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Chotimol P, Lansdowne W, Machin D, Binas K, Angelini GD, Gibbison B. Hypobaric type oxygenators - physics and physiology. Perfusion 2024:2676591241232824. [PMID: 38323543 DOI: 10.1177/02676591241232824] [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: 02/08/2024]
Abstract
Brain injury is still a serious complication after cardiac surgery. Gaseous microemboli (GME) are known to contribute to both short and longer-term brain injury after cardiac surgery. Hypobaric and novel dual-chamber oxygenators use the physical behaviors and properties of gases to reduce GME. The aim of this review was to present the basic physics of the gases, the mechanism in which the hypobaric and dual-chamber oxygenators reduce GME, their technical performance, the preclinical studies, and future directions. The gas laws are reviewed as an aid to understanding the mechanisms of action of oxygenators. Hypobaric-type oxygenators employ a high oxygen, no nitrogen environment creating a steep concentration gradient of nitrogen out of the blood and into the oxygenator, reducing the risk of GMEs forming. Adequately powered clinical studies have never been carried out with a hypobaric or dual-chamber oxygenator. These are required before such technology can be recommended for widespread clinical use.
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Affiliation(s)
- Phatiwat Chotimol
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - William Lansdowne
- Department of Anaesthesia,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - David Machin
- Department of Anaesthesia,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kressle Binas
- Department of Anaesthesia,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gianni D Angelini
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Anaesthesia,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ben Gibbison
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Anaesthesia,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Persello A, Souab F, Dupas T, Aillerie V, Bigot E, Denis M, Erraud A, Pelé T, Blangy-Letheule A, Miniou P, Guedat P, De Waard M, Abgueguen E, Rozec B, Lauzier B. A Rat Model of Clinically Relevant Extracorporeal Circulation Develops Early Organ Dysfunctions. Int J Mol Sci 2023; 24:ijms24087338. [PMID: 37108501 PMCID: PMC10139167 DOI: 10.3390/ijms24087338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
In clinical practice, extracorporeal circulation (ECC) is associated with coagulopathy and inflammation, eventually leading to organ injuries without preventive systemic pharmacological treatment. Relevant models are needed to reproduce the pathophysiology observed in humans and preclinical tests. Rodent models are less expensive than large models but require adaptations and validated comparisons to clinics. This study aimed to develop a rat ECC model and to establish its clinical relevance. One hour of veno-arterial ECC or a sham procedure were achieved on mechanically ventilated rats after cannulations with a mean arterial pressure objective > 60 mmHg. Five hours post-surgery, the rats' behavior, plasmatic/blood biomarkers, and hemodynamics were measured. Blood biomarkers and transcriptomic changes were compared in 41 patients undergoing on-pump cardiac surgery. Five hours post-ECC, the rats presented hypotension, hyperlactatemia, and behavioral alterations. The same patterns of marker measurements (Lactate dehydrogenase, Creatinine kinase, ASAT, ALAT, and Troponin T) were observed in both rats and human patients. Transcriptome analyses showed similarity in both humans and rats in the biological processes involved in the ECC response. This new ECC rat model seems to resemble both ECC clinical procedures and the associated pathophysiology, but with early organ injury corresponding to a severe phenotype. Although the mechanisms at stake in the post-ECC pathophysiology of rats or humans need to be described, this new rat model appears to be a relevant and costless preclinical model of human ECC.
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Affiliation(s)
- Antoine Persello
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
- InFlectis BioScience, 44200 Nantes, France
| | - Fouzia Souab
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Thomas Dupas
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Virginie Aillerie
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Edith Bigot
- Department of Biochemistry, CHU de Nantes, 44800 Nantes, France
| | - Manon Denis
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Angélique Erraud
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Thomas Pelé
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | | | | | | | - Michel De Waard
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | | | - Bertrand Rozec
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Benjamin Lauzier
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
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Gerstein NS, Panikkath PV, Mirrakhimov AE, Lewis AE, Ram H. Cardiopulmonary Bypass Emergencies and Intraoperative Issues. J Cardiothorac Vasc Anesth 2022; 36:4505-4522. [PMID: 36100499 DOI: 10.1053/j.jvca.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
Cardiopulmonary bypass (CPB) is a complex biomechanical engineering undertaking and an essential component of cardiac surgery. However, similar to all complex bioengineering systems, CPB activities are prone to a variety of safety and biomechanical issues. In this narrative review article, the authors discuss the preventative and intraoperative management strategies for a number of intraoperative CPB emergencies, including cannulation complications (dissection, malposition, gas embolism), CPB equipment issues (heater-cooler failure, oxygenator issues, electrical failure, and tubing rupture), CPB circuit thrombosis, medication issues, awareness during CPB, and CPB issues during transcatheter aortic valve replacement.
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Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Pramod V Panikkath
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Alexander E Lewis
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Harish Ram
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL
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4
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Ho R, McDonald C, Pauls JP, Li Z. Effect of aortic cannulation depth on air emboli transport during cardiopulmonary bypass: A computational study. Perfusion 2022:2676591221092942. [DOI: 10.1177/02676591221092942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Varying the insertion depth of the aortic cannula during cardiopulmonary bypass (CPB) has been investigated as a strategy to mitigate cerebral emboli, yet its effectiveness associated with CPB flow is not fully understood. We compared different arterial cannula insertion depths and pump flow influencing air microemboli entering the aortic arch branch arteries (AABA). Methods A computational approach used a patient-specific aorta model to evaluate four cannula locations at (1) proximal arch, (2) mid arch, (3) distal arch, and (4) descending aorta. We injected 0.1 mm microemboli (N=720) at 2 and 5 L/min and assessed the embolic load and the particle averaged transit times ( entering the AABA. Results Location 4 had the lowest embolic load (2 L/min: N= 63) and (5 L/min: N= 54) compared to locations 1 to 3 in the range of (N= 118 to 116 at 2 L/min:) and (N= 92 to 146 at 5 L/min). There was no significant difference between 2 L/min and 5 L/min (p = 0.31), despite 5 L/min attaining a lower mean (±standard deviation) than 2 L/min (38.0±23.4 vs 44.5±21.1), respectively. Progressing from location 1 to 4, increased 3.11s -7.40 s at 2 L/min and 1.81s -4.18s at 5 L/min. Conclusion It was demonstrated that the elongated cannula insertion length resulted in lower embolic loads, particularly at a higher flow rate. The numerical results suggest that CPB management could combine active flow variation with improving cannula performance and provide a foundation for a future experimental and clinical investigation to reduce surgical cerebral air microemboli.
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Affiliation(s)
- Raymond Ho
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Charles McDonald
- Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Chermside, Qld, Australia
| | - Jo P Pauls
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia
- School of Engineering and Built Environment, Griffith University, Southport, QLD, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Quintero OL, Giraldo JC, Sandoval NF. Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies. Semin Cardiothorac Vasc Anesth 2018; 23:324-332. [DOI: 10.1177/1089253218819782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.
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Affiliation(s)
- Olga L. Quintero
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Juan C. Giraldo
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
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Malik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, Woodrum DA, Arani A, Arunachalam SP, Araoz PA. Air embolism: diagnosis and management. Future Cardiol 2017. [DOI: 10.2217/fca-2017-0015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation. Immediate management includes placement of the patient on high-flow oxygen and in the left lateral decubitus and/or Trendelenburg position. Hyperbaric oxygen therapy is the definitive treatment which may decrease the size of air emboli by facilitating gas reabsorption, while also improving tissue oxygenation and reducing ischemic reperfusion injury.
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Affiliation(s)
- Neera Malik
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Paul L Claus
- Department of Hyperbaric & Altitude Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jeffery E Illman
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Seth J Kligerman
- Department of Radiology & Nuclear Medicine, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David L Levin
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | | | - Philip A Araoz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
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Smelt JLC, Phillips S, Hamilton C, Fricker P, Spray D, Nowell JL, Jahangiri M. Simulator Teaching of Cardiopulmonary Bypass Complications: A Prospective, Randomized Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:1026-1031. [PMID: 27321986 DOI: 10.1016/j.jsurg.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Complications of cardiopulmonary bypass (CPB) are rare, but life-threatening events that need prompt and rehearsed actions involving a team. This is not adequately taught to cardiothoracic surgical trainees. The objective of this study was to assess the knowledge of cardiothoracic trainees required to manage these events after simulation-based vs. lecture-based teaching. PARTICIPANTS AND DESIGN Totally, 17 cardiac surgical trainees with no formal teaching in intraoperative complications of CPB management were randomly assigned by computer to either a study group receiving simulation-based complications of CPB teaching via the Orpheus simulator (n = 9) or a control group receiving complications of CPB teaching via a lecture (n = 8). Each subject undertook a written test comprising 20 multiple choice questions on complications of CPB before and after teaching. Trainees were then asked to rate their satisfaction with each session from 1 to 5, with 5 being most satisfied. SETTING St George Simulation and Clinical Skills Laboratory, St George's Hospital, London. RESULTS There was no significant difference in the pretest scores between the 2 groups (p = 0.29). After teaching, both groups showed a statistically significant improvement in their knowledge (p < 0.05). The trainees in the simulation group performed better than the lecture-based group; however, this was not statistically significant (p = 0.21). Satisfaction levels in both the lecture session and the simulation session were very high with means of 4.4/5 and 4.8/5, respectively. CONCLUSION Despite the familiarity with CPB during surgery, the simulation group performed at least as well as the lecture group. Cardiothoracic trainees would benefit from formal teaching of complications of CPB management via either learning modality being incorporated into their training.
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Affiliation(s)
- Jeremy L C Smelt
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Simon Phillips
- Department of Perfusion, St. George's Hospital, London, United Kingdom
| | - Colin Hamilton
- Department of Perfusion, St. George's Hospital, London, United Kingdom
| | - Paul Fricker
- Department of Perfusion, St. George's Hospital, London, United Kingdom
| | - Dominic Spray
- Department of Anesthesia, St. George's Hospital, London, United Kingdom
| | - Justin L Nowell
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom.
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8
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Patel PA, Ghadimi K, Coetzee E, Myburgh A, Swanevelder J, Gutsche JT, Augoustides JGT. Incidental Cold Agglutinins in Cardiac Surgery: Intraoperative Surprises and Team-Based Problem-Solving Strategies During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 31:1109-1118. [PMID: 27624931 DOI: 10.1053/j.jvca.2016.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Divisions of Cardiothoracic Anesthesiology and Critical Care, Anesthesiology and Critical Care, Duke University Medical Center, Durham, NC
| | - Ettienne Coetzee
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adriaan Myburgh
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Zhang W, Weng G, Li M, Yu S, Bao J, Cao X, Dou Z, Wang H, Chen H. Original Research: Establishment of an early embolus-related cerebral injury model after cardiopulmonary bypass in miniature pigs. Exp Biol Med (Maywood) 2016; 241:1819-24. [PMID: 27190268 DOI: 10.1177/1535370216648804] [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: 02/01/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
Embolus-related cerebral injury is still a serious adverse event after cardiopulmonary bypass (CPB). But there is no stable animal model for basic and clinical research purposes. We chose miniature pig to establish a stable animal model of embolus-related cerebral injury after CPB and verified the validity of results by correlating the histopathological findings with those of diffusion-weighted magnetic resonance imaging (DW-MRI). Based on different treatment regimens, 24 male miniature pigs were randomly assigned into four groups: Control, CPB, embolus, and CPB-embolus groups. DW-MRI was performed before and after surgery to diagnose and locate the brain lesions. Histopathological changes in brain tissues were examined using H&E and Nissl staining. All surgical procedures were uneventful with 100% postoperative survival of pigs. Two animals in the Embolus group and six animals in the CPB-embolus group showed signs of ischemic penumbra on DW-MRI performed 6 h after surgery. Consistent with the results of DW-MRI, histopathological examination showed necrosis and ischemic lesions. In this paper, we demonstrate the feasibility and validity of a pig model of embolus-related cerebral injury associated with CPB. This model may be used in the future for basic and translational research.
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Affiliation(s)
- Weiwei Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China
| | - Guoxing Weng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
| | - Min Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China
| | - Shun Yu
- Department of Radiology, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
| | - Jiayin Bao
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
| | - Xiying Cao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China
| | - Zhi Dou
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
| | - Huan Wang
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
| | - Haiyu Chen
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China
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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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11
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Cardiopulmonary bypass in the pediatric population. Best Pract Res Clin Anaesthesiol 2015; 29:241-56. [DOI: 10.1016/j.bpa.2015.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 02/24/2015] [Accepted: 03/20/2015] [Indexed: 11/23/2022]
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12
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Kertai MD. Evolution, Practice, and Challenges of Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 2014; 18:85-6. [DOI: 10.1177/1089253214535668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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