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Perfusion cardiac surgery

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https://www.readbyqxmd.com/read/28638156/goal-directed-perfusion-methodology-for-determining-oxygenator-performance-during-clinical-cardiopulmonary-bypass
#1
Alfred H Stammers, Randi Miller, Stephen G Francis, Laszlo Fuzesi, Anthony Nostro, Eric Tesdahl
New generation oxygenators incorporate arterial line filtration either sequential to, or directly in, the gas exchange module. This unique design may affect gas exchange performance by altering the operational characteristics of the device. The present study was designed to evaluate three oxygenators in a clinical setting using a goal-directed perfusion algorithm during cardiopulmonary bypass (CPB). After institutional review board approval, 60 adult patients undergoing cardiac surgery for acquired heart disease were matched for disease state and body size into three groups based on oxygenator type: Terumo SX18(™) (n = 20), Terumo FX15(™) (n = 20), and LivaNova Inspire6F(™) 6 Dual (n = 20)...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28637170/neuroprotective-effect-of-pressure-oriented-flow-regulation-and-ph-stat-management-in-selective-antegrade-brain-perfusion-during-total-aortic-arch-repair
#2
Hisato Ito, Toru Mizumoto, Yasuhiro Sawada, Kazuya Fujinaga, Hironori Tempaku, Yasunori Yamamoto, Katsuhiro Tsutsui, Hideto Shimpo
OBJECTIVES: The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump. METHODS: Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28631316/recannulation-of-the-axillary-artery-in-aortic-and-complex-cardiac-surgery
#3
Philippa Jane Temple Bowers, Manu Narain Mathur
OBJECTIVES: Axillary artery cannulation has been used as an alternative site for cardiopulmonary bypass during surgery for aortic dissections and aneurysmal disease of the ascending aorta and arch. This study reports our experience with reusing the axillary artery for cardiopulmonary bypass during complex aortic and cardiac surgical procedures. METHODS: This was a retrospective review of a single surgeon's experience of recannulating the axillary artery for redo operations in complex aortic surgery...
June 19, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28617693/brukhonenko-s-autojector-the-first-apparatus-for-cardiopulmonary-bypass-and-extracorporeal-life-support
#4
Sergey P Glyantsev, Pavel M Bogopolsky, Vakhtang Tchantchaleishvili
Sergey Brukhonenko was a prominent Soviet physician-scientist who from 1922 to 1924 developed a methodology for perfusing a canine head and keeping it alive using the first extracorporeal life support device he created called "Autojector." From 1926 to 1927, in collaboration with surgeon Nikolay Terebinsky, he performed a series of perfusion experiments of the entire canine body using a more advanced model of Autojector. Subsequently, Brukhonenko concluded the possibility of extending this methodology to heart surgery...
June 13, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28594797/-single-centre-experience-with-implantation-of-the-e-vita-open-plus-hybrid-stent-graft
#5
B N Kozlov, D S Panfilov, V V Saushkin, M S Kuznetsov, G G Nasrashvili, A V Andriianova, V M Shipulin
Hybrid technologies appear to have been gaining ground in surgery of the thoracic aorta. The present study was aimed at assessing the immediate clinical outcomes of surgical treatment of diseases of the thoracic aorta by means of the 'E-vita open plus' hybrid stent graft. The 'E-vita open plus' hybrid stent graft was implanted to 18 patients. All operations were carried out in the conditions of moderate hypothermia. The brain was protected by unilateral cerebral perfusion through the brachiocephalic trunk. The duration of artificial circulation averagely amounted to 265...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28580658/improvement-in-perioperative-care-in-pediatric-cardiac-surgery-by-shifting-the-primary-focus-of-treatment-from-cardiac-output-to-perfusion-pressure-are-beta-stimulants-still-needed
#6
Amir-Reza Hosseinpour, Mathieu van Steenberghe, Marc-André Bernath, Stefano Di Bernardo, Marie-Hélène Pérez, David Longchamp, Mirko Dolci, Yann Boegli, Nicole Sekarski, Javier Orrit, Michel Hurni, René Prêtre, Jacques Cotting
OBJECTIVE: An important aspect of perioperative care in pediatric cardiac surgery is maintenance of optimal hemodynamic status using vasoactive/inotropic agents. Conventionally, this has focused on maintenance of cardiac output rather than perfusion pressure. However, this approach has been abandoned in our center in favor of one focusing primarily on perfusion pressure, which is presented here and compared to the conventional approach. DESIGN: A retrospective study...
June 5, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28579963/olesoxime-inhibits-cardioplegia-induced-ischemia-reperfusion-injury-a-study-in-langendorff-perfused-rabbit-hearts
#7
Aida Salameh, Maren Keller, Ingo Dähnert, Stefan Dhein
Objective: During cardioplegia, which is often used in cardiac surgery, the heart is subjected to global ischemia/reperfusion injury, which can result in a post-operative impairment of cardiac function. Mitochondria permeability transition pores (MPTP) play a key role in cardiomyocyte survival after ischemia/reperfusion injury. It was shown in clinical settings that blockers of MPTP like cyclosporine might have a positive influence on cardiac function after cardioplegic arrest. Olesoxime, which is a new drug with MPTP blocking activity, has been introduced as a neuroprotective therapeutic agent...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28557569/the-global-end-diastolic-volume-gedv-could-be-more-appropiate-to-fluid-management-than-central-venous-pressure-cvp-during-closed-hyperthermic-intrabdominal-chemotherapy-with-co2-circulation
#8
Francisco Javier Redondo, David Padilla, Pedro Villarejo, Victor Baladron, Patricia Faba, Sergio Sánchez, José Ramón Muñoz-Rodríguez, Natalia Bejarano
BACKGROUND: Closed hyperthermic intraperitoneal chemotherapy (HIPEC) may increase abdominal pressure and effects of hemodynamic changes due to maintenance hyperthermia. Our aim was to analyze the safety and effectiveness of our closed technique with CO2 circulation in management fluid status and hemodynamic parameters by means of cardiac preload control measured by Global End Diastolic Values (GEDV) and a gas exchanger. MATERIAL AND METHODS: A Pilot Clinical Study that included 18 advanced ovarian cancer patients undergoing citoreductive surgery and HIPEC...
May 30, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28508575/upregulation-of-inflammatory-mediators-in-the-ventricular-zone-after-cortical-stroke
#9
Adrianna N Gunton, Juan C Sanchez-Arias, Esther O Carmona-Wagner, Leigh E Wicki-Stordeur, Leigh Anne Swayne
PURPOSE: After cortical stroke, neural precursor cells (NPCs) in the distal ventricular zone (VZ) proliferate more rapidly and migrate towards the injured cortex. While evidence suggests this can enhance stroke recovery, the underlying molecular mechanisms initiating the response are poorly understood. Here we identified changes in protein expression in the ipsilateral VZ early (4 hours) after stroke to gain insight into the initial mechanisms involved in NPC activation post-stroke. EXPERIMENTAL DESIGN: Four hours after photothrombotic stroke (or sham surgery control) in the sensorimotor cortex, adult mice (10 stroke, 10 sham) were subjected to cardiac perfusion with PBS, and ipsilateral and contralateral VZ tissue was microdissected...
May 15, 2017: Proteomics. Clinical Applications
https://www.readbyqxmd.com/read/28494978/post-operative-chylothorax-in-patients-with-congenital-heart-disease
#10
Jill J Savla, Maxim Itkin, Joseph W Rossano, Yoav Dori
BACKGROUND: Post-operative chylothorax in patients with congenital heart disease is a challenging problem with substantial morbidity and mortality. Currently, the etiology of chylothorax is poorly understood and treatment options are limited. OBJECTIVES: This study aimed to report lymphatic imaging findings, determine the mechanism of chylothorax after cardiac surgery, and analyze the outcomes of lymphatic embolization. METHODS: We conducted a retrospective review of 25 patients with congenital heart disease and post-operative chylothorax who presented for lymphatic imaging and intervention between July 2012 and August 2016...
May 16, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28484204/hydrogen-sulfide-improves-cardiomyocyte-function-in-a-cardiac-arrest-model
#11
Nahuel Aquiles Garcia, Javier Moncayo-Arlandi, Alejandro Vazquez, Patricia Genovés, Conrado J Calvo, José Millet, Nuria Martí, Carmen Aguado, Erwin Knecht, Iñigo Valiente-Alandi, José A Montero, Antonio Díez-Juan, Pilar Sepúlveda
BACKGROUND Cardioplegic arrest is a common procedure for many types of cardiac surgery, and different formulations have been proposed to enhance its cardio-protective effect. Hydrogen sulfide is an important signaling molecule that has cardio-protective properties. We therefore studied the cardio-protective effect of hydrogen sulfide in cardiac cell culture and its potential therapeutic use in combination with cardioplegia formulations. MATERIAL AND METHODS We added hydrogen sulfide donor GYY4137 to HL-1 cells to study its protective effect in nutrient starved conditions...
May 9, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28470919/extra-corporeal-membrane-oxygenation-in-the-therapy-of-cardiogenic-shock-ecmo-cs-rationale-and-design-of-the-multicenter-randomized-trial
#12
Petr Ostadal, Richard Rokyta, Andreas Kruger, Dagmar Vondrakova, Marek Janotka, Ondrej Smíd, Jana Smalcova, Milan Hromadka, Ales Linhart, Jan Bělohlávek
AIMS: Extracorporeal membrane oxygenation (ECMO) in veno-arterial configuration represents an increasingly used method for circulatory support. ECMO in cardiogenic shock offers rapid improvement of circulatory status and significant increase in tissue perfusion. Current evidence on the use of ECMO in cardiogenic shock remains insufficient. The aim of the ECMO-CS trial is to compare two recognized therapeutic approaches in the management of severe cardiogenic shock: early conservative therapy and early implantation of veno-arterial ECMO on the background of standard care...
May 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28460021/hypothermia-and-cerebral-protection-strategies-in-aortic-arch-surgery-a-comparative-effectiveness-analysis-from-the-sts-adult-cardiac-surgery-database
#13
Brian R Englum, Xia He, Brian C Gulack, Asvin M Ganapathi, Joseph P Mathew, J Matthew Brennan, T Brett Reece, W Brent Keeling, Bradley G Leshnower, Edward P Chen, Jeffrey P Jacobs, Vinod H Thourani, G Chad Hughes
OBJECTIVES: Hypothermic circulatory arrest is essential to aortic arch surgery, although consensus regarding optimal cerebral protection strategy remains lacking. We evaluated the current use and comparative effectiveness of hypothermia/cerebral perfusion (CP) strategies in aortic arch surgery. METHODS: Using the Society of Thoracic Surgeons Database, cases of aortic arch surgery with hypothermic circulatory arrest from 2011 to 2014 were categorized by hypothermia strategy-deep/profound (D/P; ≤20°C), low-moderate (L-M; 20...
April 29, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28459760/an-international-survey-of-corticosteroid-use-for-the-management-of-low-cardiac-output-syndrome
#14
Saul Flores, Michael R FitzGerald, Ilias Iliopoulos, Joshua A Daily, Marco Rodriguez, David P Nelson, Hector R Wong, Kusum Menon, David S Cooper
OBJECTIVE: Limited evidence exists on use of corticosteroids in low cardiac output syndrome following cardiac surgery. We sought to determine physicians' practices and beliefs with regard to corticosteroids therapy for low cardiac output syndrome. DESIGN: Multinational internet-based survey. SETTING: Pediatric Cardiac Intensive Care Society member database. SUBJECTS: Pediatric cardiac intensive care physicians. INTERVENTIONS: None...
April 27, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28457779/central-venous-to-arterial-carbon-dioxide-partial-pressure-difference-in-patients-undergoing-cardiac-surgery-is-not-related-to-postoperative-outcomes
#15
Pierre-Grégoire Guinot, Louise Badoux, Eugénie Bernard, Osama Abou-Arab, Emmanuel Lorne, Hervé Dupont
OBJECTIVE: The objective of this study was to assess the association between increased central venous-to-arterial carbon dioxide difference (ΔPCO2) following cardiac surgery with cardiopulmonary bypass and postoperative morbidity and mortality. DESIGN: A prospective, observational, non-interventional study. PATIENTS: Three hundred ninety-three patients undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: The primary endpoint was the occurrence of one or more major postoperative complications...
February 3, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28457372/lung-transplantation-from-donors-after-previous-cardiac-surgery-ideal-graft-in-marginal-donor
#16
A Palleschi, P Mendogni, D Tosi, M Montoli, R Carrinola, A V Mariolo, F Briganti, M Nosotti
Lung transplantation is a limited by donor pool shortage. Despite the efforts to extend the graft acceptability with recurrent donor criteria reformulations, previous cardiothoracic surgery is still considered a contraindication. A donor who underwent cardiac surgery could potentially provide an ideal lung but high intraoperative risks and intrinsic technical challenges are expected during the graft harvesting. The purpose of this study is to present our dedicated protocol and four clinical cases of successful lung procurements from donors who had a previous major cardiac surgery...
May 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28456774/lung-protection-in-cardio-pulmonary-bypass
#17
A Salameh, W Greimann, M Vollroth, S Dhein, M Bahramsoltani, I Dahnert
Since the invention of the heart-lung machine paediatric cardiac surgery developed rapidly. For correction of complex cardiac malformations the application of a cardio-pulmonary bypass (CPB) has become indispensable but possible negative effects of this technique should not be neglected. Especially, both bypassed organs i.e. heart and lung are not perfused during the procedure and therefore are threatened by ischemia and reperfusion injury. Additionally, CPB was developed with a non-pulsatile flow but there are clinical observations that pulsatile flow might be superior with improved patient outcomes...
February 2017: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
https://www.readbyqxmd.com/read/28453800/coronary-sinus-injury-resulting-from-endarterectomy-during-multivessel-bypass-surgery
#18
Mehmet H Akay, Manish K Patel, Igor D Gregoric
Coronary sinus injury is a very rare complication of cardiac surgery and is usually related to coronary sinus perfusion catheter placement for retrograde cardioplegia infusion. It can be either a catheter-related perforation or high-perfusion pressure-related injury to the coronary sinus. Primary repair of the coronary sinus or over-sewing are two possible options to resolve this complication. Decellularized extracellular matrix from porcine intestinal submucosa is widely used as an approved material for repairing cardiac structures...
May 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28440986/-prognostic-factors-of-postoperative-severe-hyperglycemia-after-cardiac-surgery-in-pediatric-patients
#19
Ramón Raúl Marín-Vivas, Cecilio Ernesto Saldívar-Müller, Cecilia Consuelo Sánchez-Bañuelos, Janet Flores-Lujano, Juan Carlos Núñez-Enríquez
BACKGROUND: Patients who underwent surgery for congenital heart disease requiring cardiopulmonary bypass (CPB) have metabolic complications, like hyperglycemia, which is associated to a greater postoperative morbidity and mortality. Our objective was to identify predictors of severe postoperative hyperglycemia (≥ 200 mg/dL) in pediatric patients after cardiopulmonary bypass. METHODS: A case-control study was conducted from January 1 to December 31, 2014. We included all pediatric patients undergoing cardiac surgery attended at postoperative care in a pediatric intensive care unit from a third level hospital...
May 2017: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/28440739/featured-article-pharmacological-postconditioning-with-delta-opioid-attenuates-myocardial-reperfusion-injury-in-isolated-porcine-hearts
#20
Maria Seewald, James A Coles, Daniel C Sigg, Paul A Iaizzo
Ischemic preconditioning has been utilized to protect the heart from ischemia prior to ischemia onset, whereas postconditioning is employed to minimize the consequences of ischemia at the onset of reperfusion. The underlying mechanisms and pathways of ischemic pre- and postconditioning continue to be investigated as therapeutic targets. We evaluated the administration of a delta opioid agonist or cariporide on various parameters associated with myocardial reperfusion injury upon reperfusion of isolated porcine hearts...
May 2017: Experimental Biology and Medicine
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