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Perfusion cardiac surgery

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https://www.readbyqxmd.com/read/27910802/near-infrared-spectroscopy-evaluated-cerebral-oxygenation-during-anesthesia
#1
Henrik Sørensen
Likely, maintained organ and notably cerebral perfusion, secures rapid recovery following anesthesia. To secure cerebral blood flow (CBF) at least mean arterial pressure (MAP) and the arterial carbon dioxide tension (PaCO2) need to be considered. CBF is "autoregulated", i.e. stays more or less stable within a MAP of 50-150 mmHg, but the lower limit appears to depend on the central blood volume and/or cardiac output, illustrated by a decrease in CBF at a MAP of 80 mmHg with a compromised central blood volume, while CBF remains constant with a MAP < 40 mmHg, if the central blood volume is maintained...
December 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27909230/the-protective-role-of-sex-hormones-in-females-and-exercise-prehabilitation-in-males-on-sternotomy-induced-cranial-hypoperfusion-in-aortic-banded-mini-swine
#2
T Dylan Olver, Jessica A Hiemstra, Jenna C Edwards, Brian S Ferguson, Harold Laughlin, Craig A Emter
During cardiac surgery, specifically sternotomy, cranial hypoperfusion is linked to cerebral ischemia, increased risk of perioperative watershed stroke and other neurocognitive complications. The purpose of this study was to retrospectively examine the effect of sex hormones in females and exercise prehabilitation in males on median sternotomy-induced changes in cranial perfusion in a large animal model of heart failure. Cranial blood flow (CBF) before, 10- and 60 min post-sternotomy was analyzed in eight groups of Yucatan mini-swine: female-control, aortic-banded, ovariectomized, and ovariectomized+aortic-banded; male-control, aortic-banded, aortic-banded+continuous exercise trained, and aortic-banded+interval exercise trained...
December 1, 2016: Journal of Applied Physiology
https://www.readbyqxmd.com/read/27906706/effects-of-cardiopulmonary-bypass-on-renal-perfusion-filtration-and-oxygenation-in-patients-undergoing-cardiac-surgery
#3
Lukas Lannemyr, Gudrun Bragadottir, Vitus Krumbholz, Bengt Redfors, Johan Sellgren, Sven-Erik Ricksten
BACKGROUND: Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. METHODS: Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2...
December 1, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27902930/modulating-micrornas-in-cardiac-surgery-patients-novel-therapeutic-opportunities
#4
REVIEW
Giovanni Biglino, Massimo Caputo, Cha Rajakaruna, Gianni Angelini, Eva van Rooij, Costanza Emanueli
This review focuses on microRNAs (miRs) in cardiac surgery, where they are emerging as potential targets for therapeutic intervention as well as novel clinical biomarkers. Identification of the up/down-regulation of specific miRs in defined groups of cardiac surgery patients can lead to the development of novel strategies for targeted treatment in order to maximise therapeutic results and minimise acute, delayed or chronic complications. MiRs could also be involved in determining the outcome independently of complications, for example in relation to myocardial perfusion and fibrosis...
November 27, 2016: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/27866675/hemodynamics-of-patient-specific-aorta-pulmonary-shunt-configurations
#5
Senol Piskin, H Firat Altin, Okan Yildiz, Ihsan Bakir, Kerem Pekkan
Optimal hemodynamics in aorta-pulmonary shunt reconstruction is essential for improved post-operative recovery of the newborn congenital heart disease patient. However, prior to in vivo execution, the prediction of post-operative hemodynamics is extremely challenging due to the interplay of multiple confounding physiological factors. It is hypothesized that the post-operative performance of the surgical shunt can be predicted through computational blood flow simulations that consider patient size, shunt configuration, cardiac output and the complex three-dimensional disease anatomy...
November 11, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27862994/colchicine-increases-ventricular-vulnerability-in-an-experimental-whole-heart-model
#6
Gerrit Frommeyer, Julius Krawczyk, Dirk G Dechering, Simon Kochhäuser, Patrick Leitz, Michael Fehr, Lars Eckardt
The traditional gout medication colchicine has been reported to effectively prevent atrial fibrillation recurrence after atrial fibrillation ablation or cardiac surgery in a few clinical trials. Severe adverse events have not yet been reported. The aim of the present study was to assess possible direct electrophysiological effects in an experimental whole-heart model. Ten rabbit hearts were isolated and Langendorff-perfused. Thereafter, colchicine was administered in 2 concentrations (1μM and 3μM). Eight endo- and epicardial monophasic action potentials and a 12-lead ECG showed a stable QT interval and action potential duration during colchicine infusion...
November 11, 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27832832/a-pilot-goal-directed-perfusion-initiative-is-associated-with-less-acute-kidney-injury-after-cardiac-surgery
#7
J Trent Magruder, Todd C Crawford, Herbert Lynn Harness, Joshua C Grimm, Alejandro Suarez-Pierre, Chad Wierschke, Jim Biewer, Charles Hogue, Glenn R Whitman, Ashish S Shah, Viachaslau Barodka
BACKGROUND: We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. METHODS: On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m(2) and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015...
September 19, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27826336/the-association-between-whole-blood-viscosity-and-coronary-collateral-circulation-in-patients-with-chronic-total-occlusion
#8
Mehmet Serkan Cetin, Elif Hande Ozcan Cetin, Kevser Gülcihan Balcı, Selahattin Aydin, Emek Ediboglu, Muhammed Fatih Bayraktar, Mustafa Mücahit Balcı, Orhan Maden, Ahmet Temizhan, Sinan Aydogdu
BACKGROUND AND OBJECTIVES: Coronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion...
November 2016: Korean Circulation Journal
https://www.readbyqxmd.com/read/27816134/anesthesia-for-patients-with-peripheral-vascular-disease-and-cardiac-dysfunction
#9
REVIEW
Sara E Neves
Patients with vascular disease and cardiac dysfunction present particular challenges to the anesthesiologist. They are hemodynamically brittle, at high risk of morbidity and mortality during surgery, and often carry additional comorbidities that increase their complexity and risk. Those with peripheral vascular disease should be assumed to have coronary artery disease and tend to have other systemic vascular problems. Poor cardiac function further worsens perfusion in an already compromised peripheral vascular system...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27802176/complex-effects-of-apoplexy-secondary-to-pituitary-adenoma
#10
Rui-Cheng Zhang, Ying-Feng Mu, Jing Dong, Xiao-Qian Lin, De-Qin Geng
Pituitary adenoma apoplexy is a well-known clinical syndrome induced by insulin infusion, cardiac surgery, trauma, and hypothalamic releasing factors. Pituitary apoplexy can cause secondary cerebral infarct and internal carotid artery occlusion. With blockade of tumor perfusion, apoplexy triggers a sudden onset of headache, visual impairment, cranial nerve palsy, disturbances of consciousness, eyelid ptosis, and hemiparesis. However, pituitary adenoma cells with high metabolic demand cannot survive with deficient blood supply and glucose concentrations...
October 29, 2016: Reviews in the Neurosciences
https://www.readbyqxmd.com/read/27801691/sudden-cardiac-death-in-transposition-of-the-great-arteries-with-a-mustard-or-senning-baffle-the-myocardial-ischemia-hypothesis
#11
Paul Khairy
PURPOSE OF REVIEW: The literature on sudden death in transposition of the great arteries (D-TGA) with atrial switch surgery is reviewed and a pathophysiological mechanism is proposed. RECENT FINDINGS: Over 80% of sudden deaths in patients with D-TGA and Mustard or Senning baffles occur during exercise. Factors most consistently associated with ventricular arrhythmias and sudden death include heart failure parameters and atrial arrhythmias. Atrial arrhythmias have been observed to trigger malignant ventricular arrhythmias...
January 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27799177/non-invasive-measurement-of-renal-perfusion-and-oxygen-metabolism-to-predict-postoperative-acute-kidney-injury-in-neonates-and-infants-after-cardiopulmonary-bypass-surgery
#12
F Neunhoeffer, M Wiest, K Sandner, H Renk, E Heimberg, C Haller, M Kumpf, C Schlensak, M Hofbeck
BACKGROUND: The pathophysiology of acute kidney injury (AKI) after cardiopulmonary bypass surgery for congenital heart disease is not completely understood. The aim of this study was to carry out a prospective analysis of the diagnostic value of non-invasive monitoring of renal oxygenation and microcirculation by combining laser Doppler flowmetry and tissue spectrometry. METHODS: In 50 neonates and infants who underwent repair (n = 31) or neonatal palliation (n = 19) of congenital heart disease with cardiopulmonary bypass, renal oxygenation, and microcirculatory flow, the approximate renal metabolic rate of oxygen and Doppler-based renal resistive index were determined after surgery...
November 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27782315/minimally-circulatory-assisted-on-pump-beating-coronary-artery-bypass-grafting-for-patients-with-complex-conditions-for-off-pump-surgery
#13
Tomohiro Mizuno, Koso Egi, Kenji Sakai, Keiji Oi, Tsuyoshi Hachimaru, Tohru Makita, Kiyotoshi Oishi, Hirokuni Arai
Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of <30 mm Hg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion...
October 26, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27767984/the-optimum-hematocrit
#14
Walter H Reinhart
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values...
October 21, 2016: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/27740725/assessment-of-extravascular-lung-water-by-ultrasound-after-congenital-cardiac-surgery
#15
Anu K Kaskinen, Laura Martelius, Turkka Kirjavainen, Paula Rautiainen, Sture Andersson, Olli M Pitkänen
BACKGROUND: Lung ultrasounds show vertical artifacts known as B-lines in the presence of increased extravascular lung water (EVLW). We aimed to investigate whether lung ultrasound could estimate EVLW after congenital cardiac surgery. METHODS: This prospective observational study comprised 61 children (age range 3 days to 7.4 years) undergoing congenital cardiac surgery. We compared postoperative B-line scores from lung ultrasounds, early postoperative ultrasound as our primary interest, with corresponding postoperative chest radiography (CXR) lung edema scores, with static lung compliance, and with short-term clinical outcome interpreted as time on mechanical ventilation and length of pediatric intensive care unit (PICU) stay...
October 14, 2016: Pediatric Pulmonology
https://www.readbyqxmd.com/read/27729702/blood-conservation-a-team-sport
#16
REVIEW
Donald S Likosky, Timothy A Dickinson, Theron A Paugh
Cardiac surgery accounts for between 15% and 20% of all blood product utilization in the United States. A body of literature suggests that patients who are exposed to even small quantities of blood have an increased risk of morbidity and mortality, even after adjusting for pre-operative risk. Despite this body of literature supporting a restrictive blood management strategy, wide variability in transfusion rates exist across institutions. Recent blood management guidelines have shed light on a number of potentially promising blood management strategies, including acute normovolemic hemodilution (ANH) and retrograde autologous priming (RAP)...
September 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27715350/a-novel-compartmentalised-stent-graft-to-isolate-the-perfusion-of-the-abdominal-organs
#17
Yanfei Chen, Bryan W Tillman, Sung Kwon Cho, Tara D Richards, Amit D Tevar, Xinzhu Gu, William R Wagner, Youngjae Chun
Donation after cardiac death has been adopted to address the critical shortage of donor organs for transplant. Recovery of these organs is hindered by low blood flow that leads to permanent organ injury. We propose a novel approach to isolate the perfusion of the abdominal organs from the systemic malperfusion of the dying donor. We reasoned that this design could improve blood flow to organs without open surgery, while respecting the ethical principle that cardiac stress not be increased during organ recovery...
February 2017: Journal of Medical Engineering & Technology
https://www.readbyqxmd.com/read/27709094/goal-directed-perfusion-in-neonatal-aortic-arch-surgery
#18
Robert Anton Cesnjevar, Ariawan Purbojo, Frank Muench, Joerg Juengert, André Rueffer
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve...
July 2016: Translational pediatrics
https://www.readbyqxmd.com/read/27703635/anesthetic-management-during-surgery-for-left-ventricular-aneurysm-and-false-aneurysm-occurring-in-stage-a-case-report
#19
Chung Hun Lee, Dong Kyu Lee, Sang Ho Lim, Heezoo Kim
Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man...
October 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27703584/the-role-of-levosimendan-in-patients-with-decreased-left-ventricular-function-undergoing-cardiac-surgery
#20
Marija Bozhinovska, Gordana Taleska, Andrej Fabian, Maja Šoštarič
The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
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