2.7; p < 0.001) during rewarming. Changes in the SEF were not related to changes in temperature. Conclusions During hypothermic CPB, temperature changes led to concordant changes in the PSI. The SR increased during cooling and decreased during rewarming. Clinicians using SedLine for depth-of-anesthesia monitoring should be aware of these effects when interpreting the PSI and SR values.
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Affiliation(s)
- Alessandro Belletti
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Thummaporn Naorungroj
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Glenn M. Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and The Austin Hospital, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC, Australia
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Gologorsky E, Macedo FI, Salerno TA. Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits? Expert Rev Cardiovasc Ther 2014; 9:927-37. [DOI: 10.1586/erc.11.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Beating heart repair of secondum atrial septal defect without aortic cross clamp—a safe alternative. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cheng W, Xiao Y, Chen L, Liu H, Zhu Y. Application of lower sternal incision with on-pump, beating heart intracardiac procedures in congenital heart disease. Heart Surg Forum 2012; 15:E236-9. [PMID: 22917832 DOI: 10.1532/hsf98.20111189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to explore the application of lower sternal incision with on-pump, beating heart intracardiac procedures for the treatment of congenital heart disease. METHODS A total of 106 cases with congenital heart disease were performed with lower sternal incision under the beating heart condition. The sternum was sawed open to the third sternocostal joint through a small incision in the lower sternum. Cardiopulmonary bypass was developed without aortic cross-clamping. The simultaneous left atrium and ventricle suction and integrating sequential deairing procedure was established to improve the exposure of the surgical field and intraoperative de-airing. We also randomly selected 100 patients with similar disease and age as controls. These control patients underwent middle sternal incision surgery with arresting heart. RESULTS The results showed that all the patients were successfully completed with the surgery without death and serious complications, eg, air embolism, residual shunt, and complete atrioventricular block. The operative and cardiopulmonary bypass time in the experimental group was not significantly different from that in the control group. The length of the skin incision in the experimental group was shortened by 4.8 cm compared to that in the control group. The incidence of sternal deformity in patients under 3 years old in the experimental group was significantly lower than that in the control group. CONCLUSIONS Lower sternal incision with beating heart can reduce the surgical injury, simplify the operation procedure, and improve the therapeutic efficacy. It is a safe and effective approach for the treatment of congenital heart disease.
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Affiliation(s)
- Wei Cheng
- Cardiovascular Surgery Center, Xinqiao Hospital of the Third Military Medical University, Chongqing, China
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Suleiman MS, Hancock M, Shukla R, Rajakaruna C, Angelini GD. Cardioplegic strategies to protect the hypertrophic heart during cardiac surgery. Perfusion 2012; 26 Suppl 1:48-56. [PMID: 21933822 DOI: 10.1177/0267659111420607] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardioplegic arrest and cardiopulmonary bypass are key triggers of myocardial injury during aortic valve surgery. Cardioplegic ischaemic arrest is associated with disruption to metabolic and ionic homeostasis in cardiomyocytes. These changes predispose the heart to reperfusion injury caused by elevated intracellular reactive oxygen species and calcium. Cardiopulmonary bypass is associated with an inflammatory response that can generate systemic oxidative stress which, in turn, provokes further damage to the heart. Techniques of myocardial protection are routinely applied to all hearts, irrespective of their pathology, although different cardiomypathies respond differently to ischaemia and reperfusion injury. In particular, the efficacy of cardioprotective interventions used to protect the hypertrophic heart in patients with aortic valve disease remains controversial. This review will describe key cellular changes in hypertrophy, response to ischaemia and reperfusion and cardioplegic arrest and highlight the importance of optimising cardioprotective strategies to suit hypertrophic hearts.
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Affiliation(s)
- M-S Suleiman
- Faculty of Medicine & Dentistry, Bristol Heart Institute, University of Bristol, Bristol, UK
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Kervan U, Cicekcioglu F, Tuluce H, Ozen A, Babaroglu S, Karakas S, Katircioglu SF. Comparison of neurocognitive functions after beating-heart mitral valve replacement without aorta cross-clamping and after standard mitral valve replacement with cardioplegic arrest. Heart Surg Forum 2011; 14:E335-9. [PMID: 22167757 DOI: 10.1532/hsf98.20101173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to compare the postoperative long-term neurocognitive functions of patients who under-went beating-heart mitral valve replacement on cardiopulmonary bypass (CPB) without aorta cross-clamping with those of patients who underwent mitral valve replacement via the classic method. METHODS The study group included 25 randomly selected patients who underwent beating-heart mitral valve surgery. During the same period, 25 patients were randomly selected as controls to undergo mitral valve replacement procedures via the standard ascending aorta-cannulation technique. The clinical and postoperative (2 months) neurocognitive functional data of both groups were compared. RESULTS Neurologic deficit was observed in neither group during the postoperative period. There were no statistically significant differences between the control and the study groups with respect to Hospital Anxiety and Depression Scale (HADS) results (HADS: anxiety, P = .653; HADS: depression, P = .225), in the right hemispheric cognitive function test results (Raven's Standard Progressive Matrices [RSPM] and Line Orientation Test [LOT] tests: RSPM, P = .189), and in the left hemispheric cognitive function test results (the Ray Auditory Verbal Learning [RAVL] and Stroop Color-Word Test [SCWT] tests: SCWT 1 time, P = .300; SCWT 2 time, P = .679; SCWT 3 time, P = .336; SCWT 4 time, P = .852; SCWT 5 time, P = .416; RAVL total verbal learning, P = .167; RAVL immediate recall, P = .791; RAVL distraction trial, P = .199; RAVL retention, P = .174; RAVL delayed recall, P = .111; RAVL recognition, P = .282; SCWT 4 mistake, P = .306; SCWT 4 reform, P = .066; SCWT 5 mistake, P = .236; SCWT 5 reform, P = .301). CONCLUSIONS The technique of mitral valve replacement with normothermic CPB without cross-clamping of the aorta may be safely used for the majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions.
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Affiliation(s)
- Umit Kervan
- Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital of Turkey, Ankara.
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Mo A, Lin H. On-pump Beating Heart Surgery. Heart Lung Circ 2011; 20:295-304. [DOI: 10.1016/j.hlc.2011.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 01/16/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Salhiyyah K, Raja SG, Akeela H, Pepper J, Amrani M. Beating heart continuous coronary perfusion for valve surgery: what next for clinical trials? Future Cardiol 2010; 6:845-58. [DOI: 10.2217/fca.10.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prior to the introduction of cardioplegia, beating heart continuous coronary perfusion (BHCCP) was the only available method of myocardial protection. Currently, cardiac surgery on cardiopulmonary bypass with cardioplegic arrest is the gold standard strategy. Cardioplegic arrest provides an easier and safer way to operate on a still heart. It enables the performance of a broader range of cardiac procedures, and avoids the potential difficulties of continuous perfusion on a beating heart. Despite the overall effectiveness and safety of cardioplegia, some adverse effects remain, mainly due to the insult of ischemia, which results in ischemic reperfusion injury. As a result BHCCP has seen a revival as an alternative to cardioplegia for performing complex valvular surgery. Increasing experience reporting safety and efficacy of BHCCP is being published. However, despite the reported advantages, current available evidence validating safety and efficacy of BHCCP is controversial. This article provides an overview of BHCCP highlighting the current best available evidence supporting this strategy, concerns, controversies and potential areas for further research.
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Affiliation(s)
| | - Shahzad G Raja
- Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK
| | - Hiba Akeela
- Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK
| | - John Pepper
- Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK
| | - Mohamed Amrani
- Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK
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Macedo FIB, Carvalho EM, Hassan M, Ricci M, Gologorsky E, Salerno TA. Beating Heart Valve Surgery in Patients with Low Left Ventricular Ejection Fraction. J Card Surg 2010; 25:267-71. [DOI: 10.1111/j.1540-8191.2010.01000.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Salhiyyah K, Taggart D, Taggart D. Beating-Heart Valve Surgery: A Systematic Review. Asian Cardiovasc Thorac Ann 2009; 17:650-8. [DOI: 10.1177/0218492309348942] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Beating-heart continuous coronary perfusion (BHCCP) has been promoted as an alternative to the technique of cardioplegic arrest in valve surgery. Its potential advantage is the elimination of cardioplegia and the corollary risk of ischemic reperfusion injury. The use of CCP has been recommended especially when performing more complex operations, such as mitral valve repair, and particularly as surgeons become more familiar with beating-heart coronary surgery. We conducted a systematic review to assess the strength of the evidence supporting the efficacy of BHCCP compared to cardioplegia in valve surgery. Thirty nine reports were identified. Of these, only two were randomized control trials. Overall the studies were generally of poor quality and had a low evidence level. In those studies, mortality and major morbidity from BHCCP were within acceptable levels, nevertheless, there was no advantage over cardioplegic arrest. On the other hand there is weak evidence that it may reduce functional and biochemical markers of myocardial injury. In conclusion, BHCCP is an operative strategy in valve surgery with some potential benefits. There is, however a need for a high quality, prospective, randomized control trial to establish the exact role for BHCCP in complex valve surgery.
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Affiliation(s)
| | - David Taggart
- Department of Cardiothoracic Surgery Royal Brompton and Harefield NHS Trust London, UK
| | - David Taggart
- Department of Cardiothoracic Surgery John Radcliffe Hospital Oxford, UK
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Mo A, Lin H, Wen Z, Lu W, Long X, Zhou Y. Efficacy and Safety of On-Pump Beating Heart Surgery. Ann Thorac Surg 2008; 86:1914-8. [DOI: 10.1016/j.athoracsur.2008.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 06/29/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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12
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Katircioglu SF, Cicekcioglu F, Tutun U, Parlar AI, Babaroglu S, Mungan U, Aksoyek A. On-Pump Beating Heart Mitral Valve Surgery without Cross-Clamping the Aorta. J Card Surg 2008; 23:307-11. [DOI: 10.1111/j.1540-8191.2008.00648.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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