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Hussain AM, Younes MA. Early outcomes of experience warm surgery in children undergoing complete repair of tetralogy of Fallot in developing countries. BMC Pediatr 2024; 24:499. [PMID: 39097678 PMCID: PMC11297559 DOI: 10.1186/s12887-024-04976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVES While significant evidence supports the benefits of normothermic cardiopulmonary bypass (NCPB) over hypothermic techniques, many institutions in developing countries, including ours, continue to employ hypothermic methods. This study aimed to assess the early postoperative outcomes of normothermic cardiopulmonary bypass (NCPB) for complete surgical repair via the Tetralogy of Fallot (TOF) within our national context. METHODS We conducted this study in the Pediatric Cardiac Intensive Care Unit (PCICU) at the University Children's Hospital. One hundred patients who underwent complete TOF repair were enrolled and categorized into two groups: the normothermic group (n = 50, temperature 35-37 °C) and the moderate hypothermic group (n = 50, temperature 28-32 °C). We evaluated mortality, morbidity, and postoperative complications in the PCICU as outcome measures. RESULTS The demographic characteristics were similar between the two groups. However, the cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were notably longer in the hypothermic group. The study recorded seven deaths, yielding an overall mortality rate of 7%. No significant differences were observed between the two groups concerning mortality, morbidity, or postoperative complications in the PCICU. CONCLUSIONS Our findings suggest that normothermic procedures, while not demonstrably effective, are safe for pediatric cardiac surgery. Further research is warranted to substantiate and endorse the adoption of this technique.
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Affiliation(s)
- Alaa Mohamad Hussain
- University Children's Hospital, Damascus University, Damascus, Syrian Arab Republic.
| | - Mohammad Ali Younes
- University Children's Hospital, Damascus University, Damascus, Syrian Arab Republic.
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Zhang S, Li J, Wang J, Chen X, Shu G, Feng D, Zheng X. Ferroptosis Exists in Ischemia Reperfusion Injury after Cardiac Surgery with Cardiopulmonary Bypass. Cell Biochem Biophys 2024; 82:777-786. [PMID: 38363517 DOI: 10.1007/s12013-024-01228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
Ischemia-reperfusion (IR) injury commonly arises during cardiac surgery involving Cardiopulmonary Bypass (CPB), and it has relationship with ferroptosis in mice. However, the exact role of ferroptosis in the human cardiac damage caused by cardiac surgery remains unclear. Basic patient data and perioperative period information were collected, and clinic indicators related to cardiac function were detected to assess the extent of cardiac injury. Cardiac tissue samples were collected to determine histopathological changes, ultrastructure of mitochondrial and hallmarks of ferroptosis. 25 patients were involved in this study. In the present study, we observed a significant increase in the clinical indicator hs-cTnT, with levels rising more than 1393 ± 242 folds (P < 0.0001) following the cardiac surgery. Masson staining revealed a notable increase in fibrosis levels by 2.282 ± 0.259% (P = 0.0009). Furthermore, there was a significant elevation in lipid peroxidation, as evidenced by a 61.42 ± 17.33% increase in MDA (P = 0.0006). Additionally, we observed notable swelling, decreased mitochondrial crista, and even fragmented mitochondria. Notably, changes in the marker gene of ferroptosis were observed, with PTGS2 showing a 6.437 ± 0.81 folds increase (P < 0.0001). Furthermore, key regulators such as SLC7A11 and GPX4 proteins exhibited a reduction of 97.33 ± 25.78% (P = 0.0068) and 60.59 ± 14.93% (P = 0.0071), respectively, indicating the occurrence of ferroptosis following the surgery. Ferroptosis exists in myocardial IR injury caused by cardiac surgery with CPB, indicating that targeting ferroptosis could serve as a potential strategy for myocardial protection against CPB-induced IR injury. The trial has been registered in Chinese Clinical Trial Registry (ChiCTR, No. ChiCTR2200061995) on July 16th, 2022.
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Affiliation(s)
- Shenshen Zhang
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Food Laboratory of Zhongyuan, Luohe, China
| | - Junyan Li
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Food Laboratory of Zhongyuan, Luohe, China
| | - Jian Wang
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Food Laboratory of Zhongyuan, Luohe, China
| | - Xi Chen
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Food Laboratory of Zhongyuan, Luohe, China
| | - Guangjie Shu
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Food Laboratory of Zhongyuan, Luohe, China
| | - Deguang Feng
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangming Zheng
- College of Public Health, Zhengzhou University, Department of Anaesthesia,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Muehlschlegel G, Kubicki R, Jacobs-LeVan J, Kroll J, Klemm R, Humburger F, Stiller B, Fleck T. Neurological Impact of Slower Rewarming during Bypass Surgery in Infants. Thorac Cardiovasc Surg 2024; 72:e7-e15. [PMID: 38909608 DOI: 10.1055/s-0044-1787650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Hypothermia is a neuroprotective strategy during cardiopulmonary bypass. Rewarming entailing a rapid rise in cerebral metabolism might lead to secondary neurological sequelae. In this pilot study, we aimed to validate the hypothesis that a slower rewarming rate would lower the risk of cerebral hypoxia and seizures in infants. METHODS This is a prospective, clinical, single-center study. Infants undergoing cardiac surgery in hypothermia were rewarmed either according to the standard (+1°C in < 5 minutes) or a slow (+1°C in > 5-8 minutes) rewarming strategy. We monitored electrocortical activity via amplitude-integrated electroencephalography (aEEG) and cerebral oxygenation by near-infrared spectroscopy during and after surgery. RESULTS Fifteen children in the standard rewarming group (age: 13 days [5-251]) were cooled down to 26.6°C (17.2-29.8) and compared with 17 children in the slow-rewarming group (age: 9 days [4-365]) with a minimal temperature of 25.7°C (20.1-31.4). All neonates in both groups (n = 19) exhibited suppressed patterns compared with 28% of the infants > 28 days (p < 0.05). During rewarming, only 26% of the children in the slow-rewarming group revealed suppressed aEEG traces (vs. 41%; p = 0.28). Cerebral oxygenation increased by a median of 3.5% in the slow-rewarming group versus 1.5% in the standard group (p = 0.9). Our slow-rewarming group revealed no aEEG evidence of any postoperative seizures (0 vs. 20%). CONCLUSION These results might indicate that a slower rewarming rate after hypothermia causes less suppression of electrocortical activity and higher cerebral oxygenation during rewarming, which may imply a reduced risk of postoperative seizures.
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Affiliation(s)
- Geeske Muehlschlegel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Baden-Württemberg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
| | - Julia Jacobs-LeVan
- Departments of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Baden-Württemberg, Germany
| | - Rolf Klemm
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Baden-Württemberg, Germany
| | - Frank Humburger
- Department of Anesthesiology, University of Freiburg Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
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Pollak U, Zemmour H, Shaked E, Magenheim J, Fridlich O, Korach A, Serraf AE, Mishaly D, Glaser B, Shemer R, Dor Y. Novel cfDNA Methylation Biomarkers Reveal Delayed Cardiac Cell Death after Open-heart Surgery. J Cardiovasc Transl Res 2023; 16:199-208. [PMID: 35978264 DOI: 10.1007/s12265-022-10295-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
The use of cardiopulmonary bypass (CPB) is thought to cause delayed cardiac damage. DNA methylation-based liquid biopsies are novel biomarkers for monitoring acute cardiac cell death. We assessed cell-free DNA molecules as markers for cardiac damage after open-heart surgery. Novel cardiomyocyte-specific DNA methylation markers were applied to measure cardiac cfDNA in the plasma of 42 infants who underwent open-heart surgery. Cardiac cfDNA was elevated following surgery, reflecting direct surgery-related tissue damage, and declined thereafter in most patients. The concentration of cardiac cfDNA post-surgery correlated with the duration of CPB and aortic cross clamping. Strikingly, cardiac cfDNA at 6 h predicted duration of mechanical ventilation and maximal vasoactive-inotropic score better than did maximal troponin levels. Cardiac cfDNA reveals heart damage associated with CPB, and can be used to monitor cardiac cell death, to predict clinical outcome of surgery and to assess performance of cardioprotective interventions.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hai Zemmour
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel
| | - Elior Shaked
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel
| | - Judith Magenheim
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel
| | - Ori Fridlich
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel
| | - Amit Korach
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Thoracic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Alain E Serraf
- Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Benjamin Glaser
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.,Endocrinology and Metabolism Service, Hadassah University Medical Center, Jerusalem, Israel
| | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel.
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, the Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel.
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Haider A, Khwaja IA, Qureshi AB, Khan I, Majeed KA, Yousaf MS, Zaneb H, Rehman A, Rabbani I, Tahir SK, Rehman H. Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes. J Cardiovasc Dev Dis 2022; 9:151. [PMID: 35621862 PMCID: PMC9145413 DOI: 10.3390/jcdd9050151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intraoperative hypothermia is an integral part of cardiopulmonary bypass (CPB), and a precise degree of hypothermia may improve the early clinical outcomes of cardiac surgery. Presently, there is no agreement on an accurate, advantageous temperature range for routine use in CPB. To address this issue, we conducted a retrospective observational study to compare the effects of different hypothermic temperature ranges on primary (inotropic support, blood loss, and platelet count) and secondary (ventilation support and in-hospital stay) outcomes in patients undergoing elective cardiac surgery. METHODS Data were retrieved from the medical database of the Cardiovascular Surgery Department, King Edward Medical University, Lahore-Pakistan (a tertiary care hospital), dating from February 2015 to December 2017. Patients were divided into mild (34 °C to 36 °C), intermediate (31 °C to 33 °C), or moderate (28 °C to 30 °C) hypothermic groups. RESULTS Out of 275 patients, 245 (89.09%) fit the inclusion criteria. The cohort with mild hypothermic CPB temperatures presented better clinical outcomes in terms of requiring less inotropic support, less blood loss, fewer blood transfusions, improved platelet counts, shorter in-hospital stays, and required less ventilation support, when compared with other hypothermic groups. CONCLUSIONS Mild hypothermic CPB (34 °C to 36 °C) may produce better clinical outcomes for cardiac surgery and improve the quality of health of cardiac patients.
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Affiliation(s)
- Adnan Haider
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
- Department of Cardiovascular Surgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Irfan Azmatullah Khwaja
- Department of Cardiovascular Surgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Abdul Basit Qureshi
- Department of Surgery, Services Institute of Medical Sciences, Lahore 54810, Pakistan;
| | - Imran Khan
- Department of Cardiolothoracic and Vascular Surgery, Almana General Hospital, AL Khobar 31952, Saudi Arabia;
| | - Khalid Abdul Majeed
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
| | - Muhammad Shahbaz Yousaf
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
| | - Hafsa Zaneb
- Department of Anatomy and Histology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Abdul Rehman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Imtiaz Rabbani
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
| | - Sajid Khan Tahir
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
| | - Habib Rehman
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (K.A.M.); (M.S.Y.); (I.R.); (S.K.T.)
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Xiong T, Pu L, Ma YF, Zhu YL, Cui X, Li H, Zhan X, Li YX. Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A System Review and Meta-Analysis. Front Pediatr 2021; 9:757551. [PMID: 34970516 PMCID: PMC8712704 DOI: 10.3389/fped.2021.757551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/24/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: Hypothermic cardiopulmonary bypass (HCPB) has been used successfully in cardiac surgery for more than half a century, although adverse effects have been reported with its use. Many studies on temperature management during CPB published to date have shown that normothermic CPB (NCPB) provides more benefits to children undergoing cardiac surgery. The present meta-analysis investigated the effect of NCPB on clinical outcomes based on results of randomized controlled trials and observational studies on pediatric cardiac surgery. Methods: Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov were searched from inception to May 2021 to identify relevant studies published in English. Results: The present meta-analysis included 13 studies characterizing a total of 837 pediatric patients. The random effects model exhibited that the NCPB group had reduced revision for postoperative bleeding [odds ratio (OR): 0.11; 95% confidence interval (CI): 0.01-0.89; I 2 = 0%, P = 0.04], serum lactate 2-4 h after CPB (mean difference: -0.60; 95% CI: -1.09 to -0.11; I 2 = 82%, P = 0.02), serum creatinemia 24 h after CPB (mean difference: -2.73; 95% CI: -5.06 to -0.39; I 2 = 83%, P = 0.02), serum creatinemia 48 h after CPB (mean difference: -2.08; 95% CI: -2.78 to -1.39; I 2 = 0%, P < 0.05), CPB time (mean difference: -19.10, 95% CI: -32.03 to -6.18; I 2 = 96%, P = 0.04), and major adverse events (OR: 0.37; 95% CI: 0.15-0.93; Z = 2.12, P = 0.03) after simple congenital surgery compared with the HCPB group. Conclusion: NCPB is as safe as HCPB in pediatric congenital heart surgery. Moreover, NCPB provides more advantages than HCPB in simple congenital heart surgery.
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Affiliation(s)
- Tao Xiong
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Pu
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Yuan-Feng Ma
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yun-Long Zhu
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xu Cui
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Hua Li
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Xu Zhan
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Ya-Xiong Li
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
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