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Perfusion pressure CPB

D Hori, N M Katz, D M Fine, M Ono, V M Barodka, L C Lester, G Yenokyan, C W Hogue
BACKGROUND: While urine flow rate ≤0.5 ml kg(-1) h(-1) is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI) . The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI. METHODS: Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification...
December 2016: British Journal of Anaesthesia
Shigeyuki Okahara, Zu Soh, Satoshi Miyamoto, Hidenobu Takahashi, Hideshi Itoh, Shinya Takahashi, Taijiro Sueda, Toshio Tsuji
During cardiopulmonary bypass (CPB), blood viscosity conspicuously increases and decreases due to changes in hematocrit and blood temperature. Nevertheless, blood viscosity is typically not evaluated, because there is no technology that can provide simple, continuous, noncontact monitoring. We modeled the pressure-flow characteristics of an oxygenator in a previous study, and in that study we quantified the influence of viscosity on oxygenator function. The pressure-flow monitoring information in the oxygenator is derived from our model and enables the estimation of viscosity...
October 26, 2016: Artificial Organs
Shigeyuki Okahara, Zu Soh, Satoshi Miyamoto, Hidenobu Takahashi, Shinya Takahashi, Taijiro Sueda, Toshio Tsuji
This paper proposes an algorithm that estimates blood viscosity during cardiopulmonary bypass (CPB) and validates its application in clinical cases. The proposed algorithm involves adjustable parameters based on the oxygenator and fluid types and estimates blood viscosity based on pressure-flow characteristics of the fluid perfusing through the oxygenator. This novel nonlinear model requires four parameters that were derived by in-vitro experiments. The results estimated by the proposed method were then compared with a conventional linear model to demonstrate the former's optimal curve fitting...
September 19, 2016: IEEE Transactions on Bio-medical Engineering
Katrine B Buggeskov, Martin M Sundskard, Thomas Jonassen, Lars W Andersen, Niels H Secher, Hanne B Ravn, Daniel A Steinbrüchel, Janus C Jakobsen, Jørn Wetterslev
INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90 patients were randomised to receive pulmonary artery perfusion during CPB with either oxygenated blood (n=30) or histidine-tryptophan-ketoglutarate (HTK) solution (n=29) compared with no pulmonary perfusion (n=31)...
2016: BMJ Open Respiratory Research
B N Kozlov, D S Panfilov, V V Saushkin, M S Kuznetsov, G G Nasrashvili, V M Shipulin
AIM: To evaluate surgical results in adults with aortic arch interruption. MATERIAL AND METHODS: Seven patients with aortic arch interruption were operated. Two of them (28.6%) underwent aortic arch repair using allograft, 4 (57.21%) - distal arch and proximal descending aortic replacement, 1 (14.3%) - supra-coronary ascending aortic, aortic arch and proximal descending aortic replacement. All operations were performed under moderate hypothermia (25 °С), circulatory arrest with unilateral cerabral perfusion 8-10 ml/kg/min via innominate artery and pressure 69...
2016: Khirurgiia
Peter Lukas Haldenwang, Lorine Häuser, Nora Prochnow, Damian Ziebura, Andreas Baumann, Magdalena Sikole, Marcus Schlömicher, Inge Schmitz, Hildegard Christ, Justus Thomas Strauch
OBJECTIVES: The frozen elephant trunk (FET) procedure using isolated selective cerebral perfusion (SCP) at moderate hypothermia is associated with an increased risk for spinal cord ischaemia. The aim of this study was to evaluate the benefit of a combined selective cerebral and low-flow lower body perfusion (CLBP) in a porcine model. METHODS: Twenty pigs (46 ± 5 kg) were cooled on cardiopulmonary bypass (CPB) to 28°C. After aortic clamping and occlusion of the thoracic segmental arteries (TSAT4-T13), a pressure-controlled SCP (50 mmHg) was established for 90 min...
May 12, 2016: European Journal of Cardio-thoracic Surgery
Hagen Bomberg, Heinrich V Groesdonk, Miriam Raffel, Peter Minko, Wolfram Schmied, Matthias Klingele, Hans-Joachim Schäfers
BACKGROUND: Vasopressin is used as an adjunct to norepinephrine to support blood pressure in vasodilatory shock after cardiopulmonary bypass (CPB). In this study, we report our observation of vasopressin treatment in 11 patients with nonocclusive mesenteric ischemia (NOMI). METHODS: In an observational cohort study, 78 patients were studied after having been treated for NOMI with intraarterial iloprost infusion after elective cardiac operation. All patients received norepinephrine as vasopressor for marked vasodilation...
September 2016: Annals of Thoracic Surgery
Bjørg Elvevoll, Steinar Lundemoen, Øyvind S Svendsen, Arve Mongstad, Ketil Grong, Venny L Kvalheim, Paul Husby
BACKGROUND: Pulsatile versus nonpulsatile cardiopulmonary bypass (CPB) perfusion remains debated. Beneficial effects on tissue perfusion, inflammation, and microvascular fluid exchange have been linked to pulsatile perfusion by some investigators and denied by others. This study evaluated fluid extravasation and tissue perfusion during nonpulsatile or pulsatile roller pump-induced CPB perfusion. METHODS: Fourteen pigs underwent roller pump-induced pulsatile (n = 7) or nonpulsatile CPB perfusion (n = 7) for 90 minutes...
August 2016: Annals of Thoracic Surgery
I Prestes, J Riva, J P Bouchacourt, E Kohn, A López, F J Hurtado
OBJECTIVE: To evaluate microcirculation in intermediate and high mortality risk patients undergoing cardiac surgery (CS) with cardiopulmonary bypass (CPB). PATIENTS AND METHODS: The study included 22 patients with a Euroscore >3. Using the Videomicroscopy Side Stream Dark Field system, and evaluation was made of, capillary density, proportion of perfused capillaries, density of perfused capillaries, microcirculatory flow index (MFI), and heterogeneity flow index...
April 16, 2016: Revista Española de Anestesiología y Reanimación
Kum-Hee Chung, Seo Min Park, In Chan Baek, Junheum Jang, Yong-Woo Hong, SoWoon Ahn
Sodium nitroprusside (SNP) is an anti-hypertensive drug, commonly used to decrease the systemic vascular resistance and lower the blood pressure. When the amount of cyanide generated by the SNP exceeds the metabolic capacity for detoxification, cyanide toxicity occurs. Under general anesthesia and cardiopulmonary bypass (CPB), it may be difficult to detect the development of cyanide toxicity. In cardiac surgical patients, hemolysis, hypothermia and decreased organ perfusion, which emphasize the risk of cyanide toxicity, may develop as a consequence of CPB...
April 2016: Korean Journal of Anesthesiology
Zhiyong Hu, Lili Xu, Zhirui Zhu, Robert Seal, Patrick M McQuillan
The objective of this study was to evaluate the effect of hypothermic cardiopulmonary bypass (CPB) on cerebral oxygen saturation (rSO2), internal jugular bulb venous oxygen saturation (SjvO2), mixed venous oxygen saturation (SvO2), and bispectral index (BIS) used to monitor cerebral oxygen balance in pediatric patients.Sixty American Society of Anesthesiologists Class II-III patients aged 1 to 4 years old with congenital heart disease scheduled for elective cardiac surgery were included in this study. Temperature, BIS, rSO2, mean arterial pressure, central venous pressure, cerebral perfusion pressure (CPP), and hematocrit were recorded...
January 2016: Medicine (Baltimore)
Daijiro Hori, Charles Hogue, Hideo Adachi, Laura Max, Joel Price, Christopher Sciortino, Kenton Zehr, John Conte, Duke Cameron, Kaushik Mandal
OBJECTIVES: Perioperative blood pressure management by targeting individualized optimal blood pressure, determined by cerebral blood flow autoregulation monitoring, may ensure sufficient renal perfusion. The purpose of this study was to evaluate changes in the optimal blood pressure for individual patients, determined during cardiopulmonary bypass (CPB) and during early postoperative period in intensive care unit (ICU). A secondary aim was to examine if excursions below optimal blood pressure in the ICU are associated with risk of cardiac surgery-associated acute kidney injury (CSA-AKI)...
April 2016: Interactive Cardiovascular and Thoracic Surgery
Koji Hoshino, Naoki Nishimoto, Yuji Morimoto
BACKGROUND: We evaluated the impact of age and cardiopulmonary bypass (CPB) on cerebral autoregulation in pediatric patients for the cardiac surgery with near-infrared spectroscopy. METHODS: This retrospective study was conducted with 67 children undergoing closure of atrial or ventricular septal defects with CPB. The regression coefficient ((see symbol)regional cerebral oxygenation index ((see symbol)SO2)/ mean arterial blood pressure (mABP)) for each patient was calculated by simple regression analysis, assuming that higher regression coefficients indicate less functional cerebral autoregulation...
September 2015: Masui. the Japanese Journal of Anesthesiology
Laura Rigg, Bruce Searles, Edward Morse Darling
Pressure data acquired from multiple sites of extracorporeal circuits can be an important parameter to monitor for the safe conduct of cardiopulmonary bypass (CPB). Although previous surveys demonstrate that CPB circuit pressure monitoring is widely used, there are very little data cataloging specific applications of this practice. Therefore, the purpose of this study is to survey the perfusion community to catalog 1) primary CPB circuit site pressure monitoring locations; 2) type of manometers used; 3) pressure monitoring interface and servoregulation with pump console; and 4) the rationale and documentation associated with pressure monitoring during CPB...
December 2014: Journal of Extra-corporeal Technology
Y M Ganushchak, E P J Körver, Y Yamamoto, P W Weerwind
A growing body of evidence indicates the superiority of minimized cardiopulmonary bypass (CPB) systems compared to conventional systems in terms of inflammatory reactions and transfusion requirements. Evident benefits of minimized CPB systems, however, do not come without consequences. Kinetic-assisted drainage, as used in these circuits, can result in severe fluctuations of venous line pressures and, consequently, fluctuation of the blood flow delivered to the patient. Furthermore, subatmospheric venous line pressures can cause gaseous microemboli...
May 2016: Perfusion
Daijiro Hori, Charles W Hogue, Ashish Shah, Charles Brown, Karin J Neufeld, John V Conte, Joel Price, Christopher Sciortino, Laura Max, Andrew Laflam, Hideo Adachi, Duke E Cameron, Kaushik Mandal
BACKGROUND: Individualizing mean arterial blood pressure (MAP) based on cerebral blood flow (CBF) autoregulation monitoring during cardiopulmonary bypass (CPB) holds promise as a strategy to optimize organ perfusion. The purpose of this study was to evaluate the accuracy of cerebral autoregulation monitoring using microcirculatory flow measured with innovative ultrasound-tagged near-infrared spectroscopy (UT-NIRS) noninvasive technology compared with transcranial Doppler (TCD). METHODS: Sixty-four patients undergoing CPB were monitored with TCD and UT-NIRS (CerOx™)...
November 2015: Anesthesia and Analgesia
Carina Janssen, Stephanie Kellermann, Frank Münch, Ariawan Purbojo, Robert Anton Cesnjevar, André Rüffer
BACKGROUND: Selective myocardial perfusion enables repair of congenital aortic arch obstruction without cardiac arrest. This study was inspired by the lack of prospective controlled studies of the beating heart (BH) technique compared with cold crystalloid cardioplegia (CC) regarding effects on myocardial performance, ischemic damage, and serum electrolyte levels. METHODS: In a prospective study, 20 male piglets weighing 11.1 ± 1.3 kg were operated on using cardiopulmonary bypass (CPB) and underwent 60 minutes of aortic cross-clamping...
November 2015: Annals of Thoracic Surgery
L Zou, J Liu, H Zhang, S Wu, C Long, B Ji, Z Yu, Y Tang, L Meng, A Wu
OBJECTIVE: Due to the weak ascending aorta, it is extremely challenging to establish an anterograde selective cerebral perfusion (ASCP) model in rabbits, especially when cardioplegic arrest is required. Herein, the aim of this study was to establish a rabbit ASCP model with cardiac arrest being easily performed and being similar to the clinical scenario. MATERIALS AND METHODS: Twenty-two adult New Zealand white rabbits were selected for ASCP model establishment and another 22 rabbits were utilized for blood donation...
May 2016: Perfusion
Christian P Brizard, Jeffrey Y J Looi, Joseph J Smolich, Stephen B Horton, Julie Angerosa, Ngaire J Elwood, Salvatore Pepe
BACKGROUND: One potential approach for advancing univentricular heart surgical palliation outcomes is by stem cell therapy to augment right ventricular function and muscle mass. Whether the stem cell-inclusive cord blood mononuclear cells (CBMNCs) are safe to perfuse into the coronary vasculature during neonatal cardiopulmonary bypass (CPB) is unknown. We evaluated the acute safety, functional effects, and fate of human CBMNCs in a novel model of coronary vasculature delivery in a lamb model of infant CPB...
September 2015: Annals of Thoracic Surgery
Saeid Hosseini, Fahimeh Kashfi, Niloufar Samiei, Amirjamshid Khamoushi, Alireza Alizadeh Ghavidel, Forouzan Yazdanian, Yalda Mirmesdagh, Carlos A Mestres
BACKGROUND AND AIM OF THE STUDY: Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. METHODS: Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women...
March 2015: Journal of Heart Valve Disease
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