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Aludaat C, Dovonou E, Besnier E, Fauvel C, Nardone N, Le Guillou V, D’Agostino A, Nafeh-Bizet C, Gay A, Bouchart F, Bauer F. Upgrading extra corporeal life support to ECMELLA using Impella 5.0 in rescued INTERMACS 1 patients, lactate level matters! J Thorac Dis 2023; 15:3079-3088. [PMID: 37426165 PMCID: PMC10323555 DOI: 10.21037/jtd-22-1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/15/2023] [Indexed: 07/11/2023]
Abstract
Background Venoarterial extra corporeal life support (ECLS) is the treatment of choice of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 patients, but left ventricle (LV) overload is a complication of ECLS. Unloading the LV by adding Impella 5.0 to ECLS in Impella used in combination with venoarterial extracorporeal membrane oxygenation (ECMELLA) configuration is recommended only in patients with acceptable prognosis. We investigated whether serum lactate level, a simple biological parameter, could be used as a marker to select candidates for bridging from ECLS to ECMELLA. Methods Forty-one consecutive INTERMACS 1 patients under ECLS were upgraded to ECMELLA using Impella 5.0 pump implantation to unload the LV and were followed-up for 30 days. Demographic, clinical, imaging, and biological parameters were collected. Results The time between ECLS and Impella 5.0 pump implantation was 9 [0-30] hours. Among these 41 patients, 25 died 6±6 days after implantation. They were older (53±12 vs. 43±12 years, P=0.01) with acute coronary syndrome as the primary etiology (64% vs. 13%, P=0.0007). In univariate analysis, patients who died exhibited a lower mean arterial pressure (74±17 vs. 89±9 mmHg, P=0.01), a higher level of troponin (24,000±38,000 vs. 3,500±5,000 mg/dL, P=0.048), a higher level of serum lactate (8.3±7.4 vs. 4.2±3.8 mmol/L, P=0.05) and more frequent cardiac arrest at admission (80% vs. 25%, P=0.03). In multivariate Cox regression analysis, a serum lactate level of >7.9 mmol/L (P=0.008) was found to be an independent predictor of mortality. Conclusions In INTERMACS 1 patients who require urgent ECLS for restoring hemodynamics and organ perfusion, an upgrade from ECLS to ECMELLA is relevant if the serum lactate level is ≤7.9 mmol/L.
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Affiliation(s)
- Chadi Aludaat
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
| | - Estelle Dovonou
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Emmanuel Besnier
- INSERM EnVI U1096, Rouen University Medical School, Rouen, France
- Anesthesiology Department, Rouen University Hospital, Rouen, France
| | - Charles Fauvel
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
- Internal Medicine Division, Cardiovascular Department, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Nathalie Nardone
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Vincent Le Guillou
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Alessandra D’Agostino
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Catherine Nafeh-Bizet
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Arnaud Gay
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - François Bouchart
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Fabrice Bauer
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
- INSERM EnVI U1096, Rouen University Medical School, Rouen, France
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Lopez AG, Duparc C, Renouf S, Machevin E, Le Guillou V, Sabourin JC, Defortescu G, Buffet A, Gimenez-Roqueplo AP, Dubessy C, Louiset E, Lefebvre H. Expression of LHCGR (Luteinizing Hormone/Chorionic Gonadotrophin Receptor) in Pheochromocytomas Unveils an Endocrine Mechanism Connecting Pregnancy and Epinephrine Overproduction. Hypertension 2022; 79:1006-1016. [PMID: 35189708 DOI: 10.1161/hypertensionaha.121.18864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanisms by which pregnancy may unmask pheochromocytomas and paragangliomas are not totally understood. We hypothesized that gestational hormones may participate in the pathophysiology of catecholamine excess during pregnancy. We report a case of silent pheochromocytoma revealed in a pregnant woman by life-threatening adrenergic myocarditis. METHODS In vitro studies were conducted to investigate the effect of estradiol and the pregnancy hormone hCG (human chorionic gonadotropin) on epinephrine secretion by cultured cells derived from the patient's tumor. Expression of LHCG (luteinizing hormone/chorionic gonadotropin) receptor was searched for in the patient's tumor, and a series of 12 additional pheochromocytoma by RT-Q-PCR and immunohistochemistry. LHCGR expression was also analyzed in silico in the pheochromocytomas and paragangliomas cohorts of the Cortico et Médullosurrénale: les Tumeurs Endocrines and The Cancer Genome Atlas databases. RESULTS hCG stimulated epinephrine secretion by cultured cells derived from the patient's pheochromocytoma. The patient's tumor expressed the LHCG receptor, which was colocalized with catecholamine-producing enzymes. A similar expression pattern of the LHCG receptor was also observed in 5 out of our series of pheochromocytoma. Moreover, in silico studies revealed that pheochromocytomas and paragangliomas display the highest expression levels of LHCG receptor mRNA among the 32 solid tumor types of The Cancer Genome Atlas cohort. CONCLUSIONS Pregnancy may thus favor surges in plasma catecholamine and hypertensive crises through hCG-induced stimulation of epinephrine production by pheochromocytomas.
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Affiliation(s)
- Antoine-Guy Lopez
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, France. (A.-G.L., H.L.)
| | - Céline Duparc
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Sylvie Renouf
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Elise Machevin
- Department of Gynaecology-Obstetrics, Evreux Hospital Centre, France (E.M.)
| | - Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, France. (V.L.G.)
| | - Jean-Christophe Sabourin
- Department of Pathology and INSERM 1245, Rouen University Hospital, France. (J.-C.S,).,Tumor BioBank-Centre for Biological Resources, Rouen University Hospital, France. (J.-C.S., H.L.)
| | - Guillaume Defortescu
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Urology, Rouen University Hospital, France. (G.D.)
| | - Alexandre Buffet
- Université de Paris, PARCC, INSERM, Paris, France (A.B., A.-P.G.-R.).,Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France (A.B., A.-P.G.-R.)
| | - Anne-Paule Gimenez-Roqueplo
- Université de Paris, PARCC, INSERM, Paris, France (A.B., A.-P.G.-R.).,Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France (A.B., A.-P.G.-R.)
| | - Christophe Dubessy
- Normandie University, UNIROUEN, INSERM, PRIMACEN, Rouen, France (C. Dubessy)
| | - Estelle Louiset
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Hervé Lefebvre
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, France. (A.-G.L., H.L.).,Tumor BioBank-Centre for Biological Resources, Rouen University Hospital, France. (J.-C.S., H.L.)
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Rinieri P, Selim J, Le Guillou V, Baste JM. Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report. J Cardiothorac Surg 2020; 15:173. [PMID: 32677971 PMCID: PMC7367320 DOI: 10.1186/s13019-020-01200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background The management of cardiac arrest during video assisted thoracic surgery is challenging. Checklist use improve the management of operating-room crises. Case presentation: Cardiac arrest (asystole) occurred during anatomical pulmonary resection by minimally invasive surgery. Conversion to thoracotomy was decided (thoracic surgeon and anesthesiologist conjointly) to check for absence of cardiac bleeding and to start cardiac massage (4 min no-flow). After few minutes, ventricular fibrillation occurred and persisted despite shocks. Extracorporeal life support with veno-arterial extracorporeal membrane oxygenation allowed a return of spontaneous circulation (45 min low-flow). Conclusions The patient survived without central neurologic deficit due to perfect team work process using a crisis check-list (strengthened by a comprehensive simulation program with crisis resource management).
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Affiliation(s)
- Philippe Rinieri
- Department of General and Thoracic Surgery, Rouen University Hospital, Charles Nicolle Hospital, 1 rue de Germont, 76031, Rouen, France.
| | - Jean Selim
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | | | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Charles Nicolle Hospital, 1 rue de Germont, 76031, Rouen, France
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4
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Tabley A, Aludaat C, Le Guillou V, Gay A, Nafeh-Bizet C, Scherrer V, Bouchart F, Doguet F. A Survey of Cardiac Surgery Infections With PICO Negative Pressure Therapy in High-Risk Patients. Ann Thorac Surg 2020; 110:2034-2040. [PMID: 32371085 DOI: 10.1016/j.athoracsur.2020.03.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical site complications represent major concerns in many surgical specialties and lead to an increased length of hospital stay and the need for additional treatments and care. This investigation aimed to report survey data from the introduction of the PICO negative pressure wound therapy system (Smith & Nephew, Hull, United Kingdom) in a single hospital in France regarding cardiac surgical procedures through standard median sternotomy. METHODS The patients in this study were at high risk of developing surgical site infections. PICO was used immediately postoperatively on the closed incision sites in all patients undergoing cardiac surgical procedures. Data were compared with a retrospective cohort of patients in whom PICO had not been used postoperatively. In total, 233 anonymized patient records were reviewed, 142 of which used the PICO device and 91 of which did not. RESULTS PICO was shown to provide both clinical and economic benefits over standard care across a range of different cardiac surgical patients. The rates of complications, including deep surgical wound infections and mediastinitis, were reduced. CONCLUSIONS As noted, PICO had advantages over standard care in these patients, and complication rates decreased. This study demonstrated cost savings and an increase in available surgical and hospital capacity related to PICO use.
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Affiliation(s)
- Alfred Tabley
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France.
| | - Chadi Aludaat
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Vincent Le Guillou
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Arnaud Gay
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Catherine Nafeh-Bizet
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Vincent Scherrer
- Department of Anesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - François Bouchart
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Fabien Doguet
- Department of Cardiovascular and Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandy University, University of Rouen National Institute for Medical Research Unit 1096, Rouen, France
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Sadaune L, Roca F, Bordage M, Le Guillou V, Lesourd A, Michel A. Benefits of a Pre-Treatment Comprehensive Geriatric Assessment in a Rare Case of Gemella Haemolysans Endocarditis in an 86-Year-Old Patient and a Review of the Literature. ACTA ACUST UNITED AC 2019; 55:medicina55060292. [PMID: 31226808 PMCID: PMC6631016 DOI: 10.3390/medicina55060292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
Infective endocarditis is a serious condition, which is associated with high mortality in elderly patients. Gemella haemolysans (GH) is a microorganism from the Streptococcus family, rarely involved in infective endocarditis. Here, we present a case of Gemella haemolysans endocarditis in an 86-year-old patient, successfully treated by antibiotics and surgery following a pre-treatment comprehensive geriatric assessment (CGA). This case is discussed in the context of a review of all published cases of Gemella haemolysans endocarditis. We illustrate the benefit of a systematic pre-treatment comprehensive geriatric assessment in elderly patients with infective endocarditis.
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Affiliation(s)
- Lucie Sadaune
- Department of Geriatric Medicine, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France.
| | - Frédéric Roca
- Department of Geriatric Medicine, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France.
| | - Mathilde Bordage
- Department of Geriatric Medicine, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France.
| | - Vincent Le Guillou
- Department of Thoracic and Cardiac Surgery, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
| | - Anais Lesourd
- Department of Infectious Disease, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France.
| | - Anne Michel
- Department of Geriatric Medicine, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France.
- Department of Geriatric Medicine, Evangelisches Krankenhaus Kalk, Buchforststraße 2, 51103 Cologne, Germany.
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Luzurier Q, Le Guillou V, Lottin M, Vermeulin T, Marini H, Petel T, Czernichow P, Bessou JP, Bénichou J, Merle V. Is the Risk of Wound Infection Related to Bilateral Internal Thoracic Artery Graft Potentiated by Age? Ann Thorac Surg 2016; 102:1239-44. [PMID: 27234581 DOI: 10.1016/j.athoracsur.2016.03.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 02/05/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older age and the use of bilateral internal thoracic artery (ITA) grafting are both considered risk factors for surgical wound infection (SWI) after coronary artery bypass grafting (CABG). The 2014 European Guidelines recommend that bilateral ITA grafting should be considered in patients aged younger than 70 years. Our aim was to investigate interaction between age and the number of ITA grafts. METHODS All patients aged 18 years and older who had undergone CABG with at least 1 ITA at Rouen University Hospital between 2001 and 2012 were selected. Data regarding surgical procedure (single/bilateral ITA grafting) were extracted from the medical information system. SWI was identified from prospective surveillance of patients according to Centers for Disease Control and Prevention criteria. Independent factors associated with SWI were assessed by logistic regression, and an interaction test between age (≤69 or ≥70 years) and the number of ITA grafts was performed. RESULTS SWI occurred in 71 of 2,726 patients (2.6%). Bilateral ITA grafting was associated with SWI (adjusted odds ratio [aOR], 2.55; 95% confidence interval, 1.51 to 4.30). After fitting an interaction term between age and number of ITA grafts, the aORs for SWI after bilateral ITA grafting substantially differed between patients aged 69 years and younger (aOR, 1.88; 95% confidence interval, 0.94 to 3.75) and 70 years and older (aOR, 3.52; 95% confidence interval, 1.69 to 7.33). However, this interaction failed to reach statistical significance (p = 0.2213), possibly because of insufficient statistical power (23.5%) despite the large sample size. CONCLUSIONS Age 70 years and older compared with age 69 years and younger was associated with higher occurrence of SWI after bilateral ITA grafting, but this interaction was not statistically significant. Larger studies are needed to test this interaction.
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Affiliation(s)
- Quentin Luzurier
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France.
| | - Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France
| | - Marion Lottin
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
| | - Thomas Vermeulin
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Hélène Marini
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
| | - Tristan Petel
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
| | - Pierre Czernichow
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
| | - Jean-Paul Bessou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France
| | - Jacques Bénichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Véronique Merle
- Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
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Le Guillou V, Bouchart F, Gay A, Nafeh-Bizet C, Hubscher C, Tabley A, Bessou JP, Doguet F. The Ross procedure in endocarditis: a report of 28 cases. Eur J Cardiothorac Surg 2013; 45:153-8. [PMID: 23625453 DOI: 10.1093/ejcts/ezt206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Ross procedure has received increasing interest as an attractive alternative to a prosthetic aortic valve. Given its presumably greater resistance to infection, the pulmonary autograft is theoretically preferable for active endocarditis. The objective of this retrospective study was to present our experience in aortic valve endocarditis treated using the Ross procedure. METHODS Between May 1997 and February 2011, the Ross procedure was performed on 142 patients in our institution. Twenty-eight patients had aortic valve endocarditis at the time of operation. Fourteen patients had urgent or emergency procedures, and 13 had active disease at the time of surgery. Twelve patients were alcoholics and/or drug addicts. Eight patients had an abscess of the aortic annulus. Clinical follow-up was complete. RESULTS Hospital mortality was 10.7%. Overall patient survival (± standard deviation) was 47 ± 13% at 10 years with no cardiac-related death during the mean follow-up of 6.4 ± 4.2 years. There were 3 cases of recurrent endocarditis including anterior mitral leaflets endocarditis and right-sided endocarditis to another germ in a drug addict. Four patients required further surgery, 2 on the pulmonary autograft; 18 of the 19 survivors were in New York Heart Association class I. At the final investigation, all patients had no or grade I autograft regurgitation. The mean pressure gradient across the homograft was 9 ± 7.5, 11 ± 9.5 and 15 ± 9.5 mmHg, respectively, for patients between 0-3, 4-9 and >9 years. CONCLUSIONS Endocarditis can be treated with good results using the Ross procedure, with a very low rate of recurrence of endocarditis.
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Affiliation(s)
- Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France
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Le Guillou V, Tamion F, Jouet I, Richard V, Mulder P, Bessou JP, Doguet F. Mesenteric endothelial dysfunction in a cardiopulmonary bypass rat model: the effect of diabetes. Diab Vasc Dis Res 2012; 9:270-9. [PMID: 22278737 DOI: 10.1177/1479164111434432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes is a risk factor for perioperative complications after cardiac surgery. We studied its effects on mesenteric endothelial function in a cardiopulmonary bypass (CPB) model. METHODS Forty Wistar rats were divided into four groups: sham (D-CPB-), cardiopulmonary bypass (D-CPB+), diabetic (D+CPB-) and diabetic that have undergone CPB (D+CPB+). Two samples of mesenteric artery were used for nitric oxide synthase (NOS) Western blot analysis, and two others for assessing contractile response and endothelium relaxations. Nitrite products and tumour necrosis factor-alpha (TNF-α) were assessed as markers of inflammatory response. RESULTS We observed an enhanced contractile response to the α-adrenergic agonist associated with impairment of mesenteric vasorelaxation in D+CPB+ rats. Western immunoblot analysis of D+CPB+ highlighted an additive effect of hyper-expression of inducible NOS. A significantly increased inflammatory response was observed after CPB in diabetic animals. CONCLUSIONS This work confirms the potential deleterious impact of diabetes on the mesenteric endothelium during CPB in cardiac surgery.
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Affiliation(s)
- Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, France
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Doguet F, Tamion F, Le Guillou V, Bubenheim M, Thuillez C, Richard V, Bessou JP. Albumin limits mesenteric endothelial dysfunction and inflammatory response in cardiopulmonary bypass. Artif Organs 2012; 36:962-71. [PMID: 22888788 DOI: 10.1111/j.1525-1594.2012.01492.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the potential anti-inflammatory and endothelial protective properties of albumin during cardiopulmonary bypass (CPB) in an experimental porcine model. Two groups underwent CPB for 90 min (n = 7 in each group), and a baseline (BL) control group did not undergo CPB (n = 7). Priming consisted of a gelatin solution (4% gelofusine, CPBG group) or colloid solution (5% albumin, CPBA group). Mesenteric arterial segments were isolated and exposed in vitro to phenylephrine (with or without nitric oxide synthase inhibition) to assess contractility, and exposed to acetylcholine and sodium nitroprusside to assess relaxation. Plasma tumor necrosis factor (TNF)-α levels, intestinal and pulmonary TNF-α and heme oxygenase (HO)-1 mRNA expression, and organ injury were studied. Upon sacrifice, TNF-α levels were significantly higher in the CPBG group than in the CPBA and BL groups. The contractile response was significantly higher in the CPBG group, whereas the response to acetylcholine was significantly lower in the CPBG group than in the other groups. HO-1 mRNA expression was significantly higher in intestine samples in the CPBA group than in the CPBG and BL groups. HO-1 mRNA expression was significantly higher in lung samples in the CPBA group than in the CPBG group. Leukocyte infiltration was significantly higher in intestine and lung samples in the CPBG group than in the CPBA and BL groups. Albumin priming reduced CPB-induced mesenteric vascular dysfunction and prevented the development of a systemic inflammatory response by modeling HO-1 expression in target organs.
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Affiliation(s)
- Fabien Doguet
- INSERM U, Rouen Biomedical Research Institute, France.
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