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Sandrio S, Beck G, Krebs J, Otto M. [Peripheral extracorporeal membrane oxygenation in perioperative medicine : Principles, indications and challenges]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02135-5. [PMID: 39145870 DOI: 10.1007/s00104-024-02135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/16/2024]
Abstract
In recent years the number of patients treated in intensive care units by extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure or cardiogenic shock has steadily increased [1]. Consequently, the number of invasive procedures and operations in these patients has also increased. A fundamental understanding of these systems and the clinical indications is therefore helpful for the practicing (non-cardiac) surgeon. This review article focuses on peripheral ECMO procedures: venovenous (V-V) ECMO for patients with respiratory failure and venoarterial (V-A) ECMO for circulatory support in cardiogenic shock.
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Affiliation(s)
- Stany Sandrio
- Klinik für Anästhesiologie, Operative Intensiv- und Schmerzmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Grietje Beck
- Klinik für Anästhesiologie, Operative Intensiv- und Schmerzmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Joerg Krebs
- Klinik für Anästhesiologie, Operative Intensiv- und Schmerzmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Matthias Otto
- Klinik für Anästhesiologie, Operative Intensiv- und Schmerzmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Sabe SA, Harris DD, Broadwin M, Sellke FW. Cardioprotection in cardiovascular surgery. Basic Res Cardiol 2024; 119:545-568. [PMID: 38856733 DOI: 10.1007/s00395-024-01062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
Since the invention of cardiopulmonary bypass, cardioprotective strategies have been investigated to mitigate ischemic injury to the heart during aortic cross-clamping and reperfusion injury with cross-clamp release. With advances in cardiac surgical and percutaneous techniques and post-operative management strategies including mechanical circulatory support, cardiac surgeons are able to operate on more complex patients. Therefore, there is a growing need for improved cardioprotective strategies to optimize outcomes in these patients. This review provides an overview of the basic principles of cardioprotection in the setting of cardiac surgery, including mechanisms of cardiac injury in the context of cardiopulmonary bypass, followed by a discussion of the specific approaches to optimizing cardioprotection in cardiac surgery, including refinements in cardiopulmonary bypass and cardioplegia, ischemic conditioning, use of specific anesthetic and pharmaceutical agents, and novel mechanical circulatory support technologies. Finally, translational strategies that investigate cardioprotection in the setting of cardiac surgery will be reviewed, with a focus on promising research in the areas of cell-based and gene therapy. Advances in this area will help cardiologists and cardiac surgeons mitigate myocardial ischemic injury, improve functional post-operative recovery, and optimize clinical outcomes in patients undergoing cardiac surgery.
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Affiliation(s)
- Sharif A Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Dwight D Harris
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Mark Broadwin
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA.
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Liu T, Dogan I, Rothe M, Potapov E, Schoenrath F, Gollasch M, Luft FC, Gollasch B. Effect of cardiopulmonary bypass on plasma and erythrocytes oxylipins. Lipids Health Dis 2023; 22:138. [PMID: 37644527 PMCID: PMC10463967 DOI: 10.1186/s12944-023-01906-z] [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: 04/12/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Oxylipins, the oxidative metabolites of polyunsaturated fatty acids (PUFAs), serve as key mediators of oxidative stress, inflammatory responses, and vasoactive reactions in vivo. Our previous work has established that hemodialysis affects both long chain fatty acids (LCFAs) and oxylipins in plasma and erythrocytes to varying degrees, which may be responsible for excess cardiovascular complications in end-stage renal disease. In this study, we aimed to determine changes in blood oxylipins during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery to identify novel biomarkers and potential metabolites of CPB-related complications. We tested the hypothesis that CPB would differentially affect plasma oxylipins and erythrocytes oxylipins. METHODS We conducted a prospective observational study of 12 patients undergoing elective cardiac surgery with expected CPB procedure. We collected venous and arterial blood samples before CPB, 15 and 45 min after the start of CPB, and 60 min after the end of CPB, respectively. Oxylipins profiling in plasma and erythrocytes was achieved using targeted HPLC-MS mass spectrometry. RESULTS Our results revealed that most venous plasma diols and hydroxy- oxylipins decreased after CPB initiation, with a continuous decline until the termination of CPB. Nevertheless, no statistically significant alterations were detected in erythrocytes oxylipins at all time points. CONCLUSIONS CPB decreases numerous diols and hydroxy oxylipins in blood plasma, whereas no changes in erythrocytes oxylipins are observed during this procedure in patients undergoing cardiac surgery. As lipid mediators primarily responsive to CPB, plasma diols and hydroxy oxylipins may serve as potential key biomarkers for CPB-related complications.
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Affiliation(s)
- Tong Liu
- Experimental and Clinical Research Center (ECRC), a joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular Medicine, 13125 Berlin, Germany
| | - Inci Dogan
- LIPIDOMIX GmbH, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - Michael Rothe
- LIPIDOMIX GmbH, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany Charité − Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany Charité − Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Maik Gollasch
- Experimental and Clinical Research Center (ECRC), a joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular Medicine, 13125 Berlin, Germany
- Department of Internal Medicine and Geriatrics, University Medicine, Greifswald, 17475 Greifswald, Germany
| | - Friedrich C. Luft
- Experimental and Clinical Research Center (ECRC), a joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular Medicine, 13125 Berlin, Germany
| | - Benjamin Gollasch
- Experimental and Clinical Research Center (ECRC), a joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular Medicine, 13125 Berlin, Germany
- Department of Nephrology and Internal Intensive Care, Charité – University Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
- HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
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Trancart L, Rey N, Scherrer V, Wurtz V, Bauer F, Aludaat C, Demailly Z, Selim J, Compère V, Clavier T, Besnier E. Effect of mechanical ventilation during cardiopulmonary bypass on end-expiratory lung volume in the perioperative period of cardiac surgery: an observational study. J Cardiothorac Surg 2022; 17:331. [PMID: 36550556 PMCID: PMC9784092 DOI: 10.1186/s13019-022-02063-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many studies explored the impact of ventilation during cardiopulmonary bypass (CPB) period with conflicting results. Functional residual capacity or End Expiratory Lung Volume (EELV) may be disturbed after cardiac surgery but the specific effects of CPB have not been studied. Our objective was to compare the effect of two ventilation strategies during CPB on EELV. METHODS Observational single center study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative intra and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Main endpoint was EELV at the end of surgery. Secondary endpoints were EELV one hour after ICU admission, PaO2/FiO2 ratio, driving pressure, duration of mechanical ventilation and post-operative pulmonary complications. RESULTS Forty consecutive patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796 ± 586 mL vs. 1844 ± 524 mL, p = 1) and one hour after ICU admission (2095 ± 562 vs. 2045 ± 476 mL, p = 1). No significant difference between the two groups was observed on PaO2/FiO2 ratio (end of surgery: 339 ± 149 vs. 304 ± 131, p = 0.8; one hour after ICU: 324 ± 115 vs. 329 ± 124, p = 1), driving pressure (end of surgery: 7 ± 1 vs. 8 ± 1 cmH2O, p = 0.3; one hour after ICU: 9 ± 3 vs. 9 ± 3 cmH2O), duration of mechanical ventilation (5.5 ± 4.8 vs 8.2 ± 10.0 h, p = 0.5), need postoperative respiratory support (2 vs. 1, p = 1), occurrence of pneumopathy (2 vs. 0, p = 0.5) and radiographic atelectasis (7 vs. 8, p = 1). CONCLUSION No significant difference was observed in EELV after cardiac surgery between not ventilated and ventilated patients during CPB.
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Affiliation(s)
- Léa Trancart
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Nathalie Rey
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Vincent Scherrer
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Véronique Wurtz
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France
| | - Fabrice Bauer
- grid.41724.340000 0001 2296 5231Department of Cardiac Surgery, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Chadi Aludaat
- grid.41724.340000 0001 2296 5231Department of Cardiac Surgery, CHU Rouen, 76031 Rouen, France
| | - Zoe Demailly
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Jean Selim
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Vincent Compère
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1239, 76000 Rouen, France
| | - Thomas Clavier
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Department of Anaesthesiology and Critical Care, CHU Rouen, 76031 Rouen, France ,grid.10400.350000 0001 2108 3034Rouen Univ, Inserm U1096, EnVi, 76000 Rouen, France ,grid.417615.0Departement d’Anesthésie-Réanimation, CHU Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
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Russell C, Keshavamurthy S. Acute Massive and Submassive Pulmonary Embolism: Historical Considerations/Surgical Techniques of Pulmonary Embolectomy/Novel Applications in Donor Lungs with Pulmonary Emboli. Int J Angiol 2022; 31:188-193. [PMID: 36157100 PMCID: PMC9507568 DOI: 10.1055/s-0042-1756178] [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: 10/14/2022] Open
Abstract
Pulmonary embolectomy has a chequered history but the quest to surgically treat a patient diagnosed with pulmonary embolism effectively spurred the development of cardiopulmonary bypass and a new dawn for cardiac surgery. The advent of cardiopulmonary bypass, extracorporeal membrane oxygenation, and computed tomography pulmonary angiogram has allowed rapid diagnosis and made surgical pulmonary embolectomy a relatively safe procedure that should be considered when indicated. Pulmonary emboli in donor lungs, often get rejected for transplantation. Ex vivo lung perfusion is among newly available technology with the ability to not only recondition marginal lungs but also treat donor lung pulmonary embolisms, effectively increasing the donor pool.
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Affiliation(s)
- Cody Russell
- The American University of the Caribbean School of Medicine, Pembroke Pines, Florida
| | - Suresh Keshavamurthy
- University of Kentucky College of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Lexington, Kentucky
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Zhang S, Huang S, Tiemuerniyazi X, Song Y, Feng W. A Meta-Analysis of Early, Mid-term and Long-Term Mortality of On-Pump vs. Off-Pump in Redo Coronary Artery Bypass Surgery. Front Cardiovasc Med 2022; 9:869987. [PMID: 35548406 PMCID: PMC9081922 DOI: 10.3389/fcvm.2022.869987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to compare the early, mid-term, and long-term mortality between on-pump vs. off-pump redo coronary artery bypass grafting (CABG). We conducted a systematic search for studies comparing clinical outcomes of patients who underwent on-pump vs. off-pump redo CABG. We pooled the relevant studies quantitatively to compare the early (perioperative period, whether in hospital or within 30 days after discharge), mid-term (≥1 year and <5 years), and long-term (≥5 year) mortality of on-pump vs. off-pump redo CABG. A random-effect model was applied when there was high heterogeneity (I2 > 50%) between studies. Otherwise, a fixed-effect model was utilized. After systematic literature searching, 22 studies incorporating 5,197 individuals (3,215 in the on-pump group and 1,982 in the off-pump group) were identified. A pooled analysis demonstrated that compared with off-pump redo CABG, on-pump redo CABG was associated with higher early mortality (OR 2.11, 95%CI: 1.54-2.89, P < 0.00001). However, no significant difference was noted in mid-term mortality (OR 1.12, 95%CI: 0.57-2.22, P = 0.74) and long-term mortality (OR 1.12, 95%CI: 0.41-3.02, P = 0.83) between the two groups. In addition, the complete revascularization rate was higher in the on-pump group than the off-pump group (OR 2.61, 95%CI: 1.22-5.60, P = 0.01). In conclusion, the off-pump technique is a safe and efficient alternative to the on-pump technique, with early survival advantage and similar long-term mortality to the on-pump technique in the setting of redo CABG, especially in high-risk patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021244721.
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Affiliation(s)
| | | | | | | | - Wei Feng
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Machine Perfusion of the Human Heart. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This brief communication about machine perfusion of potential human donor hearts describes its historical development. Included in the review are both the isolated perfusion of donor hearts retrieved from heart beating and non-heart-beating donors. Additionally, some detail of in-situ (within the donor body) normothermic regional reperfusion of the heart and other organs is given. This only applies to the DCD donor heart. Similarly, some detail of ex-situ (outside the body) heart perfusion is offered. This article covers the entire history of the reperfusion of donor hearts. It takes us up to the current day describing 6 years follow-up of these donor machine perfused hearts. These clinical results appear similar to the outcomes of heart beating donors if reperfusion is managed within 30 min of normothermic circulatory determined death. Future developments are also offered. These are 3-fold and include: i. the pressing need for objective markers of the clinical outcome after transplantation, ii. the wish for isolated heart perfusion leading to improvement in donor heart quality, and iii. a strategy to safely lengthen the duration of isolated heart perfusion.
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Hatami S, Hefler J, Freed DH. Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support. Front Immunol 2022; 13:831930. [PMID: 35309362 PMCID: PMC8931031 DOI: 10.3389/fimmu.2022.831930] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.
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Affiliation(s)
- Sanaz Hatami
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Canadian National Transplant Research Program, Edmonton, AB, Canada
| | - Joshua Hefler
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Darren H. Freed
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Canadian National Transplant Research Program, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
- Alberta Transplant Institute, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Darren H. Freed,
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Moh'd AF, Al-Odwan HT, Altarabsheh S, Makahleh ZM, Khasawneh MA. Predictors of aortic clamp time duration and intensive care unit length of stay in elective adult cardiac surgery. Egypt Heart J 2021; 73:92. [PMID: 34677684 PMCID: PMC8536812 DOI: 10.1186/s43044-021-00195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Aortic cross-clamp utilized during cardiac surgery facilitates motionless and bloodless surgical field. However, the duration of clamp time has an inverse effect on early post-operative recovery period. In this study, we sought to examine the predictors of aortic clamp duration and intensive care unit length of stay.
Results Six hundred and nine adult patients presented for elective cardiac surgery between December 2019 and December 2020 were enrolled. The age of patients ranged from 18 to 82 years (mean 55.62 years, SD ± 12.3 years). Male/female ratio is 4.6:1. Most patients (87.2%) were planned for coronary artery bypass grafting (CABG) and 78 patients (12.8%) for single heart valve procedure. Operative time (OT) ranged from 120 to 402 min and averaged 259.4 min (SD ± 45.9 min). ACC time ranged from 15 to 159 min and averaged 50.56 min (SD ± 19.4 min). Factors associated with significantly longer ACCT were: smoking (OR = 1.89 (95% CI 1.3–2.74), p value = 0.01), respiratory disease (OR = 0.48 (95% CI 0.24–0.96), p value = 0.039), obesity (OR = 1.76 (95% CI 1.18–2.63), p value = 0.005) and AVR (OR = 2.11 (95% CI 1.17–3.83), p value = 0.013). Low cardiac output syndrome (LCOS) was observed in 19.2% of patients. Longer than average ACCT was associated with increased use of inotropes (p value < 0.001), intra-aortic balloon pump (p value < 0.001) and first 24 h post-operative blood loss (p value < 0.001). The average intensive care unit length of stay (ICULOS) was 1.64 days (SD ± 1.1 days). Patients' ACCT converged positively and significantly on ICULOS (Beta coefficient = 1.013 (95% CI 1.01–1.015), p value < 0.001). Conclusion Aortic cross-clamping is a crucial method in cardiac surgery to achieve motionless field; however, prolongation of this method had an incremental risks for the development of low cardiac output syndrome, increased first 24 h post-operative blood loss and longer stay in the intensive care unit. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00195-0.
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Affiliation(s)
- Ashraf Fadel Moh'd
- Queen Alia Heart Institute/Jordanian Royal Medical Services, Amman, Jordan.
| | | | - Salah Altarabsheh
- Cardiac Surgery Department, Queen Alia Heart Institute/Jordanian Royal Medical Services, Amman, Jordan
| | - Zeid Mohammad Makahleh
- Cardiac Surgery Department, Queen Alia Heart Institute/Jordanian Royal Medical Services, Amman, Jordan
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Demeekul K, Sukumolanan P, Bootcha R, Panprom C, Petchdee S. A Cardiac Protection of Germinated Brown Rice During Cardiopulmonary Bypass Surgery and Simulated Myocardial Ischemia. J Inflamm Res 2021; 14:3307-3319. [PMID: 34290516 PMCID: PMC8289443 DOI: 10.2147/jir.s321241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The potential cardio-protective property of germinated brown rice (GBR) has been revealed by ameliorating risk factors related to cardiovascular diseases. This study hypothesized that the combination of GBR and cardioplegic solution could protect the cardiomyocytes exposed to simulated ischemic reperfusion injury in vitro study and preserve cardiac function during cardiopulmonary bypass surgery in animal models. Methods Primary porcine cardiomyocytes were isolated and experimented cell viability against simulated ischemic reperfusion injury. In a cardiac surgical animal model, six pigs were randomly assigned to receive the two types of cardioplegic solution: i) St. Thomas cardioplegic solution (20 cc/kg); and ii) St. Thomas cardioplegic solution plus GBR (1 mg/kg). During open-heart surgery, the aorta was cross-clamped for 20 minutes, followed by reperfusion for 1 hour. Cardiopulmonary bypass parameters were recorded until the end of the procedure. Furthermore, hemodynamic parameters and arterial blood gas characteristics of animals among groups were monitored at different time points, including baseline before cardiopulmonary bypass (T1), during cardiopulmonary bypass (T2), during aortic clamp on (T3), and aortic clamp off (T4). Results Primarily, GBR cotreatment with cardioplegic solution essentially resulted in the improvement of cell viability in primary porcine cardiomyocytes against simulated ischemic reperfusion induction. The findings from cardiac surgery demonstrated that mean arterial pressure and heart rate are constantly stable in cardioplegic solution combined with the GBR group, while the trend of potassium and lactase concentration was decreased in the animals receiving GBR group. Consistently, all parameters from arterial blood gas showed better outcomes in animals receiving GBR; however, there were no statistically significant differences between groups, except hepatic enzymes. Conclusion Therefore, GBR might exert cardio-protective effects against ischemic reperfusion injury in the porcine cardiac surgery model due to anti-inflammatory response. These protective actions of GBR may explain the benefits gained from applying GBR products as a possible therapeutic supplement on cardiac diseases.
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Affiliation(s)
- Kanokwan Demeekul
- Graduate School, Program of Bio-Veterinary Science, Kasetsart University, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Pratch Sukumolanan
- Veterinary Clinical Study Program, Faculty of Veterinary Medicine, Kasetsart University, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Ratikorn Bootcha
- Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Chattida Panprom
- Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kamphaeng Saen, Nakorn Pathom, Thailand
| | - Soontaree Petchdee
- Department of Large Animal and Wildlife Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, KamphaengSaen Campus, Kamphaeng Saen, Thailand
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11
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Chong A, Sun Z, van de Velde L, Jansen S, Versluis M, Reijnen MMPJ, Groot Jebbink E. A novel roller pump for physiological flow. Artif Organs 2020; 44:818-826. [PMID: 32065666 PMCID: PMC7496437 DOI: 10.1111/aor.13670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 01/24/2023]
Abstract
Having physiological correct flow waveforms is a key feature for experimental studies of blood flow, especially in the process of developing and testing a new medical device such as stent, mechanical heart valve, or any implantable medical device that involves circulation of blood through the device. It is also a critical part of a perfusion system for cardiopulmonary bypass and extracorporeal membrane oxygenation procedures. This study investigated the feasibility of a novel roller pump for use in experimental flow phantoms. Flow rates of carotid flow profile measured directly with the ultrasonic flow meter matched well with the reference flow rates programmed into the machine with similarity index of 0.97 and measured versus programmed flow rates at specific time‐points of peak systolic velocity (PSV): 0.894 vs 0.880, end systolic velocity (ESV): 0.333 vs 0.319, and peak diastolic velocity (PDV): 0.514 vs 0.520 L/min. Flow rates derived from video analysis of the pump motion for carotid, suprarenal, and infrarenal flows also matched well with references with similarity indices of 0.99, 0.99, and 0.96, respectively. Measured flow rates (mean/standard deviation) at PSV, ESV, and PDV time‐points for carotid: 0.883/0.016 vs 0.880, 0.342/0.007 vs 0.319, and 0.485/0.009 vs 0.520; suprarenal: 3.497/0.014 vs 3.500, 0.004/0.003 vs 0, and 1.656/0.073 vs 1.453; infrarenal: 4.179/0.024 vs 4.250, −1.147/0.015 vs −1.213, and 0.339/0.017 vs 0.391 L/min, respectively. The novel roller pump is suitable for benchtop testing of physiological flow.
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Affiliation(s)
- Albert Chong
- Department of Medical Radiation Sciences, Curtin University, Perth, WA, Australia
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA, Australia
| | - Lennart van de Velde
- Multi-Modality Medical Imaging (M3I) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Surgery, Rijnstate, Arnhem, The Netherlands.,Physics of Fluids Group, TechMed Center and MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Vascular Surgery, Curtin University, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Michel Versluis
- Multi-Modality Medical Imaging (M3I) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Physics of Fluids Group, TechMed Center and MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - Michel M P J Reijnen
- Multi-Modality Medical Imaging (M3I) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Surgery, Rijnstate, Arnhem, The Netherlands
| | - Erik Groot Jebbink
- Multi-Modality Medical Imaging (M3I) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Surgery, Rijnstate, Arnhem, The Netherlands
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12
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Anderson K, Ziegler O, Shi G, Sodha N, Ikeda I, Feng J, Sellke F. Younger age is associated with greater early neurocognitive decline postcardiopulmonary bypass. JTCVS OPEN 2020; 1:1-9. [PMID: 36445369 PMCID: PMC9665169 DOI: 10.1016/j.xjon.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/06/2019] [Accepted: 02/03/2020] [Indexed: 12/14/2022]
Abstract
Objective To examine the effect of aging on postoperative neurocognitive decline (NCD) in cardiac surgery patients. Methods Patients undergoing coronary artery bypass graft or open aortic valve replacement were administered the Repeatable Battery for the Assessment of Neuropsychological Status at preoperative, postoperative day (POD) 4, and 1 month. Blood samples were collected at preoperative, 6 hours postoperative, and POD 4. Plasma interleukin (IL)-6, tumor necrosis factor-α, and C-reactive protein (CRP) levels were quantified. Quality of life was measured with the 12-Item Short Form Health Survey. Data were analyzed using paired ratio and unpaired t tests with Welch's correction, and linear regression for cytokine levels. Results NCD occurred in 15 patients (N = 33, 45.5%). Dichotomized at age extremes (<60 years; ≥75 years), youngest patients had greater preoperative scores (P = .02) with lower scores by POD 4 (P = .03). There was no NCD in the oldest patients, and scores were not different between age groups on POD 4 (P = .08). Regression at 1 month showed NCD scores again declined by age (n = 15), with younger scores returning toward baseline (P = .008). Regression analyses showed decline by age at 6 hours postoperative and POD 4 in plasma CRP levels (P = .05 6 hours, P = .02 POD 4). Dichotomizing IL-6 levels by age (<70 years, ≥70 years) demonstrated that levels were greater in younger versus older patients at 6 hours postoperative (P = .03), but not on POD 4. Conclusions Younger patients tend to have better cognitive scores before surgery but scores at POD 4 are similar to those of older patients, with this trend disappearing at 1 month. IL-6 and CRP upregulation is greater in younger patients, suggesting that a robust perioperative inflammatory response may be associated with reduction in neurocognitive function, and this may be greater in younger versus older patients.
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Key Words
- CABG, coronary artery bypass grafting
- CP, cardioplegia
- CPB
- CPB, cardiopulmonary bypass
- CRP, C-reactive protein
- IL, interleukin
- MCS, mental component summary
- NCD, neurocognitive decline
- PCS, physical component summary
- POD, postoperative day
- QOL, quality of life
- RBANS, Repeatable Battery for the Assessment of Neuropsychological Status
- SF-12, 12-Item Short Form Health Survey
- TNF-α, tumor necrosis factor-α
- age
- cardiothoracic surgery
- inflammation
- neurocognitive decline
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Affiliation(s)
| | - Olivia Ziegler
- Alpert Medical School of Brown University, Providence, RI
| | - Guangbin Shi
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Neel Sodha
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Ian Ikeda
- Alpert Medical School of Brown University, Providence, RI
| | - Jun Feng
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Frank Sellke
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
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13
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Huber W, Ruiz de Garibay AP. Options in extracorporeal support of multiple organ failure. Med Klin Intensivmed Notfmed 2020; 115:28-36. [PMID: 32095838 PMCID: PMC7220977 DOI: 10.1007/s00063-020-00658-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
Multiorgan failure is among the most frequent reasons of death in critically ill patients. Based on extensive and long-term use of renal replacement therapy, extracorporeal organ support became available for other organ failures. Initially, most of these techniques (e.g. extracorporeal membrane oxygenation, extracorporeal CO2 removal [ECCO2R] and extracorporeal liver support) were used as stand-alone single organ support systems. Considering multiple interactions between native organs (“crosstalk”), combined or integrated extracorporeal organ support (ECOS) devices are intriguing. The concept of multiple organ support therapy (MOST) providing simultaneous and combined support for different failing organs was described more than 15 years ago by Ronco and Bellomo. This concept also implicates overcoming the “compartmentalized” approach provided by different single organ specialized professionals by a multidisciplinary and multiprofessional strategy. The idea of MOST is supported by the failure of several recent studies on single organ support including liver and lung support. Improvement of outcome by ECOS necessarily depends on optimized patient selection, integrated organ support and limitation of its side effects. This implicates challenges for engineers, industry and healthcare professionals. From a technical viewpoint, modular combination of pre-existing technologies such as renal replacement, albumin-dialysis, ECCO2R and potentially cytokine elimination can be considered as a first step. While this allows for stepwise and individual combination of standard organ support facilities, it carries the disadvantage of large extracorporeal blood volume and surfaces as well as additive costs. The more intriguing next step is an integrated platform providing the capacity of multiple organ support within one device. (This article is freely available.)
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Affiliation(s)
- W Huber
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany.
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14
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Numerical Investigation of Blood Flow Characteristics through Cannulated Aorta. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2019. [DOI: 10.4028/www.scientific.net/jbbbe.43.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cannulation of the aorta is done in order to provide oxygenation and circulatory function through the use of the heart lung machine during cardio-pulmonary bypass (CPB). The nature of the blood flow through the aorta and its ramifications during CPB is mostly linear as compared to the physiological flow, which is pulsatile in nature. This leads to the development of multiple morbidities caused by the development of emboli and atheromas. Perioperative postoperative care is necessitated by these conditions. As such the understanding of the blood flow characteristics is necessitated in order to effectively prevent the formation of emboli and to prevent the "Sandblasting" effect. The authors in this work seek to investigate the nature of blood flow through the aorta under such circumstances. The results obtained show the nature of blood flow in the cannulated aorta as well as the optimum angle of placement of the cannula with respect to the aortic wall.
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15
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Nguyen LS, Merzoug M, Estagnasie P, Brusset A, Law Koune JD, Aubert S, Waldmann T, Grinda JM, Gibert H, Squara P. Low tidal volume mechanical ventilation against no ventilation during cardiopulmonary bypass heart surgery (MECANO): study protocol for a randomized controlled trial. Trials 2017; 18:582. [PMID: 29197407 PMCID: PMC5712097 DOI: 10.1186/s13063-017-2321-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/08/2017] [Indexed: 11/11/2022] Open
Abstract
Background Postoperative pulmonary complications are a leading cause of morbidity and mortality after cardiac surgery. There are no recommendations on mechanical ventilation associated with cardiopulmonary bypass (CPB) during surgery and anesthesiologists perform either no ventilation (noV) at all during CPB or maintain low tidal volume (LTV) ventilation. Indirect evidence points towards better pulmonary outcomes when LTV is performed but no large-scale prospective trial has yet been published in cardiac surgery. Design The MECANO trial is a single-center, double-blind, randomized, controlled trial comparing two mechanical ventilation strategies, noV and LTV, during cardiac surgery with CPB. In total, 1500 patients are expected to be included, without any restrictions. They will be randomized between noV and LTV on a 1:1 ratio. The noV group will receive no ventilation during CPB. The LTV group will receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive end-expiratory pressure of 5 cmH2O. The primary endpoint will be a composite of all-cause mortality, early respiratory failure defined as a ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg at 1 hour after arrival in the ICU, heavy oxygenation support (defined as a patient requiring either non-invasive ventilation, mechanical ventilation or high-flow oxygen) at 2 days after arrival in the ICU or ventilator-acquired pneumonia defined by the Center of Disease Control. Lung recruitment maneuvers will be performed in the noV and LTV groups at the end of surgery and at arrival in ICU with an insufflation at +30 cmH20 for 5 seconds. Secondary endpoints are those composing the primary endpoint with the addition of pneumothorax, CPB duration, quantity of postoperative bleeding, red blood cell transfusions, revision surgery requirements, length of stay in the ICU and in the hospital and total hospitalization costs. Patients will be followed until hospital discharge. Discussion The MECANO trial is the first of its kind to compare in a double-blind design, a no-ventilation to a low-tidal volume strategy for mechanical ventilation during cardiac surgery with CPB, with a primary composite outcome including death, respiratory failure and postoperative pneumonia. Trial registration ClinicalTrials.gov, NCT03098524. Registered on 27 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2321-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lee S Nguyen
- Critical Care Medicine Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
| | - Messaouda Merzoug
- Critical Care Medicine Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France
| | - Philippe Estagnasie
- Critical Care Medicine Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France
| | - Alain Brusset
- Critical Care Medicine Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France
| | | | - Stephane Aubert
- Cardiac Surgery Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Thierry Waldmann
- Cardiac Surgery Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Jean-Michel Grinda
- Cardiac Surgery Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Hadrien Gibert
- Anesthesiology Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Pierre Squara
- Critical Care Medicine Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France
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