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Onorati F, Santarpino G, Rubino AS, Caroleo S, Dardano A, Scalas C, Gulletta E, Santangelo E, Renzulli A. Body Perfusion during Adult Cardiopulmonary Bypass is Improved by Pulsatile flow with Intra-Aortic Balloon Pump. Int J Artif Organs 2018; 32:50-61. [DOI: 10.1177/039139880903200107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion. Methods 158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic ballon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure). Results IABP induced Surplus Hemodynamic Energy was 15.8±4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1–2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01). Conclusion Pulsatile flow by IABP improves whole-body perfusion during CPB.
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Affiliation(s)
- F. Onorati
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - G. Santarpino
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - A. S. Rubino
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - S. Caroleo
- Department of Clinical and Experimental Medicine, Anesthesiology Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - A. Dardano
- Department of Clinical and Experimental Medicine, Biochemistry Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - C. Scalas
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - E. Gulletta
- Department of Clinical and Experimental Medicine, Biochemistry Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - E. Santangelo
- Department of Clinical and Experimental Medicine, Anesthesiology Unit, Magna Graecia University Medical School, Catanzaro - Italy
| | - A. Renzulli
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro - Italy
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Onorati F, Pasceri E, Scalas C, Santarpino G, Mastroroberto P, Indolfi C, Renzulli A. Aortic tube grafts wrapping with hemostatic fleeces reduces postoperative pericardial effusions. J Cardiovasc Surg (Torino) 2008; 49:393-397. [PMID: 18446127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pericardial effusions often complicate the postoperative course of ascending aortic surgery. We evaluated whether an unconventional use of hemostatic fleeces (TachoSil, Nycomed; Austria), wrapped around aortic tube grafts, may reduce such complication. Twenty-nine consecutive patients undergoing button-Bentall were submitted - according to surgeon's choice - to 360 degrees wrapping of the aortic grafts with hemostatic fleeces immediately before sternal wiring (11 patients - group A) or sternal wiring without any wrapping of the prosthesis (18 patients - group B). Hospital outcome was recorded. No differences were recorded in hospital mortality and major organ morbidity. When pericardial complications were considered, group A showed lower chest drains (P=0.0001), time of chest drainage (P=0.002), pretamponade/tamponade with need for pericardiocentesis (P=0.039), predischarge echocardiographic amount of pericardial effusion (P=0.026), fever (P=0.029), need for anti-inflammatory (P=0.05) or antibiotic drugs (P=0.007), hospital stay (P=0.010) and white blood cell count (P=0.016 on postoperative day 3; P=0.014 on day 6). Wrapping of aortic tube grafts with hemostatic fleeces is effective in reducing pericardial effusion and its deleterious effects following aortic surgery.
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Affiliation(s)
- F Onorati
- Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
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