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Ohri SK, Abel PD. Review article : The pathophysiology of nephrourological complications following cardiopulmonary bypass. Perfusion 2016. [DOI: 10.1177/026765919100600202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- SK Ohri
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Royal Postgraduate Medical School
| | - PD Abel
- Department of Urology, Hammersmith Hospital, Royal Postgraduate Medical School, London
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Mathie RT, Desai JB, Taylor KM. The effect of normothermic cardiopulmonary bypass on hepatic blood flow in the dog. Perfusion 2016. [DOI: 10.1177/026765918600100403] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatic blood flow was investigated in two groups of eight anaesthetized dogs during and after one hour of either pulsatile or non-pulsatile cardiopulmonary bypass (CPB). Mean perfusion pressure was maintained at 60 mmHg. Hepatic arterial (HA) and portal venous (PV) blood flows were measured using electromagnetic flow probes, and hepatic O 2 consumption determined. The results demonstrate that: (a) pulsatile CPB reduces peripheral vascular resistance during and after perfusion, and more effectively preserves pump flow rate and cardiac output than non-pulsatile CPB; (b) total liver blood flow is sustained more effectively by pulsatile CPB than by non-pulsatile CPB due to relative preservation of both HA and PV flows; (c) hepatic O2 consumption is only marginally better preserved during and after pulsatile CPB than with non-pulsatile perfusion. We conclude that: (a) pulsatile CPB tends to maintain hepatic blood flow through a relative reduction in HA vascular resistance and an improvement in PV flow produced passively by a greater pump flow rate; (b) pulsatile CPB less effectively benefits hepatic O2 consumption because of poor O2 uptake from the hepatic PV blood supply.
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Affiliation(s)
- RT Mathie
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital
| | - JB Desai
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital
| | - KM Taylor
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital
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Kiessling AH, Khalil M, Assaf O, Isgro F, Kretz KU, Saggau W. Blood-Air Interface during Cardiopulmonary Bypass. Asian Cardiovasc Thorac Ann 2016; 12:198-201. [PMID: 15353455 DOI: 10.1177/021849230401200304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to compare the systemic blood activation with open and closed perfusion management during cardiopulmonary bypass. In 30 patients undergoing coronary artery bypass grafting, we prospectively studied systemic blood activation, blood loss and the need for donor blood. In 15 patients we used an open venous reservoir consisting of a hard shell venous reservoir with an integrated cardiotomy filter. In another 15 patients we used a totally closed venous reservoir consisting of a collapsible venous reservoir, no coronary suction, modified vent and cell saver. Venous blood samples were collected pre, post and 24 hours postoperatively. Sex, age and perfusion times were identical in both groups. There were no statistically significant differences in concentrations of FXIIa and C3a, amount of blood loss and need for donor blood. Interleukin-6 and Elastase levels showed trends toward a lesser inflammatory reaction in closed venous reservoir patients. Modification of perfusion management with optimized air management does not seem to be an effective strategy in reducing the inflammatory response and influencing the coagulation system in this small cohort.
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Affiliation(s)
- Arndt-H Kiessling
- Heartcenter Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Germany.
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Role of nitric oxide in regulation of systemic vascular resistance during and after cardiopulmonary bypass. J Artif Organs 1999. [DOI: 10.1007/bf02480059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This report discusses pulsatile and nonpulsatile perfusion with regard to hemodynamics, cell metabolism, and the visceral consequences of these forms of cardiopulmonary bypass. It argues that differences between the two modes and a benefit for pulsatile perfusion, are most clearly manifested in identifiable high-risk patient groups.
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Affiliation(s)
- P Hornick
- Department of Cardiothoracic Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Mathie RT, Ohri SK, Keogh BE, Williams J, Siney L, Griffith TM. Nitric oxide activity in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996; 112:1394-5. [PMID: 8911343 DOI: 10.1016/s0022-5223(96)70160-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R T Mathie
- Department of Surgery, Royal Postgraduate Medical School, London, United Kingdom
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Mathie RT, Fleming JS, Barrow SE, Arnold JV, Brannan JJ, Becket JM, Ritter JM, Taylor KM. The haemodynamic effects of the thromboxane A2 receptor antagonist GR32191B during cardiopulmonary bypass in the dog. Perfusion 1995; 10:403-13. [PMID: 8747897 DOI: 10.1177/026765919501000604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study examined whether treatment with the specific thromboxane (TX) A2 receptor antagonist GR32191B would result in an improvement in peripheral haemodynamics during and after cardiopulmonary bypass (CPB) in anaesthetized dogs compared with animals given either saline (control) or aspirin. Following thoracotomy, heparinization and aortic cannulation, and 35 minutes before CPB, dogs received intravenously either GR32191B (15 micrograms/kg/min), saline (50 ml bolus) or aspirin (225 mg bolus) (n = 6 per group). Cardiac output (dye dilution), femoral artery blood flow (electromagnetic flowmeter), gastrocnemius muscle tissue perfusion (133Xe clearance), retinal blood flow (fluorescein angiography), and thromboxane biosynthesis (urinary excretion rates of TXB2 and the metabolite 2,3-dinor-TXB2) were measured before, during and after a standard 90 minute period of CPB at 2.4 l/min/m2 and 28 degrees C. The aspirin-treated group manifested an eightfold reduction in TXB2 excretion compared with controls, indicating a decrease in TXA2 biosynthesis. There were few haemodynamic differences between the groups, though the aspirin-treated group had better maintained muscle tissue perfusion post-CPB and significantly fewer retinal microcirculatory occlusions than GR32191B-treated animals. We conclude that specific TXA2 receptor antagonism provides no significant improvement in peripheral haemodynamics; rather aspirin provides a modest haemodynamic benefit.
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Affiliation(s)
- R T Mathie
- Department of Surgery, Royal Postgraduate Medical School, London
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Tuman KJ, McCarthy RJ, OʼConnor CJ, Holm WE, Ivankovich AD. Angiotensin-Converting Enzyme Inhibitors Increase Vasoconstrictor Requirements After Cardiopulmonary Bypass. Anesth Analg 1995. [DOI: 10.1213/00000539-199503000-00007] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tuman KJ, McCarthy RJ, O'Connor CJ, Holm WE, Ivankovich AD. Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass. Anesth Analg 1995; 80:473-9. [PMID: 7864410 DOI: 10.1097/00000539-199503000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstrictor therapy required to maintain systolic blood pressure at more than 85 mm Hg despite a normal cardiac output after CPB in 4301 adults undergoing elective coronary artery and/or valve surgery. Hypothermic, nonpulsatile CPB and either opioid or ketamine-benzodiazepine anesthesia were common features of the operations. At least two vasoconstrictor infusions (phenylephrine, norepinephrine, or dopamine) were required for low perfusion pressure despite adequate cardiac output after CPB in 7.7% of 519 ACE-inhibited patients and 4.0% of 3782 patients not receiving ACE inhibitors (P = 0.0001). In the first 4 h after arrival in the intensive care unit, the need for vasoconstrictor infusions to treat hypotension with adequate cardiac output did not differ, although more ACE-inhibited patients (6.4%) exhibited low values of systemic vascular resistance (< 600 dyne.s.cm-5) than patients not receiving ACE inhibitors (2.8%; P = 0.0002). Logistic regression analysis identified preoperative ACE inhibitor use, congestive heart failure, poor left ventricular function, duration of CPB, reoperative surgery, age, and opioid anesthesia as independent risk factors for requiring > or = 2 vasoconstrictor infusions after CPB. No other preoperative drug therapy significantly altered this outcome.
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Affiliation(s)
- K J Tuman
- Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
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Licker M, Neidhart P, Lustenberger S, Kalonji T. Vascular alpha-1 adrenergic responsivness during cardiac surgery in patients on chronic angiotensin-converting enzyme inhibitors. J Cardiothorac Vasc Anesth 1994. [DOI: 10.1016/1053-0770(94)90440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thaker U, Geary V, Chalmers P, Sheikh F. Low systemic vascular resistance during cardiac surgery: case reports, brief review, and management with angiotensin II. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1990; 4:360-3. [PMID: 2131886 DOI: 10.1016/0888-6296(90)90046-i] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- U Thaker
- Department of Anesthesiology, Albany Medical Center Hospital, NY 12208
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Nagaoka H, Innami R, Arai H. Effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system following open heart surgery. THE JAPANESE JOURNAL OF SURGERY 1988; 18:390-6. [PMID: 3172580 DOI: 10.1007/bf02471462] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system and tissue metabolism, especially those which occur soon after surgery, were studied in 26 patients who required total cardiopulmonary bypass for longer than 60 minutes. These patients comprised 11 who underwent open heart surgery utilizing nonpulsatile cardiopulmonary bypass (Group I) and 15 who underwent open heart surgery utilizing pulsatile cardiopulmonary bypass (Group II). Plasma angiotensin II and serum aldosterone levels were significantly increased one and 5 hours postoperatively in Group I when compared with the preoperative values, whereas no significant elevations were observed in Group II. Plasma angiotensin II and serum aldosterone levels one hour postoperatively in Group II were significantly lower than those in Group I. Lactate levels in the arterial blood were significantly elevated, one and 5 hours postoperatively in both Groups I and II. Moreover, no significant difference was observed in the lactate levels between Groups I and II, one hour postoperatively. In the nonpulsatile group (Group I), plasma angiotensin II levels one hour postoperatively were correlated significantly with the duration of total cardiopulmonary bypass. In conclusion, pulsatile cardiopulmonary bypass offers significant advantages in terms of lower plasma angiotensin II and serum aldosterone levels, when compared with nonpulsatile cardiopulmonary bypass soon after open heart surgery requiring total cardiopulmonary bypass for longer than 60 minutes, however, it does not offer a definite advantage for tissue metabolism.
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Affiliation(s)
- H Nagaoka
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Feddersen K, Aurell M, Delin K, Häggendal J, Arén C, Rådegran K. Effects of cardiopulmonary bypass and prostacyclin on plasma catecholamines, angiotensin II and arginine-vasopressin. Acta Anaesthesiol Scand 1985; 29:224-30. [PMID: 3883684 DOI: 10.1111/j.1399-6576.1985.tb02190.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Infusion of prostacyclin during cardiopulmonary bypass (CPB) reduces platelet activation, diminishes postoperative blood loss and decreases arterial blood pressure. In spite of continuous prostacyclin infusion, there is a delayed gradual rise in arterial pressure and resistance from low initial levels. We measured epinephrine (E), norepinephrine (NE), serotonin (5-HT), angiotensin II (ATII) and arginine-vasopressin (AVP) in plasma and carried out hemodynamic studies in 19 patients operated for coronary vascular disease. Eight patients served as a control group and were subjected to routine CPB. Eleven patients received prostacyclin 50 ng/kg/min during CPB. E and NE increased four- to sixfold during CPB from about 0.5 ng/ml (P less than 0.001). There was no difference between the groups. During CPB AVP increased sixfold from about 20 pg/ml in both groups (P less than 0.001), decreased early after CPB and increased again to high levels 3 h after CPB. The combined action of E, NE and AVP is of likely importance for the rise in systemic vascular resistance and/or need of vasodilation during CPB in the control group. ATII did not increase in the control group, but increased fourfold to about 20 pg/ml (P less than 0.01) during CPB in the prostacyclin group. The addition of AT II to E, NE and AVP seems responsible for the gradual return of arterial pressure and resistance during prostacyclin infusion. Postoperative hypertension and/or need of vasodilation 3 h after CPB was associated with high AVP levels in both groups. Hypotension caused by prostacyclin infusion did not increase E, NE or AVP above levels produced by CPB and moderate hypotension alone.
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Pitt BR, Gillis CN, Hammond GL. Depression of pulmonary metabolic function by cardiopulmonary bypass procedures increases levels of circulating norepinephrine. Ann Thorac Surg 1984; 38:508-13. [PMID: 6497479 DOI: 10.1016/s0003-4975(10)64193-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We measured plasma levels of endogenous norepinephrine radioenzymatically in mixed venous and arterial blood simultaneously sampled from anesthetized dogs before, during, and after 1 to 4 hours of total cardiopulmonary bypass (CPB) or 2 hours of left heart bypass. Prior to bypass, arterial levels of norepinephrine were 0.41 +/- 0.04 ng/ml and pulmonary extraction of norepinephrine was 25 +/- 3% (N = 20). During bypass, norepinephrine levels significantly increased from control to 1.41 +/- 0.15 (1 or 2 hours of CPB; N = 8) and 1.97 +/- 0.30 (3 or 4 hours of CPB; N = 8) or 0.97 +/- 0.29 (2 hours of left heart bypass) ng/ml. Restoration of normal pulmonary blood flow was associated with a rapid and significant decrease in arterial levels of norepinephrine, which, after 1 or 2 hours of CPB or 2 hours of left heart bypass, returned to levels obtained before bypass. However, arterial levels of norepinephrine remained higher than 1 ng/ml in the 3-hour recovery period after prolonged bypass. In these animals, pulmonary extraction of norepinephrine was significantly less than control. These data suggest that the lung's ability to remove norepinephrine is altered by CPB and that the severity of the alterations is directly related to pump time. The impairment in extraction allows higher than normal concentrations of norepinephrine to enter the arterial circulation and may contribute to systemic hypertension after bypass.
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Taylor KM. Plasma vasopressin during cardiopulmonary bypass. Ann Thorac Surg 1982; 34:222. [PMID: 7103591 DOI: 10.1016/s0003-4975(10)60890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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